Tangent but the fact that they charged 195k or even 33k after the patient died is outrageous.

If you are not going to do universal healthcare at least do outcome based charging.

I hope this will have an impact, but I worry it will be “AI can fix US healthcare”.

I appreciate the author’s disclaimers about that and especially about double checking AI output.

To me, in the UK, it sounds like there is an opportunity here for some sort of centralised representation and/or app that can fight claims for people

AI is finally leveling the playing field on all those long and confusing documents that were designed to make regular people give up and pay whatever

4hrs of hospitalization => $195k. America is great!

the nice thing about Medicare is that if he was +65 y/o Medicare patient, the hospital is not allowed to do this. If you are an American and under 65 and make too much money to be covered by medicaid, then you are vulnerable...

Also...having heard a talk given by the hospital administrator's association lobby...you can kinda get a sense where this funny math comes from....

I really hope this being on Threads is not the start of a trend. I don't really need or want to rely on another social media outlet.

People blame insurance, but insurance is just a willing punching dummy. Insurance just charges a percentage over the base costs. This is why every president who has tried insurance reform has failed. The guilty are the hospitals and the American Medical Association, which limits seats of new doctors in the USA. It is the strongest trade union on the planet, making millions for it's members and using the excuse of "safety" to try to pull the wool over your eyes.

Well this is a depressing forum. I'm going to go back to work and pretend that I will live a hundred more years, thank you. :(

The estate of the dead person would be on the hook for the bill, unless the spouse co-signed. You might want to check that.

Of course, there will be another insurance AI whose job will be delaying and denying coverage for those who appealed.

interesting, the alternate headline "using AI to negotiate a $33k hospital bill down to still $33k" would have been pretty egregious too

what would the outcome of the charity option have been? they did not change any practice here, the hospital almost got caught, once, for one bed that was occupied for 4 hours in a single day

"figured it could just grab money from unsophisticated people"

This sums up my experience with US Healthcare. They bill expecting you to autopay, and either have no incentive to bill correctly or they outright are trying to scam but the result is that every hospital bill is sus.

This also makes insurance a lot less inherently valuable: you are paying for someone to do this untangling shitshow on top of the actual insurance. As if the hospitals just put the billing burden on the client.

There has to be a penalty for sending wrong bills, or they should pay me for my time wasted.

Finally, the prices are so inflated that often the price without insurance in Europe is the same as the copay/coinsurance in the US.

Its a fucking catastrophe.

What a deeply dystopian future y'all are building for us :( -- (Including the fact that this link leads to nothing but a logo, for me).

There's a nonzero chance his AI bot was just talking to their AI bot to reach this happy conclusion.

One of my most successful uses of ai is dealing with various obtuse German bureaucracies, private and public.

I don’t think the ai is being particularly smart in my case, and its occasionally flat wrong.

What it does give me is persistence and motivation. I have a nice workflow cobbled together that lets me dump OCRd scans and digital comms into “workspaces” organized by topic. With that workflow, I can basically dump a letter in, say “wtf is it now?”, and have the llm spit out a response. I do basic due diligence and send. Done. They don’t have to be that accurate, and neither do I.

I feel like I have a new superpower now: outlasting it, whatever it is this time.

I would like to think our children will one day live in a society where healthcare is nominal.

AI good or US health system trash?

I'm too european for this.

Getting it down to 33k may seem like a success story. It is not. 33k is still messed up.

This reads like an ad for Claude

Good news, everyone! We don’t need single-payer healthcare after all, just use an AI!

Ai may not be able to pass the butter but at least it can save on hospital bills

For those of us who do not access Thread, if there is a copy elswere we can read?

I would of applied to the charity relief after lowering to 35K.

What it the dystopian fuck is this headline

imagine paying 33k in hospital bills when all you have to do is ignore it and pay nothing...AI ripped them off here

Another day thanking God I don't live in the United States.

this is what the doomers want to take from you

This is the exact sort of performative garbage that LLMs are great for. I had to do an electrical install, but the installer felt that the code required additional work (I don't think he was trying to rip us off, he sincerely believed it, since it's a volume business model).

I got ChatGPT to come up with some plausible interpretations of the electrical code that allowed the install to continue, including citations. I don't know how accurate it all was, but I sent the argument off to the installer, and he came back and did the work the next day. Even if it gets audited, the chances of the auditor picking apart the arguments are probably slim to none. He has plausible deniability.

This is also why schools and colleges are struggling. No one expected superficially "high quality" work from average and poor students, and now that they have to carefully evaluate everyone's work, they've been caught with their pants down.

Someday superficial AIs will talk to other superficial AIs and they'll deadlock, requiring humans back into the mix. Until then, it's a useful way to do bureaucratic judo.

The inflated medical bills are not malice from the medical provider, they're incentivized by the insurance system. Providers are required to have a standard price list for all their billing codes; hospitals are required to publish it even, although compliance with publishing is sketchy.

Their contracts with insurers says they can't bill the insurer more than what's on the standard price list, but the insurer won't pay more than the contracted amount for each billing code. As a result, the standard way to make a price list is to periodically review what insurance has paid on all the billing codes you've used lately, and if there's any billing code for which insurance has fully paid, increase the price.

This is exacerbated by the fact that a single encounter might be encoded into multiple billing codes. One billing code for an aspirin, one for the nursing time to administer it, for example. Suppose insurance A pays reasonably for the nursing time but in exchange pays a pittance for the aspirin, but insurance B pays enough for the aspirin to cover the nursing time to administer it, but doesn't pay the nursing time billing code, but insurance C pays for an omnibus code for "spent a couple hours in the ER", but doesn't pay for nursing time or aspirin separately at all. A provider can agree to all three contracts, because they each give them enough money to profitably provide the service, but that requires that their price list has a high price for the aspirin, an high price for the nursing time, and a high price for the omnibus billing code.

A cash payer gets the same bill an insurance company would - high prices on all three items. But insurance companies never pay that. In the old days, you would just have a totally separate cash pay price list, but medicare rules don't allow that anymore, and limit the magnitude of cash discounts.

Fix the insurance system, and the bogus hospital bills that the hospital doesn't actually expect people to pay go away.

Never pay the first hospital bill if it's a non-trivial amount and you've waited a few months to get all the bills. 100% of time there is an error, mis-code, up-code, outright fabrication, etc. In California you cannot be taken to collections for less than $500 and they have to wait at least 180 days. If insurance denies a claim, you can ask for an internal appeal and then ask an independent medical review(IMR) (always do this, the internal appeal never works). With today's context windows, you can shove the whole insurance coverage booklet into the LLM and have it draft everything.

I've had $10k+ bills brought down to $200. $2k+ tests re-coded and fully covered, etc.

There is definitely a business in a LLM-powered medical billing agent that could handle this end to end (esp, contacting hospitals/insurance, waiting on hold, etc).

Relevant: The End of the Rip-Off Economy https://www.economist.com/finance-and-economics/2025/10/27/t...

I don't know about using AI to win legal and procedural arguments outright, but it seems like an interesting way to at least help win the war of attrition that corporations and weaponized bureaucracies wage on us to make a buck and keep us from claiming ours.

Worst part it shouldn't even be called "negotiation". It was just plainly fraudulent.

Related: https://www.economist.com/finance-and-economics/2025/10/27/t...

I don't understand how this is not wildly illegal fraud. They intentionally bill you incorrectly, charge you twice for costs that they know they're not allowed to bill you twice for. This is blatant fraud. Why is that not enforced?

The real wtf is that they consider $33k for four hours of 'treatment' a win.

Used Claude to negotiate a 50% bump in a car insurance payout citing laws I didn't know existed. Yeah you have to cross check things and direct the prompt for tone and angle, but what an incredible leveling mechanism.

I assume the law will only award a medical provider in a fee collection dispute for fees that are reasonable and within what the provider usually charges and receives in the normal course of business.

Every EOB I receive shows medical charges many multiples of what insurance actually pays (and the provider actually accepts). IMO that is not only prima facie evidence of fraud, but - since every provider does the same thing - of collusion on fees amongst and within the medical industry - worthy of anti-trust investigations (I have no anti-trust experience).

Double billing is an insanely common problem. How it’s gone for me in the past is like this:

Provider wants to do procedure. You need it right away, or the procedure allows pre approval with the assumption insurance won’t haggle or deny payment

insurance company denies payment

provider bills you

what i learned is, often, the provider will eventually be paid. do they tell you? not usually. oh woops. I haven’t very successfully fought these other than just hours of phone calls with both companies chasing down what actually got paid and when, and they on purpose make it difficult. If you find yourself in this situation do NOT pay the hospital until the last possible moment it will go to collections. often, you’ll find it mysteriously disappears. it also doesnt hurt your credit very much anyway if it does.

