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Notes -
Yes, I agree healthcare provision is different in many ways, but that also sets the context for this entire discussion and criticism. Your argument is the end-user has a moral obligation to pay whatever $$ bill is sent to them (if you have some restricting condition, you have not yet mentioned it although I would assume you have some sort of "reasonableness" limit). You justify this by saying healthcare providers cannot refuse to provide services.
The main issue I have with this argument is you're using situations which do not account for the overwhelming vast majority of healthcare in order to justify practices and moral obligations. An example is your ringer neurologist to a patient having a stroke with other examples being almost entirely focused on ED care, but this is not representative of the majority of healthcare expenditures. Healthcare providers can and do refuse non-emergency care to people who they know will not pay for it. Perhaps in the context of megacorps and hospital systems, it is true individual doctors cannot de facto refuse care due to billing.
You set this context by essentially requiring the end user who is being screwed to think of it in situations which aren't representative and about individual doctors and other providers who have limited choice with pay structures likely irrelevant of whether or not each individual pays any bill sent to them.
But then, so what? This would be a systemic criticism, not a moral obligation on the final screwed person. The enduser can simply respond with your same moralizing back at you.
One, not a tourist. Two, your claim is that the healthcare system may automatically writes off tourist patients (I wasn't a tourist) and don't even bother at point of contact to tell them the cost and ask for payment? not that they give a bill they don't think will be paid
this criticism doesn't even stand on the face of it, it's little more than handwaving
knocks, stitches, broken bones, nose bleeds, etc., the kind of care which is being discussed as the example in the OP
again, you're using specific situations not described in the OP to justify obligations in other different situations
summaries of total delivered services, avg pay, total cost, number of ppl employed in industry, etc.
more money being spent and more people being employed to deliver healthcare to a populace which gets sicker and sicker every year isn't exactly a ringing endorsement of the healthcare being delivered let alone the healthcare system
no, my claim is that the practice described in the op isn't "necessary" and that the word "necessary" has little meaning in your sentence
I cannot find any support that "people" are leaving medicine in drones: more people work in "healthcare" now as doctors, nurses, etc., than ever before
yeah, well no one is saying that
Nurses are leaving bedside nursing in droves and while some specialties are keeping up with retirement rates we are slipping behind our overall healthcare needs.
My problem is not that OP has a moral requirement to pay a bill no matter how stupid it is, it's that he doesn't know if it's stupid or not in this case, he (and everyone else) is blaming the wrong parties (the PA has no idea what's being charged and has no control over it, blame the insurance company or the hospital/practice management group that owns the PA). He also went to an inappropriate level of care and was surprised that costs were excessive. If you get admitted and demand to be in the ICU instead of on the floor it'll be your fault when the bill is an order of magnitude higher.
if you're going to design a system for the purpose of extracting more money by surprise fucking over patients, don't be surprised when they're angry or refuse to pay
Again, the entity extracting more money and surprise fucking over the patient isn't the hospital or the healthcare provider it's the insurance company.
OP paid the insurance company for a service (covering healthcare needs) and then the insurance company was like lol nah we aren't going to do that, and instead of refusing to pay the insurance company or complaining about the insurance company they take it out on essentially a third party with no control.
If I wire transfer some money to 419 scammers and then walk into a bank and punch an employee in the face for allowing me to get scammed then I'm the asshole.
The ED is literally required by law to provide care regardless of insurance status, ability to pay, or appropriateness of that level of care. There's literally nothing the ED can do to stop this, it's OP's job to go to an appropriate level of care, think critically about whether an ED visit is required, investigate his insurance, or get new insurance.
OP and the Hospital are both victims of the insurance company being an asshole.
But if, hypothetically, the OP didn't have insurance and just wanted to pay cash, do you think the bill would have been any lower? My impression is that paying cash for healthcare in the US is strangely difficult, expensive, and prices just as (if not more) opaque.
Short version: costs are weird, sometimes outright unknown (the accounting for some stuff gets bizarre), charges are generally inflated as a result an annoying dance with insurance companies and the federal government to get things paid for (ex: for a lot of stuff medicaid and medicare pay less than cost so things get...creative and the insurance company goes "we'll pay you 1.05 times the cost...").
Professional fees are like likely to do this because it's a little more obvious to pay out a portion of a staff members salary based off of how long the encounter is supposed to go (very doctors, NPs, or PA are self-employed these days, almost everyone is "owned" sometimes by a hospital but also by....).
Based off the absurdly inflated price and and the lack of willingness to negotiate (most health systems will be flexible with cash pay) (and also the fact this is the ED) the PA was probably owned by a practice management group which is when a PE firm buys a physician group and does things like cut salaries, raise prices, and be an asshole (and give the money back to whoever is invested in it). It's a huge problem right now.
It is also possible that this primarily driven by what happens when your insurance company just refuses to pay for things but that's less likely.
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again, the healthcare industry and hospital systems are participants with agency in this game which designed this setup as part of the negotiating game with insurance companies
this new bank employee analogy is even worse than your car mechanic one
Negotiating prices for services is not "extracting" money unexpectedly, being unaware of what the insurance will cover is not "surprising fucking over," the insurance knows what they will pay for and we often don't and have to fight them, even for clearly necessary stuff.
Hospitals can't know (as in knowing and changing your decisions as a result is illegal, specifically for emergency medicine) what the insurance is going to do, the agency is extremely limited.
In response to this sort of fuckery places have literally closed their EDs. Hospitals are going out of business at record rates and posting record lows for profit. Meanwhile the insurance companies are posting record highs.
What are they supposed to do? Break the law and not treat the guy? Just not get paid and then go out of business? Stop victim blaming.
And that's completely ignoring the other layer of this which I can't verify with the details OP provided, but the PA is probably owned by a third party - a private equity group that does enjoy the revenue associated with skull fucking patients and everyone in healthcare would love for that behavior to get banned but we don't have any control...
I don't know how the fuck the scummy companies won the psyop where they blame everything on doctors who have zero administrative or financial control.
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