There’s no real defense of these practices or of the industry in general as it exists in the USA.

anything <$500 now by CA law cant show up on credit report so I basically stopped paying those. unethical? sure. will it affect the quality of my care? probably. sometimes though being a deliberate pain in the ass feels better than letting the system fuck you over and over.

with or without AI you'd be shocked at how much of a medical bill can disappear if you just ask. Ask for an itemized bill, then ask what programs they have available to help. The real fact is that the hospital barely knows what they did to you, has no idea what it should cost overall, has a foggy idea of much you'll pay vs your insurance (but only a foggy idea because of all of the constantly-shifting backroom deals that insurers and providers make with one another), and then whatevertf price they arrive at with all of this gets an arbitrary number tacked onto it designed to mitigate the fact that a lot of people just don't pay their bill at all and it's not like the hospital can reach into them and claw back their $80 tylenol if they don't get paid, so they just bill it forward and hope that most people will look at their bill as the final word on the subject and pay it despite the fact that they're being badly overcharged. Combine this with the "reject all claims and hope they don't follow up" model of insurance and you can see where this all clearly needs to burn to the ground so that something that works can grow in its place, but also where a lot of people get really rich doing it this way and no one gets super rich when services are provided at a reasonable price so there's no real will to unruin this system. So what we end up with is a system where we pay a lot more than everyone else in the developed world and, for our money, we get to die earlier, which may or may not be preferable to dealing with the american healthcare system. When I was figuring out what I actually owed for my 4 days in the hospital for diverticultitis I strongly considered just dying next time.

This is why hospitals go broke. While it is great for the individual, society suffers.

Here in Australia, our 2nd biggest private hospital owner has just gone broke.

At a fire sale, there was so little interest in buying the hospitals that many will be shut down.

The rest of the unsalable hospitals will be shoved into a stripped down charitable tax exempt trust so that the creditors ( banks and pension funds ) can recoup a small amount of the money they lent the hospitals.

I used AI to deal with customer support when a company tried to assign me the rental contract from the previous owner. ChatGPT correctly quoted the relevant Ontario Consumer Protection Act sections that applied. I just did quick verifications to make sure it wasn't hallucinating (it didn't). They tried to push back, but I had ChatGPT write a few responses standing first and they relented after a few exchanges.

That such a thing is even possible shows how messed up the system is. Basically they are charging some fantasy amount of money. I would love Medicare for All but if we want to keep doing some kind of free market approach, let’s at least make sure there is a real market where everybody knows the price of things and can make an informed decision. Right now it seems you have to go to a hospital and just hope for the best.

The problem is the insurance+hospital industrial complex. The insurance companies will negotiate this down on your behalf. They basically operate on fear of walking into a hospital and getting a 6-figure bill.

My SO had to take a medevac helicopter once: we got a $65k bill just for the 20-minute helicopter ride which suddenly became under $4k with insurance. The discount made me feel like I was getting a deal, so I gladly paid.

Not low enough.

You could probably tell them to eat dirt,the receiver of services can't be collected against as he's no longer physically here.

Getting the money from his estate would probably take years, if possible at all. I am not a lawyer, so I might be completely wrong, but suing a widow for 200k would be a nightmare for any hospital.

Anyway, maybe one day we'll join the civilized world and not bankrupt families for the crime of being suck.

Does someone here understand how exactly to fight Facility Fees — outside of indiana or a state where its outlawed — which is what the author mentioned most of their fees were? Could one when signing admission forms accidentally agree to paying them without fully understanding it? After one gets the the bill can one simply get an itemized breakdown, spot these fees and negotiate them down?

Apart from anything else, family has zero obligation to pay their brother-in-laws medical bills after death (or before).

Hospitals will pull all sorts of shady stuff to strongly imply that you should pay for a family members medical bill, however. From very strongly hinting that you're obligated to, through to impugning honor, "It would be doing the right thing by your dad", etc.

For folks who aren't healthcare tech nerds, what happened in this case is called "unbundling" which is a fraudulent practice that can have steep penalties from CMS.

CMS maintains a service and set of tools to help prevent payers from getting hit with this called the National Correct Coding Initiative (NCCI) [1]. NCCI only applies to provider services and outpatient billing codes, but is still applicable for emergency room services.

There are a bunch of technical details for implementing the edits in the NCCI, but I think it's worth taking a moment to reflect on this.

It's pretty popular to point to the insurance company as the "bad guy" in healthcare, but this is the sort of stuff they deal with thousands of times per day.

As frustrating and horrible as this story is, it's not unique to an uninsured individual. A big problem in US healthcare is provider overbilling.

One of the most tragic jobs I held in healthcare tech was developing software for billing negotiation between providers and insurance companies. It was pretty eye-opening how terribly everyone behaves, and I learned to have a lot more sympathy for what insurance companies/government payers have to deal with.

As a patient trying to have necessary treatment paid for, it's incredibly frustrating to have a claim denied, and these are what we see in the news and experience personally.

As an insurance company, building robust systems that authorize necessary care while catching overbilling, overutilization and outright fraud is unfathomably complex and error prone.

This one of the reasons I've become a fan of DPC (direct primary care) models [2] with HSAs and supplement high-deductible catastrophic insurance to protect against hospital stays. It puts primary care back into a direct relationship with the patient, and lets insurance companies do what they are good at: pricing risk.

Some of the unintended consequences of how insurance companies are currently regulated is that in some states it can be difficult or impossible for an insurance company to provide a low cost, high deductible plan. They are forced to cover things that drive the costs up, so it's hard to do a DPC + catastrophic insurance option.

[1] https://www.cms.gov/national-correct-coding-initiative-ncci

[2] https://www.aafp.org/family-physician/practice-and-career/de...

Granted, $33k vs $195k is an excellent saving ... but $0k is what I, or my family, would pay. Which makes the cost seem insane by any measure.

What's crazier is that for 80k you can get a jet to fly you anywhere in the world and for far lesser than that get world class treatment. What's even more bonkers is that the private and govt insurance companies, and hospitals have negotiated those rates and there is a market to fly people to other countries that is just sitting there and no one is really exploiting it.

These exorbital numbers are due to government and voters not willing to regulate the industry and rely on free market instead, correct?

Rookie mistake. Should have identified as an undocumented immigrant. $0 bill.

Are there still first world countries without public healthcare?

Amazing story. And if Anthropic is really in it for humanity and spreading good, they’ll productize this for all of us to drive efficiency!

Or, more likely, they’ll just sell enterprise products to wealthy hospitals and look the other way.

> So the hospital had billed us for the master procedure and then again for every component of it.

Uh. Call me naïve, but how is this not fraud?

So, his brother in law was married to his sister-in-law?

The irony is they would have been happy receiving $10k for not saving a man's life. So at the end of the day, they still swindled you.

The comments surrounding this story feel so alien to so many outside the US.

Negotiating with a hospital caught double and triple billing and somehow being happy with a bill for four hours down to just $33k? This should have ended in litigation.

Elsewhere I see people facing $4k Ambulance rides jubilant at only paying $500. People laughing that they've already paid so many tens of thousands out of pocket that year so can't be gouged any further. And so many others just saying "Oh that's how hospital billing works" as if you've just explained how central locking works.

Guys, this isn't civilised. It's exploitative and in many cases just outright fraud. Why can't you fix it?

From the artichokel: "If bills are a fiction in order to back up the fiction of charity so the hospital can write off accounts and look like they are somehow doing right by people, this is an effed system."

So close, yet so, so far! If a corporation commits fraud against you, and you literally ask if the corporation has committed fraud against you, and you proceed to voluntarily send that corporation THIRTY-THREE THOUSAND DOLLARS anyway, are you not a willing co-conspirator in the fraud?

Gotta up vote here, well done!

Only in America.

Why are we accepting this?

Some will say this is the great innovation that can cone from free market capitalism. Completely forgetting that the problem it solves was created by that very same system.

Just tell the hospital you don't have much money but will pay what you can with cash. I got a $2k bill down to $200 like that.

The system is totally absurd.

I have a better idea

> We asked for a bill with the standard CPT codes. No reply. Asked again. “Oh, we meant to send it. We upgraded our computers five months ago and nothing works.” Uh-huh. Finally got the CPT codes.

I work in healthcare RCM. I have no trouble believing the staff here that nothing in their system works.

wtf is this threads' login sh*t

Can we ask why do we even have to freaking negotiate ? Many of them are non profit, the costs and margins should be transparent.

Next up: A start-up that spins up AI instances to negotiate against AIs trying to negotiate hospital bills down!

Now you just need to vibe code it into agentic solution and sell subscriptions to it!

This is insane. 4h in the hospital, 195k (or even 33k). Pure madness.

how the hell is that possible. Why isn't someone taking economical advantage of offering lower prices. Costs can't be that high.

What a terrible medium for long form story telling

1000

Ah, gotcha. So you're still paying (just via taxes, not at time of service). But, I'd much prefer something closer to a European system vs what we have in the States.

Criminal.

Here's the fundamental problem I have with this: This is treating the symptom and not addressing the problem.

The problem is that America's healthcare system is ridiculously broken. The symptom of that problem is that prices are astronomically high.

I am happy AI is useful for things like this, but I want to focus on CURING the problem and not just making the symptoms more tolerable.

Is there a service that you can buy where they will do this sort of thing for you automatically for every medical bill? E.g. "Here's an obfuscated, probably incorrect bill." "Ah, okay, go ahead and send that to my billing scam insurance and they'll let you know what we'll actually pay you."

A fit sequel to a line in Dead Souls https://www.theparisreview.org/blog/2021/05/17/americas-dead...

A meager amount of AI will insulate you from a lifetime of woe, exactly as it was designed to.

The most impressive part to me is finding the right channel to communicate with the hospital. We had to dispute a billing issue with our hospital and it simply wasn't possible to talk to any person that wasn't part of the "patient relations" team. Billing problems went through patient relations who talked to the billers.

I find it odd that his brother in law was married to his sister-in-law. How exactly does that work?

Can a bill for one patient be sent to their spouse? I don't understand how this even starts.

This is probably the first instance AI has provided real world value, I'm cheering on this

The hospital billing system (built by 3 Harvard MBAs) probably had $10k as the break even point.

I've just ignored any medical bill I don't agree with or think was fair ($10k+ worth in the last 10 years). At least in new york state there has been no downside for me. It never went on my credit score and I bought a house a few years ago.

The most appalling thing in this whole post is that people are still using Threads (TM).

Somewhere down the line I have a feeling that there is a human in the loop somewhere in between who's expert at reviewing these kind of bills. How the expert or their knowledge was added to the flow is the engineering art in here

It's always interesting to hear stories from third world countries, it's good to be mindful about how different their lifestyles are to ours. Having lived in Europe my whole life, I couldn't imagine this scenario.

Can't wait for it to be AIs arguing back & forth with all sorts of unforeseen consequences arising. We have much to think through, & strong, simple rules to put in place, or things are going to get rather out of hand.

I'm too european for this.

I'm confused about some particulars here. Who was on the hook for the bill here? The wife?

What state is this? At least in Minnesota my understanding is I'm not on the hook for my wife's medical bills if she were to pass.

It isn’t clear to me that the OP’s sister-in-law would be responsible to pay these debts and they couldn’t have just allowed payment from the estate. Since insurance had lapsed, I’m assuming the estate was not large.

I will never understand why people tolerate the US healthcare system. If anything points to complete ideological capture of the general population then it's this. (I live in the UK if that's relevant)

I’m really curious if every patient started using Claude or GPT to negotiate with hospitals, how would the system respond? Maybe hospitals and insurers would start using AI too to fight back?

> Long story short, the hospital made up its own rules, its own prices, and figured it could just grab money from unsophisticated people.

America in a nutshell.

To be fair, I'm taking this whole twitter thread at face value.

Such a case when one must pay a good portion of a home price for a man dying in a hospital, is why I won't ever try to move to the US, and will retell story to everyone considering.

I also had success, less negotiating, more just helping me form the letters in a few minutes rather than hours so I could get reimbursed for denied coverage, and it did get reimbursed.

Hospital pricing transparency is a joke as reported on by WSJ here too https://archive.ph/bp2Mc

$33,000 is still so unreasonable from the perspective of anyone who has lived in a first world nations with socialised healthcare. It is just absolutely mind boggling.

iirc before the law was passed, there were policies at the agencies themselves to wait at least 3 years before letting medical debt onto credit reports.

You're missing the point completely. I was not talking about why hospital debt is big, but the difference in how debt in general of all sizes gets collected.

Because in most of Europe even a 50 Euro debt will be collected, medical or not. while in the US it seems you can live just fine with a lot of debt that somehow nobody bothers to collect.

And your hospital in Europe DOES collect the half million Euro bill, for say a heart transplant, from your insurance company. You just never see the massive bill because it goes directly to your insurer but someone always pays.

Damn, well in that case that explains why a lot of people in the US can be in debt yet so care free, which is unthinkable to us here in Europe as even small debts carry consequences.

How do they track credit-worthiness inside the EU? I thought Germany had something equivalent? Maybe it's government-managed instead of private? Not that I like the US system, but it sort of makes sense (barely).

not sure why you're getting downmodded. People will say M4A ("medicare for all") polls at super high levels, and they're right, it does. But poll those same people telling them "would you favor that your employer-based healthcare would be rescinded and you would instead get healthcare from a new government controlled plan, where there would be no other options", which is the assumption M4A's viability is based on, and that poll turns right upside down.

The alternative is no surgery and no choice, which is what happens with government-run healthcare.

I don't think this has much to do with being a democracy. I, for one, wouldn't trust our federal government to competently run an efficient, most uncorrupted healthcare system for all.

The incentive structures that have built up around US politicians simply doesn't leave any room for it to realistically happen. Until the incentives are changed I'd vote against nearly any major government program.

It's not a democracy. You were told wrong, it's a republic.

The are advertised as a democracy, but ever since Citizens United was passed we became an Oligarchy. Money now takes the place of votes since the rich can donate unlimited funds to a candidate. Candidates have zero incentive to serve the public.

Non US as well. Life saving saving surgeries get denied, delayed and otherwise screwed all the time. Not sure where exactly it is worse since absolutely atrocious cases can be found in every G7 country never mind the rest

We have a lot of people being constantly brainwashed that we have the most amazing system in the world and that any attempt to change it is communism.

Yes, it is what they want.

In the end there are more of them who want to "own the libs", or "not pay for freeloaders" than those who want to contribute to another's child surviving.

I think the root cause of the problem is not insurance companies but they definitely do play a part. The real reasons are multiple but can be listed as below.

1 A very high cost of drugs due to no intervention by the government as part of free market philosophy. This means that the same insulin that costs $25 in Canada can be sold for up to $1000 per month. New introduced drugs for Alzheimer's or other diseases can cost up to 50k per year - again because no price controls.

2. Insanely high prices of services due to a captive market - example a ten minute ambulance ride can cost up from $1000 to $5000. The private ambulance companies know they can charge a high base rate because they are connected to a city or municipality via contracts. Bribes as campaign funds are popular here. E.g. a new York based ambulance operator paid 45k in campaign funds to NY's governor elect and got a contract worth one billion dollars

https://www.wkbw.com/news/state-news/report-nysdoh-awards-mu...

3. Overcharging by hospitals for medicines and services again due to a captive audience. The hospitals are free to maintain various price books and you are not told what each service will cost at the time of administration of service. lately the hospitals have been forced to open up their price books but they are so convoluted that no normal human can decipher those prices.

Thus a ten cent aspirin would cost you $25 in the hospital and a MRI can run up to 15k.

4. Very high charges for doctors due to strict control on the number of MD positions and no increase in colleges or D seats over multiple years.

https://www.aamc.org/news/press-releases/new-aamc-report-sho...

5. Insurance companies have a for profit motive and need to extract their profits from premiums paid. Thus they fight tooth and nail to deny procedures and medications and set up convoluted processes for appeals.

6. Extensive fraud on Medicare and other government run health programs especially in durable medical goods and fake billing. In fact one of sitting US senators medical care company was involved in the largest Medicare fraud fines in the US and he still holds his seat.

https://www.justice.gov/archive/opa/pr/2003/June/03_civ_386....

Infact fraud billing Medicare for services not rendered is so popular that even Insurance companies do it

https://oig.hhs.gov/fraud/enforcement/united-states-interven...

Combine all the above factors and you will see why the US consumer gets so little while paying so much for his healthcare.

We fucking hate it don't worry

Yes, but we also want universal healthcare. What we don't want is only universal healthcare with death panels like the UK and Canada has. Give us universal health care where we can also get insurance if we want, and we'll vote it in. That's never what comes up though. I firmly believe we could gut medicare/medicaid and the savings from the bureaucratic administration costs alone could pay for universal healthcare.

> incompetence

No, that's the goal. Denying coverage is how insurance companies make money. The less money they give, the more money they keep.

Insurance companies have become cartoonishly evil. It’s going to get really nasty out there at some point.

Happy to hear this all worked out. Have you thought about reaching out to local news to get the word out? That insurance company should be called out.

I'm glad you were able to use these tools to help your family though such tough times!

> The hopeful part of me is that many others can use similar techniques to win.

And the realistic part in me says that these tools will be used to deny appeals without a human ever looking into them and making sure you will never get to talk to a human or get approval for anything ever again.

A few of the sentences don't make sense to me. Who is "they" and "their" in the last two paragraphs?

I was under the impression that if you were to go to an emergency room, life saving surgery would be scheduled regardless of who is paying (or not paying), due to EMTALA. I can't imagine a hospital waiting for an insurance company's approval to pay for a procedure to schedule a child's life saving surgery.

Is this incorrect?

The other side of this is that your LLM interaction can be leveraged to train adversarial models that find ways to still deny or delay your claim despite your LLM-advised actions.

Insurance companies, or the companies they pay to launder their involvement, would pay a lot more for that than the public would be able to.

Great story, and encapsulates what I find most powerful about LLMs.

I'm curious, where do you live that denies a child a life saving surgery just because insurance won't cover it? Because in the US there's laws against that.

Man that’s terrifying. I can’t imagine going through that due to admin incompetence

The US healthcare system sounds horrific

Amazingly happy to hear you were able to drive the process! FWIW, surgical centers usually have to do the exact same thing for their patients (typical role: coordinator), and they do it the same way you did (plus knowing a few counterparties because they work together regularly).

The lack of data standardization in health insurance is atrocious. (In the US, CMS/Congress pushing what it can, but at a glacial pace)

The strongest argument for single payer is that a diverse marketplace has demonstrated a fundamental inability to interoperate.

This is why AI is an equalizing force.

Eventually, we'll just have a free (or at least much cheaper) psychiatrist in our pocket.

Sure, AI advice is workse than the advice of a competent professional, but it's very often better no advice, and that's what you get if you can't afford the professional.

(this thread paid for by OpenAI)

I’d love to see a poll asking Americans: “Do you want to maintain the status quo?”

Even for politicians who are not absorbed in wedge issues, meaningful reform is a long term task. It would require multiple elections in a row showing that there is a durable political coalition for universal healthcare.

So much this.

Also, this works for every people, not just American.

Medicaid is apparently 77MM including CHIP. The underlying compromise in the system that you're describing is sane: people's health care costs rise dramatically and unpredictably at retirement age, just as their ability to pay plummets, so socializing health care at that point makes a lot of sense.

Is this a comment for or against socialized medicine?

It is very interesting that you do not where they are from but you assume longer wait times and lower quality of care. This suggests you believe the US has the shortest wait times and highest quality of care, which is objectively not true.

A good example that "public" campaigning can work, but not necessarily for the better - there's been a systematic campaign to delegitimize trans healthcare.

There's comparable examples from other places; Ireland has come a long way in getting the church out of reproductive health, but there are still problems. And of course it doesn't matter whether it's public or private, abortion care is at risk in many US states.

The UK does allow you to go private, remember.

And statistical modelling. LLM's must have a weights that associate _seen X chemical high, so Y condition likely follows in the documents I've read_.

How right you are, and more than you know

Oh, I’m not suggesting this system is normal or sane at all. Merely that OP could have understood it better and paid $0 instead of $33k.

that sounds like 0.0001% of sectors

> I m lucky enough to afford healthcare

Up to a point, I guess? Correct me if I'm wrong.

So basically they accept and approve of them being bankrupted by an unfortunate medical event no matter how top tier their health insurance package. Right?

Do negotiated rates not affect quality of care? I work in contracting and negotiated rates allow me to add quality, while systems like price codes incentivize minimum effort/outcomes.

I know doctors probably take their jobs more seriously, but I'd be surprised if it doesn't bleed over into healthcare quality.

Pharmaceuticals are only a (high) single-digit percentage of medical spending in the USA, and the (likely) reason for the ads is the highly competitive nature of the market. Most of healthcare spending is on labor, specifically doctors and nurses, who are protected by highly effective trade and lobby organizations.

India is larger and yet.

Left wing won't solve it either. They profit from the crisis by promising each election and not delivering.

Bingo. It's not important.

I doubt this comment is true, given that other countries with government run healthcare have surgeries and choice. Do you happen to have any evidence that every country with government run healthcare has no choice or surgeries at all? Your comment seems to imply as such.

So build faster and better than YC to defend society|humanity against YC portfolio companies (not all, of course, just the harmful ones) until politics can close the gap. There is no speed limit. There is no moat. The only thing you don't have is ~$500k in investment [1]. Constraint breeds creativity. Be creative, stay curious.

[1] https://www.ycombinator.com/deal

I think a lot of "let's use technology to solve a social problem" takes forget to assume that both sides have access to technology.

Note that Massachusetts and San Francisco have universal healthcare. Mass. is also home to one of the best healthcare systems and children’s hospital in the word.

UK/CA healthcare sounds like hell. Every doctor is under the government, so even if you have money for a procedure the government doesn't want to cover, you can't get it done. And of course because there is no rationing by price there is rationing by time, so you end up with 13mo waits for an MRI.

> It's not a simple democracy, no (i.e. "enact a national-level vote for every issue and majority vote wins").

But it's worth remembering that, if it were, Trump would still have won. He won the popular vote. So, assuming that enough votes were legitimate, a majority of Americans actually do want the current health situation in the US, in fact arguably they want even less coverage.

Just reminding you that American citizens continue to be detained

https://www.techdirt.com/2025/10/22/more-than-170-u-s-citize...

Have some more

https://www.cbc.ca/news/world/us-citizens-ice-arrests-detent...

FoxNews has only been the number one TV news channel for the last 20 something years because almost everyone under 40 doesn't watch TV anymore. Yes, there are a lot of conservatives in the US, but the demographics is really skewed if you just look at people who watch TV and have cable.

I hope you refuse Medicare at 65 under those same principles

Most other countries have voter ID, and the controversy surrounding it is puzzling to most foreigners. Additionally, parliamentary systems which result in majority governments are much more ‘dictatorship-like’ than the US system where individual representatives retain some autonomy.

Good reminder that "life saving" and "elective" are orthogonal.

> not be copyright infringement to train on them either

Copyright is about reproduction. It does not cover uses. Once you bought it, it's yours, as long as you don't reproduce it outside of fair use.

The problem with most language models is they will often uncritically reproduce significant portions of copyrighted works.

If you buy the codes, yes. If you only license them (which is what the original comment claims is the only way to get them legally), and that license explicitly forbids training, that seems to be less clear-cut. I have no idea if such restrictions are legal or would hold up to challenge, but it's less clear than the case where you buy a book and can then do whatever you want with it.

IANAL, you're right.

I am not sure it's that simple. Thing is many costs are due to information assymetry: you not knowing something that they do.

For example them counting on you to big hire a lawyer for collecting medical debt or mortgage debt your spouse or parent owes. As a general rule you aren't responsible for it. There are exceptions. e.g. Filial laws(children responsible for parent's debts) exist in many states, but are difficult to invoke. Community property laws https://www.irs.gov/publications/p555#en_US_202502_publink10... in 9 states that can link your income to your partner, when the state you were domiciled in with your partner in a home/condo you bought together.

So in general, adverserial use of AI cannot bring claims "back to pre-AI" levels. Much more likely is the fact is reduced debt collection activity and illegal billing will reduce to a new baseline.

The work I know of, I'm not in USA only have an interest in copyright laws in general, is Feist v Rural Telephone (1991) -- which appears to mirror codes for health procedures quite closely; but not exactly.

There's old but more recent law from Practice Management v AMA (1997) supporting that AMA's codes can't be copyrightable as they're part of legislation.

Berne's Art 2(8), to which USA are signed, related to non-copyright of facts.

I'm afraid I'm not appraised of the full situation, however.

No - see https://en.wikipedia.org/wiki/Feist_Publications%2C_Inc._v._....

The Surgery Center of Oklahoma publishes all their prices, and do not take insurance:

https://surgerycenterok.com/surgery-prices/

They're the pioneer, but there are other clinics like that.

The “full” prices are basically just made up. If this was like the insurance company negotiates a 15% discount than OK. But the reality is crazy stuff like the “full price” is $7,623 but “your insurance company paid” $34.12. It’s totally bonkers and should be illegal.

In the EU you can also generally look up the cost, even in cases where the patient doesn't pay, there is a bill and fixed costs. The costs are what the government pays or what a foreigner with no medical coverage and insurance would pay. It's also generally a tiny fraction of the cost in the US.

I will throw a story out here because I don't know where else to put it and want it off my chest (I will leave a lot out of this):

Daughter tried suicide a few weeks ago. "It was not a serious attempt," but obviously it is. We go to only local hospital; they don't have a pediatric unit, so ER basically just looks at her and aren't sure what to do because it's not like she's bleeding out. They clean the cuts and ask if I want county behavioral health involved. I'm in over my head and need help, so I say yes.

Behavioral health mobile response person comes out -- good guy, made me see something I hadn't prior -- because I've had her in therapy for half a year prior but we weren't really making much progress on anxiety/depression issues -- but he says we weren't going to get anywhere with therapy before drugs, that she was too far out, and in retrospect that was absolutely the right call. Anyway, he puts her on 72-hours mandatory hold. Here, this means the child must be transferred to a pediatric health facility with suicide watch and psychiatric services. This became a big problem.

Cincinnati Childrens Hospital had no beds (and I have ill will toward them anyway). Dayton had no beds. Charge nurse was calling people for hours and hours, and I joined in calling places (we stayed at hospital the whole time without sleeping), and it wasn't until 24 hours after admission we're finally transferred. My mom was/is a social worker for those with developmental disabilities, and spent about a decade working at long-term facilities for juveniles, where it was almost always court-ordered. I spent a fair bit of my time there for economic/childcare reasons while she was working -- awful place for the kids (not for me; I hung out in staff rooms and watched movies). Doors, by law, could not be locked, and they were terribly understaffed; violence and rape was expected. We had a second person from county behavioral come out, and once I realized the only kinds of places open to us, started pleading and insisting to have the hold lifted, but they refused. I wind up with one out-of-state option, and one in-state; both about an hour and a half away, and both the kinds of facilities I was terrified of. I later talked to other parents and was surprised to find time to find a facility, lack of beds, and travel time were all common issues between us. I went for visitation every day, and at least one adult would almost always come out of visitation crying, not realizing these places are poorly-staffed, unsafe prisons until they first visit and talk with their kid.

Anyway, so the 72-hour clock starts only once daughter's transferred to this pediatric psych facility (she wound up staying for 5 days; this is a whole other issue where they had no social worker available to provide AMA paperwork, they claimed). -And this place is a long-term juvenile psych facility, so it tends to have a lot of kids who were sentenced by courts to be there; violent offenders, but it was a mix (daughter has a story about playing Uno with a kid experiencing "weed psychosis", which'd I'd never heard of before; interesting stuff). You know, so I'm going to bed every night, and I've got some wild nightmares I could share -- BUT everything turned out mostly fine. At one point, daughter witnessed staff slam a kid against the wall hard enough for him to bleed from the head, and didn't clean the blood off the wall; the toilet in her room didn't work and the room smelled like feces; they couldn't lock doors, and the facility was severely understaffed. A recipe for disaster, but it could have been a LOT worse than it was, though trauma is there nonetheless from the experience.

Now, the reason the county insisted on sending her to this hellhole is because it's the only way to unlock county behavioral services. You must first have committed an attempt to harm yourself or someone else, or be ordered by courts. I wrote at the beginning I was able to get a counselor before all this, but this took a lot of emails and phone calls, and the place I found with help required 2 hours on the road per visit. The person I got was new in the field and didn't specialize in pediatric; he was not a licensed psychologist nor psychiatrist, but he was the only person I could get and I was grateful for any assist. There were/are no available pediatric psychiatrists or psychologists EXCEPT through county behavioral; they have them all locked away from the market, basically.

The total bill for all this, by the way (uninsured, cash, including the ambulance) was $8,709.45. I didn't negotiate; I've planned for this, I took out $20k from broker on the first day I got to go home. Money isn't the issue; it's the non-availability of service which's the real problem here, for us. I was surprised to walk into county behavioral and be told while registering at front desk they don't accept self-pay; that they aren't set up for it. I've never run into this before, and it got a morbid chuckle out of me because this's been a heck of a roll of the dice up to now, specifically to get in county services, and now I'm told they don't offer anything for us.

I ask for the people who insisted on the 72-hour hold (and btw, the facility which held daughter prescribed nothing but an antihistamine, with trauma inflicted, though minor; worthless experience except to unlock services) to speak with me, and I get one of them. She talks to supervisor, and apparently nobody knows their own policies because they do, in fact, accept self-pay. I had to fill out a Medicaid form, which we don't qualify for. Now, the strange part about this is if you have insurance (and this is why they have you apply for Medicaid), they charge you on a sliding scale, but if you don't have any insurance and get rejected by Medicaid, they really don't have any system set up to bill you, so everything's free. The psychiatrist and counselor both are free; it's crazy, so I'll kick some money to food pantries while SNAP's cut off in the state due to federal shutdown, but it's like nobody's ever really thought through the systems we have for healthcare; it's inefficient and brittle from every angle, not just the providers/insurers screwing people over for capitalism angle; like a proof-of-concept someone slapped together over a weekend where everyone's spinning their wheels without a clue what to do, except it's something we've had for centuries and are spending $trillions/year on. -And every time the government provides new weapons or issues new mandates, it somehow seems to get worse.

(Things are going well now, btw; we got a real psychologist scheduled same-day, and first appointment with psychiatrist was 2-3 days after intake. She's doing better, but the journey here was straight Hell.)

Yes. Though I think technically none of that happened here.

If I sound like I'm defending the morality of the hospital for billing a private individual $190k for services they'd expect to be paid $37k for, please know that I'm not. But it helps to understand WHY the hospital billed that much, and whether it's legal for the hospital to bill that much.

The biggest semantic "mistake" the author makes in their thread is saying, "Claude figured out that the biggest rule for Medicare was that one of the codes meant all other procedures and supplies during the encounter were unbillable."

The Medicare rule does not make those codes "unbillable" - it makes them unreimburseable.

The hospital can both bill Medicare for a bigger procedure code, and the individual components of that procedure, but Medicare is gonna say, "Thanks for the bill, you're only entitled to be paid for the bigger procedure code, not the stuff in there."

Neither the FBI nor Medicare is gonna go after the hospital for submitting covered procedure codes and individual codes that are unreimbursable under those procedure codes. That's not crime, that's just medical billing.

Actual double billing would occur if, say, your insurnace paid the hospital for a procedure, and then they came after you for more money, or billed a secondary insurance for the same procedure. Or if they'd said, "Oh no, the OP's brother in law wasn't here for just 4-hours, they were here overnight so now we're billing for that as well."

NOW - a much better way for the hospital to handle this scenario would be to see that the patient is cash-pay, and then have separate cash-pay rates that they get billed that essentially mirror Medicare reimbursement. That's essentially what the author got them to do, and it absolutely sucks that's what he had to do.

And yet Florida elected a Senator who earned over $100M doing just that.

https://en.wikipedia.org/wiki/Rick_Scott

In my experience, most people underestimate what's negotiable across the board. Especially those making enough to do most of their business with mass-market operations, like big-box stores and retail service providers, that profit by doing many, many standardized transactions every day, with minimal discretion or even personal involvement.

Below that, lots of haggling and informal trade often help people get by. The costs of that process can be another burden on the poor. At the high end, it's worth involving people with discretion on the sell side. Additionally, sales are often one-off and customized. They may also bundle a bunch of different items and benefits without clear line-item breakdowns.

When hiring a lawyer, I'd nearly always recommend getting terms down in a written and signed engagement letter before work starts. That is very much a negotiation, but it's fine to ask questions and comparison shop.

If you're starting with a call, it's perfectly normal to start by asking whether initial consultation will be billed or not. If it will be, ask the rate. If it won't be, expect some limits on what can be discussed. The best lawyers I know aren't cheap or easily tricked into giving free advice on consultation calls with speedrunners, but they are up-front about what they charge for and how.

Disclosure: Am lawyer. Negotiate professionally.

The AMA is functionally the trade union for doctors. They work to maximize the income of their members. Maintaining a shortage of doctors is one of their primary tools.

If this also helps the medical industry, it's an accidental side effect.

Absolutely. It's cheap (as far as the user is concerned) to just fire off a question. And it can even be really fuzzy/ambiguous/ill-defined sometimes. It's a great starting point.

Then who pays? If your argument is that we should socialize the cost of that ambulance ride across all Americans, they won’t go for that. Americans don’t want more taxes, but more importantly, Americans deeply mistrust their fellow citizens, and don’t want to feel like they’re paying for someone else’s life decisions.

America doesn’t have the same kind of social cohesion as most countries. We’re a nation of individualists. The general feeling here (rightly or wrongly) is that healthcare costs are largely driven by your choices in life, and Americans don’t want to feel like they’re on the hook for other people’s bad choices.

i don't really disagree with you, but i do think it is funny given that the single largest policy targeting medical price transparency came from a republican admin.

i'm potentially on board with signing up everyone for medicare, but only if we actually can get voters to vote for the taxes necessary to fund that. i doubt we will be able to given we can't get voters to vote for the taxes necessary to fund existing medicare consumption.

If, as someone with money, you look across systems, the US is one of the best. That's the point I'm making. There's plenty of places where all the money in the world won't buy you the quality of care you can get in the US.

Quality of care available to wealthy people is an important factor in evaluating a system. In the US, there are many millions of wealthy people who the system is great for.

> Another was a code that was inpatient only and because it was an emergency he had never been admitted.

The threads says this was 4 hours of work and they billed for things that weren't even used.

> While the outcome was horrible, all of those people need to get paid for the services rendered somehow if we want folks in the US to continue receiving this standard of care.

Food for thought:

- this approach produces systemic outcomes that are worse and cost more than other approaches

- there are lots of ways for people to get paid to provide medical care. Medical professionals do not work for free in other countries, and they buy the same equipment and drugs from the same suppliers as Americans do.

- we are allowed to look at how other countries have solved this problem without hitting people with giant medical bills. We are allowed to apply those solutions here.

- the US standard of care is overall not particularly high in the global rankings. We may decide that we don't want to continue providing this standard of care, we may decide we want to be in the top 10 globally.

Except everything in America is ludicrously priced. The cost of supplies and equipment is not even close to being realistic in America vs what you'd be charged for equal care in another country.

No that isn't universally true. There's plenty of countries (eg Cuba) with entirely state-run healthcare systems where more money won't get you better care.

Then it'll come down to an individualist vs a collectivist take.

Triage priorities in referrals are an acceptable trade-off for broadly improved access to health care. The reality is that my eczema doesn't need to be seen before someone else's melanoma.

While I appreciate being able to see a specialist earlier in the US with my health insurance, I know that many ordinary American citizens aren't able to at all and that my insurance displaces incentives to serve underserved communities. I'm not yet an American citizen so I will not preach what the US should or should not do, but I do think it is unfortunate that is the case and I hope that improves.

Fair everywhere I have lived the system was spread thin by personell shortages, mostly driven by long hours, bad working conditions, and austerity driven budget cuts.

That source is from 2008. Now (https://dqydj.com/household-income-percentile-calculator/) its at 11%. And its not a binary. Anyone making six figures (nearly half of households) should be able to easily afford the best care. I'm sure there are people with spending problems who are exceptions to this.

Did he have French citizenship or similar connection to France?

Americans still have higher take home pay and lower cost of living than Europeans. You also need to understand that the 22% who have full free coverage pay nothing, and because of their income also don't pay taxes.

There are also subsidies for middle-low earners, and most full time jobs offer insurance (which people foolishly wave to save a few bucks, but end up being another horror story).

The situation is not nearly as dire as the young American crowd that dominates social media makes it out to be. It could be much better, but as I alluded to in my other comment, don't let stories of car crashes scare you from getting a license.

Or they value privacy? Especially regarding their children?

Many people nondescriptly don’t gender themselves in online discussions.

I usually read Hacker News, not comment...this story just grabbed my attention because of my kid's situation and wanting to maybe give others hope fighting a similar battle.

You know, when you deal with the past 18 months where your kid has 6 hospitalizations due to illness, 2 minor surgeries, 3 major surgeries (this last one was spine related, others heart), countless appointments, multiple feeding tube feedings a day to sustain nutrition, nearly $2 million lifetime billed do insurance (as a 6 year old)...who the fuck cares about what gender I decide to write about or the reason I might not share it?

It's largely a side effect of a couple things... first the ACA (ObamaCare) limited the percentage of profit that insurance and medical providers can make... so they instead just grow the pie larger by inflating everything. Second is that they are allowed to have effectively vertical monopoly investments controlling multiple layers of healthcare as a whole from insurance, providers, pharma and pharmacies.

Trust busting and multiple supply lines really need to be established in order to have a chance at restoring normalcy. Which is all but impossible as Pharma alone is the single biggest spender of advertising alone, let alone policy influence over politicians.

The problem is that the insurance is provided by private companies whose incentive is to earn as much money as possible, at cost of the people in need of medical care. In my country, I never heard of anyone going bancrupt over a hospital bill. It just isn't a thing.

Here's a fun story: my sister was living with an exchange student from the US. Some day the student was complaining about intense intestinal pain she's had for the past few days. My sister told her to go the hospital. The student asked her if she was crazy. My sister then had to explain her that hospitals are free and won't bancrupt her...

As Lawrence Lessig put it: before the general election and before the primary election, there is a "Lester" election where donors choose who is able to mount a campaign. Candidates are effectively pre-qualified by 0.0005% of Americans. It's probably an even smaller crowd than that as that includes Joe Nobody who gives $20. Those who "bundle" $1 million in donations or write a mega check themselves have exponentially more access.

> The United States is a democracy, but more specifically, a representative democracy.

As your following explanation makes clear, it's actually an unrepresentative democracy.

Ah, so Americans are okay with that system as well. Got it.

How much money and how does it suck?

At ~$250k TC I get better care than I could in any of the socialized systems. Concierge care, advanced treatments if I want/need them, out of pocket max that is easily affordable, etc

No, but it does with singling them out in particular.

Right. The mainstream progressive proposal for comprehensive health care reform in the US is single payer, so-named because it does not nationalize the providers. But the providers are where all the cost is!

But then somehow they know how much things are when they send you the bill?

I don't know what I said that is wildly false. Or even false for that matter.

People getting surprise bills that their insurance will not cover is rare, because being in a situation where it's a possibly is rare. Insurance pre-approves or denies care before it is done, so you really need to be in the ER and getting odd-ball care that falls outside standard procedure.

I'm also not defending them system, it is a mess (even I posted a story in this thread), but the fact of the matter is that the system largely works for most people, so things like inflation, wages, housing which have daily reminders of shittyness for huge swaths of people gets political priority.

A better way to think of this is like bad car accidents. They are horrific and most people know someone who knows someone with a story, but we don't put a lot of political capital into improving vehicle safety. Most people go their whole lives with no accident.

> Nobody should have to be wondering what company an ambulance works for.

Is this real?!

Is it not? He did still win the popular vote.

The problems with the electoral system are just one symptom of a deeper issue: unlimited political donations. The wealthiest individuals in the world can funnel endless money to politicians through Super PACs, and that influence shapes policy more than an individual voter ever could.

Even if we magically fixed the electoral system tomorrow, the results would be superficial. Sure, we might see more Democrats in office—but if they’re still beholden to massive, uncapped donations, how can we expect them to enact real, meaningful change?

This problem with money in politics is not something that only affects one party. It's a systematic issue that needs regulation. Without real regulation on money in politics, everything else is a band-aid on an open and festering wound.

Every actuarial study about the switch projects total cost savings even during the first year. This scarsity of providers is artificial there haven't been enough medical student slots ever in America. American life expectancy isnt in the top 25 nations, while having the largest percapita GDP.

> "would you favor that your employer-based healthcare would be rescinded and you would instead get healthcare from a new government controlled plan, where there would be no other options", which is the assumption M4A's viability is based on

No, that's just the condition for one proposal for Medicare For All.

As much as Americans complain about healthcare in general, most people don't want to give up their own health insurance once they have it. This is a known political trap that the previous M4A proposals walked right into, before crashing and burning.

When you say "Medicare for All" to people without details, they assume it means a Medicare option for all. When they start reading the details and realize they have to give up their current insurance, they don't like it.

lol, get a life dude.

I think he meant literally criminal.

The hospital double billed for over $100k worth of services on the original invoice.

At a certain point a pattern of issuing inaccurate invoices crosses the line into negligence.

If a business just have a habit of blasting out invoices that bill for services never received, and they know that they keep doing this, and only correct it when the customer points it out, at a certain point it turns into a crime.

Lol. Who do you think makes the Medicare rules?

I haven't paid a lot of attention to Stoller particularly, but the rest of that line of thinking frequently correlates with also believing that monopolies are exclusively a result of active government regulation, a belief which is naturally attracted to Republican deregulatory rhetoric.

I make a good living. I have some of the "best" available health insurance. It's just bordering on scam/fraudulent. Not aware of what programs you're talking about other than medi-cal (medicaid). Which I do not qualify for.

As I alluded in another post I do often let debt go to collections. The issue is often not the collections calls, but that your provider will be even more aggressive about demanding up front payment to continue receiving care. Or stop seeing you. I have a rare neuro muscular disease that only a handful of doctors are even very knowledgeable about where I live.

Well it was a democratic republic. Now it is an electoral autocracy. He fixed it so good those christians will never have (or be able) to vote again. Just like he said he would. A Republic where the representatives are chosen by a popular vote are still democracies.

In the US, you'll be billed the maximum out of pocket for your health insurance whether your little one is in the ICU for months or whether it was a easy delivery though, so at least birth is a predictable medical expense.

Realistically it's much more likely that someone in the US would be telling this story vs someone from Norway.

Norway has only 50k births a year. The US has 3.6 Million, and >40% of those are 100% free to Medicaid recipients. So 1.4 million each year, meaning a story like this is about 28 times more likely to be told from someone in the US than Norway.

Ouch.

Is this a somewhat remote location? With all the insurance options I've had from work, the "in-network overlap" was something like 90-95%. People didn't change insurance to get access to providers - it was mostly a better rate, etc.

Cancer rates are hard to compare across countries because overdiagnosis is such a common issue.

A higher survival rate is to be expected when the doctors have a financial incentive to treat benign growths which the patient would have survived anyway. It can indicate overdiagnosis rather than indicating successful treatment.

You're taking quite a small view of healthcare in the end looking at only cancer outcomes. Just ignoring things like maternal mortality, infant mortality, cardiovascular issues, etc.

A family member had a procedure a few years ago. Provider told the patient that they had contacted their insurer and received confirmation it would be covered. Went ahead with the procedure.

Bill arrives and the insurer denies coverage. Provider says "oh well <shrug> you owe us $$$ now".

Since I am the resident argumentative asshole in the family I dig into the situation a bit. After many phone calls I am eventually told that the hospital routinely records all phone calls with insurance companies and furthermore has found the recording where they gave advance guarantee of coverage for the procedure.

At this point I realized we are being shaken down by a corrupt/criminal enterprise. Even with the recorded phone call the insurer refused to pay and so the patient had to pay off the $$$ over many months.

I share the exasperation about the lack of empathy. I know these providers are humans and would ask the same questions. They probably negotiated their car, housekeeper over a few hundred dollars. But when I ask about $10k here or there for critical care suddenly I’m greedy or unrealistic?

Ya, I wonder how younger Trumpers are organizing, surely not FoxNews. Twitter/X, those weird social networks popping up...they seem to be really really active in trolling facebook.

Zero to you. Whatever it reasonably costs to government. A bit from you later in tax, but much more from Bezos.

What's "short" in your context? 20min?

That means the organization and selection of data is copyrightable, and only if they are creative. If you write your own tags for the codes, and makes a compilation of them all, none of that will cover your database.

I’m sure it’s crossed the mind of many people in the industry. But it’s a comprehensive taxonomy of all diseases, medical conditions, causes, procedures and treatments. Starting from scratch would be much more expensive than just paying the licensing.

It's a constitutional republic. Democracy is optional. We'll either discover it now or discover it later.

How exactly do they make more money by not paying? They're required to spend 80% of their funds on provider expenses. The only obvious way to sustain the narrative that insurers are distorting the system for profit is the preceding comment's hypo that they'd be over-paying (and then driving rates up as their expenses increased). You propose the opposite fact pattern here.

(Net cost of health insurance, all expenses, is around 6.5% of total US spending, as against 51.5% of direct provider costs for doctors, nurses, and procedures, not counting prescriptions.)

Oh wow, I had independently formulated that as the duality/parallel between corruption and cheat codes: "The more out-of-band information you need in order to be treated normally/fairly, the more corrupt the system is."

https://news.ycombinator.com/item?id=9933801

This reflects a common complaint in social engineering.

People keep trying to enact rules to stick it to the elites and make the downtrodden better off.

And as the rules get more and more complex, the position of the elites gets more and more solid.

I just looked it up and I'm wrong, estate recovery is for anyone at any age who is institutionalized and/or anyone over 55 receiving care. States can additionally choose care and populations from which they do estate recovery for their Medicaid programs.

All I know is a family member would get the Medicaid warnings about their estate each month in the mail.

If one lives in a state like CA, the taxes (income, sales, etc) basically are equal to that of Norway/etc. The downside, we don't get any real benefit from those taxes paid out.

I know of Indian immigrants who suffered for decades/years on H1B, endless anxiety and tensions, eventually make it to GC, then a passport.

Then all of a sudden fall ill, lose everything and return back to India.

People keep forgetting the US society is a giant stack/pyramid ranking system, the structure keeps getting narrow as you move upwards. You get pushed off the sides, in the ever narrowing funnel, and you need increasing levels of luck at every level to survive.

BTW, this is not just with regards to health care. You could lose your job, suffer from ageism. Lose your home, run out of money. A million different things can happen, that can cause the above said phenomenon.

You can be a small business owner, employer and (low) multimillionaire, and still have it go down the drain via an accident, illness or disability that affects you and/or your family. Over time, disabilities can cost millions of dollars. Surviving a heart attack can cost hundreds of thousands to a million dollars. Long-term care insurance can still deny coverage based on pre-existing conditions, and long-term care is very expensive.

Horrible system.

That's the 'societal' part of living in society, sharing the risks and yes sharing the gains a bit too. I know some right wing folks see it as unnecessary burden, either they are above the financial cut or (dumbly) believe their health is and will remain stellar for rest of their lives. That tiny minority shouldn't ever decide such societal policies and shouldn't be let to do so.

Its shortsighted and plain stupid and properly selfish move. It works rather well short term if one simply doesn't give a fuck about suffering of others, but even thats shortsighted and stupid long term - we live in hyper-interconnected society and not some prepper wet dream, what goes around always comes around.

Another similar is public education, literally defining future of society. How dumb is to not have it in stellar shape, shitting on one's own kids and mankind future.

But hell will freeze sooner than majority of americans will realize and accept that. Till then, if its important enough for you, you can vote with your feet, its easier than ever.

You can use the difference in comp to buy a Cadillac level plan with zero deductible, zero out of pocket max. You won’t be going bankrupt.

This is why insurance plans have out of pocket maximums. To prevent this exact issue.

We can say whether those maximums are still too high (some really are), but the mechanism is there.

The real issue is that most people don't have a rainy day fund to deal with such emergencies. And that they are too expensive anyway.

There are 2 concepts you should always keep in mind.

1. Always avoid the hospital unless you are literally dying. Surgery centers are owned by doctors who will negotiate a fixed fee, because there's someone to negotiate with (unlike Hospitals which run on the CYA principle). Also, most doctors can do procedures in office, if they have the right one.

2. Medical debt will never lead to collections. Hospitals may sue you, depending on the state, but that carriers reputational risk. A good PR push and a decent lawyer to threaten discovery will be enough to fend off even the most aggressive hospitals - this allow you to setle at a very reasonable price vs what insurance would normally pay.

If an insurance company owns 20% of the service provider, they only make a fraction of what the insurance arm pays to the provider arm.

Your software is definitely artistic expression. You signed over the rights to those expressions to your employer.

(IANAL)

Copyright under US law does not require "artistic expression". One of the requirements is called "creativity", but it's very easy to meet. The key phrase is literally "some minimal degree of creativity".

The fundamental policy choice was to protect computer software under intellectual property law, with exclusive rights and market compensation. There were a number of ways that could have been done. Other jurisdictions toyed with new, software-specific laws. But in the end the call in the US was to bring it under existing copyright law with some tweaks to definitions and a small handful of software-specific rules.

A code in this sense is something different. It's a shorthand for a longer description of an object. It'd be like a hotel copyrighting the relationship between a room number and its physical location within the building, or copyrighting resistor colors.

Consider these thoughts: https://wiki.c2.com/?SoftwareIsArt

Artistic expression isn't the standard in US law.

> Hard to believe you say we aren't subject to rationing when pre-authorization is as big as it is.

If you want to see true rationing, look to the UK (especially) or Canada (less so) where I know plenty of people who have to wait over a year to see a specialist even after doctor referral.

Meanwhile, my parents in the US at a hospital get a CT scan, MRI 'just in case' immediately (or close-to for the MRI) and pay nothing for it.

In the middle of Albuquerque. Rural areas offer hardship pay to attract medical professionals, but it’s really touch and go. IHS has its own host of issues.

> My primary point was comparative - wait times are considerably longer for the NHS than in the US.

So we're talking about a situation where a doctor thought a patient required an MRI-- using your word-- "immediately."

In the NHS when a doctor requests a patient get an immediate MRI, what are you claiming is the average wait time?

Edit: clarification

> My primary point was comparative - wait times are considerably longer for the NHS than in the US.

It depends what it's for. If you want something non-urgent, you may be waiting a bit longer.

If you go to A&E you'll be seen very quickly in the UK, but unless you're lucky with which hospital you pay to get into you could be waiting quite a while in the US.

Medicare has pretty good negotiating power, rather like the NHS. Medicare patients may not care how much Medicare is paying for their treatment, but the US government cares how much it spends on Medicare, and the IRA has given it some additional powers to negotiate drug prices in recent years.

> Do you think countries with even the most coveted universal healthcare just approve everything blindly?

Yes. Everything that they are trained and able to do here, is covered by the national insurance, at least where I live.

We never even have to explicitly ask them to approve anything, it's all automatic. You don't see the bill.

You might have to pay the difference for "nonessential upgrades", like a plastic cast instead of a normal one when you break your arm. Had to pay 5.00 EUR for that and it was the only time I had to pay out of pocket in my entire life.

Everything? No. But routine stuff will NEVER be denied. If your doctor thinks you need a scan, you're getting the scan. I have quite literally NEVER heard of someone in my country (Australia) going bankrupt from medical bills. It can happen but the rate is so low it's not something anyone ever worries about happening to them.

> Should everyone (anyone?) receive monoclonal antibodies, gene therapies, biologic medications? What criteria should be used to make these determinations?

Yes, if that's an indicated and effective treatment.

Do you think people should just be left to die if they can't pony up the dough in the hospital? Oh, your card's declined, no oncology ward for you?

>The wider implications of this are left to the reader.

IMHO, it's actually worse than we realize. The Medical Loss Ratio requirement is good because it requires insurance companies to spend 80% or 85% of premiums on health care. It's bad because one way for insurance companies to make more money is to have inflated health care prices to justify increasing premiums so they can get 80% of a bigger pie. It also gives them incentives to provide care themselves so they can capture some of that 80% spend.

> For the uninsured this sort of thing is actually really common. Had an online friend who had to get emergency treatment and they sent him a bill for $20k.

I experienced this personally with my own insurance. My bill was over $20k, and it took a year to convince the insurance company that removing a few feet of my intestines was actually emergency surgery. I ended up paying $800. My roommate in the hospital had no insurance and ended up not paying anything (which I did not begrudge them at all, since the reason for no insurance was debilitating back pain that led to unemployment)

I used to live with a guy from Guatemala, who at some point or another wound up at the ER. At the time his insurance apparently had some huge deductible for ER visits so he got the whole bill in excess of $1000. He was going to pay it, so I suggested he just call and tell them he was planning to leave the country and not come back. I told him to tell them there was no way he could pay the full amount, but didn't want to leave a debt out there like this. They lowered the bill to $150 after a few minutes on the phone.

Many years ago, I managed to stab my face with a screwdriver (not my proudest moment), and had to go to the ER. After the stitches, I was asked whether I wanted to pay with insurance. If I did, it was something like $2,000. If I didn't, there was a 75% discount off MSRP. My deductible was like 25%, so it ended up basically being the same out of pocket either way.

The fact that there seems to be a 4x markup means makes me think insurance companies are in bed with these hospitals. If you can mark up prices arbitrarily high, the insurance "discount" is fake.

> Yeah, US hospital billing is based on the idea that the patient has insurance and won't really care about what their insurer gets charged. (The wider implications of this are left to the reader.)

Don't leave out the part where the consumer doesn't even shop (or sometimes pay) for the insurance policy either, it is determined by their place of work.

So the consumer of healthcare is doubly shielded from any price signals the market might supply.

I know a couple that avoided marriage so she could negotiate the childbirth bill on the basis that she was an uninsured single mom who didn't own property, etc, etc.

Health Care Sharing Ministries (HCSMs) are an interesting loophole in healthcare regulations that excepts uninsured people that participate in an HCSM from paying the tax penalty.

HCSMs are membership organizations in which people with common religious or ethical beliefs share medical expenses with one another. They are not the same as traditional health insurance.

Because patients are considered "self-pay", they negotiate their own prices with providers and they are likely to get an 80% or more discount on "list price" for the service. They are reimbursed by the HCSM if the HCSM approves the reimbursement.

As of 2025, approximately 1.7 million Americans participate in Health Care Sharing Ministries (HCSMs), which amounts to about 0.5% of the U.S. population. In Colorado alone, HCSM enrollment (at least 68k) is equivalent to 30 percent of Obamacare enrollment.

Because HCSMs often exclude essential health services and are therefore more attractive to people who are relatively healthy, enrollment of this size, relative to marketplace enrollment, may increase premiums for marketplace plans.

I am not promoting HCSMs but I did research it when I lost my COBRA coverage a few years ago. I do find it an interesting alternative approach to paying for healthcare. We really do need to explore options in this country.

I can definitely see AI being applied in the HCSM context.

https://www.commonwealthfund.org/publications/fund-reports/2...

https://www.youtube.com/watch?v=oFetFqrVBNc

> Yeah, US hospital billing is based on the idea that the patient has insurance and won't really care about what their insurer gets charged.

Not quite: US hospital billing is based on the idea that the insurance company does the haggling for you.

Insurance companies negotiate (cough) "the best rate that the hospital has to offer," therefore: What the insurance company pays is confidential, and the official unnegotiated price is highly inflated. That's why hospitals will always negotiate with uninsured patients, because they're deliberately inflating their fees.

---

In 2011 I had surgery. The first bill was for $100,000, which was sent to the insurance company. Then the insurance company got a letter (cough) "reminding" the hospital of the negotiated rates. The next bill was $20,000. On a follow-up visit, they did an X-ray, and sent me the bill. I sat on it, and then called my insurance company. The insurance company called the hospital to (cough) "remind" them that the negotiated rate for that kind of X-ray was $0.

So you're saying one solution is to get rid of all insurance and make hospitals charge a reasonable price. Sounds good to me. You sound conservative!

A large portion of the US economy is based on this entire grift pipeline (settling before getting to court). And it's very costly and pushes up insurance costs and costs in general for everyone else.

this looks like shopping in Moroccan bazaar with no price labels. But here you bargaining not for couple fruits but for your health and price range is in thousands. WTF :)

My analogy is not with socialized healthcare but with the medicare scheme. Socialized healthcare works in lots of other countries due to a combination of rationing and (in the case of drug prices) prioritizing accessibility over R&D.

> I suspect that it’s mainly doctors who need to be more responsive to cost incentives as they’re often the ones recommending unnecessary tests or treatments.

Doctors would recommend fewer tests if their patients were more price sensitive, I think. I'm not sure a more direct route to making doctors price sensitive when they are on the provider-side, why would they want you to utilize less? There probably also needs to be malpractice/tort reform in the US.

The point is that there's a value judgment being made somewhere - who should be the arbiter and why?

Diagnostics aren't free, either: many (most?) countries do not have anything remotely resembling the private offerings that Quest Diagnostics and Labcorp provide (breadth of tests, 3+ different methodologies for some tests, etc.)

Gemini states that an ultrasound is just as good for diagnosis as an MRI and is much cheaper. Could it be that the denial was correct and the mistake was from your doctor ordering a less cost effective diagnostic test, not from the insurance company?

And from my personal experience with narcolepsy, AI is a much better doctor than most human doctors.

Dental is an entirely different system: dental insurance isn't actually insurance.

I am in 100% agreement with you about dental insurance, but that's a completely separate system.

While you're not wrong that most "justice" processes are expensive, I think the parent-poster is referring to a different kind of "government inefficiency", things like:

1. Single-payer health insurance.

2. Laws that insurance-companies must actually use X% of their premiums on payouts.

3. Laws requiring disclosure of negotiated prices, to encourage competition via free-market forces.

>Why would they when continuing to be part of the problem makes them more and more profits each year?

In real-life America, they don't even earn enough profit to earn their shareholders a better return than SP500:

https://news.ycombinator.com/item?id=45736978

And in real-life America, the only people health insurance companies engage in price wars with is the state insurance regulator who gets to deny requested price increases.

The military encourages them to buy each other because it's much easier to regulate an industry with fewer companies in it.

Four or five competitors is plenty for a healthy market.

Where I live, they do compete on price - prices vary by about 30% for similar coverage. They can't engage in the kind of price war you're thinking of since insurance companies, by law, have to maintain a fund able to cover costs, have to get rate changes approved by regulators and are largely banned from price discrimination.

I understand the desire to shift blame entirely onto insurance companies rather than providers. After all, one is all about money and the other is seemingly all about healing.

Heck, when a provider does bill people directly because an insurance company refused to pay, we blame insurance companies - even when the charges on those bills are highway robbery - like those in the article itself.

The fact is, the net cost of health insurance was about $279 billion in 2022. Meanwhile, $3.7 trillion went to healthcare providers, pharmacies and the like for care. The ones who stand the most to gain from higher prices are providers.

Frankly, decades of lobbying from the healthcare provider lobby to enrich themselves should have made it this obvious, but sadly, people see doctors as selfless angels and it blinds them.

Then they must suck at collusion, given they can't even beat a risk-less broad market index.

SP500 10 year annual return: 14.6%

UNH: 13.59% Elevance: 10.79% Cigna 9.42% Humana: 6.1% CVS: 0.55% Molina: 9.42% Centene: 0.9%

Or, the likelier explanation, is that health insurance prices are highly regulated and have to get their prices approved by a government official(s), and B) they don't have a lot of pricing power due to the competition and they are not colluding.

As a non-american (from South America) who lived in both USA an Europe:

Yes, in USA you get much more money, like you said 2x~5x, but then:

University is expensive as fck. Health care is expensive as fck. You have 5 days of paid sick leave per year in most companies. You have 10 days of paid holidays per year in most companies.

In contrast, in Europe: University was cheap or free. Healthcare is cheap and universal. If you are sick you are sick, either the company or the health insurance pay. You have between 20 and 30 days of paid holidays.

This is why quality of life in Europe, is so superior. And again, I am saying this as a non-European.

> So like these are less serious issues if you are paid an extra $1-200k/ year

Ok but to be fair most people in the US aren't making "extra $1-200k / year" over a person in Europe. They aren't even making $100k / year to begin with.

> people know it is a problem but ideologically they really disagree about what to do about it

Can we really say this is true about individuals in the US?

I think it's pretty clear the propaganda machine has successfully privatized health care to the great detriment of the populace and have the clamps on it.

After all, if you told everyone you had a solution where insurance rates would be cheaper, their healthcare system would cost less overall, and the health outcomes would be superior, they would all be like "sounds great". Then, when you reveal this solution is the complete destruction of the insurance "industry", insurance payments are "tax", and the health provider is the government, they would balk, scream about socialized healthcare, and say how they don't trust the government.

That's a trained response, not a real thought.

Yes, a challenge for major structural alterations to the American system is that the median American family is probably better off under this system than they would be under any of the European-style systems: the wage premium enjoyed by many Americans and the lower tax level offsets the cost of insurance and copays.

So when you're talking about how bad the American system is, you're really talking about a minority of its users. That doesn't make everything OK, but does highlight the political difficulty of enacting seemingly-popular changes.

I think you are underestimating the number of Americans who make less than what Europeans make.

In both systems, the upper X% can afford it. But it makes no sense to focus on that. What matters is how many don’t have access.

That number is much larger percentage-wise here than in Europe. And it will only increase the way things are going.

As with many things, in the US if you're part of the privileged minority you do well. The top 10% of earners in the US earn a lot more than the top 10% in Europe – that covers tech, high end knowledge work, that sort of stuff.

But the bottom 90% do badly. Society is very divided, and most people lack social mobility, they lack a voice on the national and international stage, they lack the security that either a social safety net or high pay would give them.

The UK is similar, although much less pronounced. I moved to Australia about 18 months ago and society here is much flatter, the difference between the top 10% and bottom 10% is much less. There are still problems here, it's not a utopia, but it's very noticeable how most people are struggling less, and how the top 10% of earners aren't living that different a life.

Wrong - sorry. The reason is that politically the US public is very skillfully managed from above via divide and conquer strategies and beaureaucratic techniques (i.e. identity politics, gerrymandering voting districts). The public polling is very clear about US citizen preferences, but US Govt policy is rarely aligned that way.

Oddly enough the big rhetorical push against a universal system from prior decades was about "death panels" deciding what care somebody would get. And guess what's happened with insurance? Death panels!

The propaganda spin on the health care system in the US has been on overdrive ever since Hillary Clinton wanted to implement some reforms in the 1990s, leading to absolutely massive resistance to any change whatsoever. Even the changes implemented by Obama, which were a HUGE improvement in access, barely made it across the legislative line, and dismantling that access to the health care system has been a huge rallying cry for one of the major political parties. I won't say which one because mentioning that fact results in people turning off their brains and downvoting.

The US healthcare has optimized for availability and higher access to the most treatment options. This does not mean evenly distributed treatment options, but that people have the chance to get access to things more quickly.

And for most people, the healthcare system works fairly great. There are exceptions, like the denial described in this thread, and they usually get lots of attention because holy hell is that a messed up situation. But the everyday care that most people get is better than adequate.

You could offer me 10x my current salary and I wouldn’t take it if it meant I had to stress and be terrified about the life of my 6 year old daighter because a company wants to make more money.

That is the definition of not worth it.

A Princeton study showed over a decade ago that the policy preferences of the vast majority of Americans have no correlation with actual policies. That you put forth these completely detached theories is quite impressive.

I don’t know if this a case of ideological delusion to go along with political impotence or just the usual upper middle class playing their part in obfuscating the on-the-ground realities. Structurally the latter is more likely.

In fact, US Americans are paid so well, the GDP per capita of the poorest state (Missisipi) is about the GDP per capita of France. In fact, the gross average wage of Missisipi is just barely lower than the average salary in Germany. Americans are paid really, really well.

> they really disagree about what to do about it

What is there to disagree with? Are there any option other than introduction of universal healthcare?

> ideologically they really disagree about what to do about it

I really don't understand this sentiment. It's not like the current state of the US insurance market were based on the principles of a free market. On the other hand, not coupling your health insurance to an employment contract that can be cancelled at will has nothing to do with socialism.