Insured, but Still Owing $109K for a Heart Attack - <AUTHOR> https://khn.org/news/a-jolt-to-the-jugular-youre-insured-but-still-owe-109k-for-your-heart-attack/ <comment><USER2> > UPDATE: Monday, shortly after publication and broadcast of this story by > Kaiser Health News and NPR, St. David's said it was now willing to accept > $782.29 to resolve the $108,951 balance because Drew Calver qualifies for > its "financial assistance discount."

Sounds all fine and dandy until you realize that these charges will just be made up for by people that aren't able to get NPR to publish a story about them.

<comment><USER3> There is a whole industry of "medical billing advocates" you can pay to find what is likely thousands if not tens of thousands of dollars of completely made up charges on any given US hospital bill and "negotiate" them away. You don't necessarily need press coverage though it obviously helps.

Hell one time I got a $15k bill for something insurance should have covered. Called the hospital, turns out insurance had covered it and I didn't actually owe any money at all. How many people get this kind of stuff and just pay it anyway?

<comment><USER4> Yea, but to hire a medical billing advocate, you need: 1) knowledge/information that they exist and that hospital bills are BS, and 2) money to pay the advocate AND the reduced bill. If the final bill is $800 and the advocate gets a cut of the savings, how many people in dire straights are likely to be able to afford that? Keep in mind, most Americans don't have 1k in savings, living pay check to pay check _because they have no choice_. Facing a 100k bill, people are more likely to wait for the collector to show up and then declare bankruptcy, facing damage to their already poor credit, garnishment of already subsistence wages, etc..

I'm much less worried about the folks who pay it anyway than I am about the folks whose lives are destroyed by an industry predating on people in the worst of circumstances.

<comment><USER5> sounds like an opportunity....

<comment><USER4> For what? Lay out a business plan in this area for me that doesn't take money from the worst off.

<comment><USER6> If you make money off them but save them more money than you costs, it is still towards their benefit. The only problem occurs when you start working with the hospital to create even more arcane bills that you get into immoral territory.

<comment><USER4> That's exactly the circumstance I outlined previously. This plan has you taking the debts of somebody who cannot afford to pay, reducing them to something above the actual cost, then asking them to pay the higher amount. You are making money from the least able to pay and profiting from a system driving people into bankruptcy. I cannot imagine starting such a company without serious empathy issues.

</comment></comment></comment></comment></comment></comment></comment><comment><USER7> > St. David's HealthCare defended its handling of Calver's bill and sought to > blame the school district and Aetna for offering such a narrow network.

So while dying of a heart attack he should have been negotiating with the ambulance driver, the paramedics, the nurses, each intern and doctor to make sure they are "in-network".

> St. David's said it was now willing to accept $782.29 to resolve the > $108,951 balance because Drew Calver qualifies for its "financial assistance > discount." I

You can pay $100k or just $700, whatever is cool with us. I guess, go to the media and try to shame everyone involved is your best hope? I can see if they did this to people buying luxury suites or yachts. Doing this to people who are dying of a heart attack is particularly disgusting. And it's not like anyone involved is going to be punished for this practice or learn a lesson. They'll turn around and do the same thing to the next patient.

<comment><USER8> I once got cut by a skate playing hockey. Showed up at the hospital pulsing blood from my leg. My first question to them, "Do you take X insurance?" Only after they assured me that my insurance would be accepted did I drag my bloody leg into the care room.

Turns out the doctor that the hospital assigned to me did _not_ take my insurance.

I got billed the full amount, yelled very loudly at lots of people, and when I "resubmitted" the claim ended up paying like $50 out of pocket. I'm pretty sure that every item in the hospital is purchased by a separate company and that the Venn diagram of approved insurance companies never intersects.

My dad is a nurse and I grew up hearing how insurance was destroying health care. As a free market libertarian, I have no idea what to do about it. But next time I need stitches I think I'll just opt for the super glue in my workshop...

<comment><USER9> It's not a free market if you (literally) can't walk away from the transaction. Trying to apply free market principles to non-free markets is what got us into this mess in the first place.

</comment></comment></comment><comment><USER10> My father had a heart attack 4 months ago, and he's been in and out of the ICU for 3 of those months. Everyone likes to think "oh, I'm insured. I'll be fine." But let me tell you, you won't be fine. 3 months of ICU at Robert Wood Johnson was billed for $4Mn. BCBS-NJ only paid out $750k. The headache begins there- from a personal financial standpoint, and Tri-party incentive standpoint. Ignoring the difference of $3.25Mn "owed" to the hospital (technically, this $4Mn is an exaggerated number by RWJ to recoup as much as they can), the insurance company is essentially denying basic/reasonable services. The doctors have been fighting with insurance to get him to an LTACH, but the most they'll pay for is a nursing home.

Insurance is a business. They aren't looking out for you, or your loved ones. I hate to sound cynical, but boy, these past 4 months have shown me the deepest, ugliest side of commerce that inevitably results from aligning incentives with profits.

<comment><USER11> Health insurance companies' profit margins are restricted by law, whereas Robert Wood Johnson and its executives and doctors profit margins are not restricted. If anyone is on the patient's side from a cost perspective, it's insurance, and the ones benefiting from higher pricing and unnecessary procedures are the providers.

<comment><USER4> I've suddenly started seeing this take all over the place and I have no idea where it comes from because it doesn't make sense. That the insurance _companies_ profit margins are restricted means rather little because executive pay isn't capped: if they earn too much money, they can simply pay bonuses to raise their expenses. Or cut shareholders a check. Or. Or. Or. Tangentially, this is why "non-profit" doesn't mean what people think it means.

And despite what caps exist (can you point me to resources on this topic?), the industry is enjoying record profits right now. That's not to say hospitals aren't as well, but I'm puzzled that so many people seem to want to point the fingers at _doctors_. Doctors and nurses actually provide the care. If there's anyone I'm less worried about making a little more, it's the people actually doing the work. The administrators and the corporations that set and negotiate prices with the insurance companies though... I'm with you there.

Lastly, the incentives of insurance companies do _not_ align with the patients unless you ignore most of how the industry works. Insurance companies make money when they're able to _deny_ you coverage or require you to pay more out of pocket (in vs out of network). That doesn't align with patients at all.

There should not be a profit incentive in health insurance.

<comment><USER12> > _I 've suddenly started seeing this take all over the place and I have no > idea where it comes from because it doesn't make sense. That the insurance > companies profit margins are restricted means rather little because > executive pay isn't capped: if they earn too much money, they can simply pay > bonuses to raise their expenses. Or cut shareholders a check. Or. Or. Or. > Tangentially, this is why "non-profit" doesn't mean what people think it > means._

This is not correct, as I understand it. Under the ACA (Obamacare), health plan providers had to ensure that at least 80% of premiums were paid out for patient services. That leaves 20% for overheard, including profit and compensation.

The "trick" here is that service providers (doctors, hospitals, MRI facilities, labs, etc.) are _not_ limited in this way (except by "usual and customary" terms where applicable), and there are LOTS of layers of providers. So in the end you can get many multiples of actual costs by simply washing the underlying treatment or service through 5 or so layers of providers.

<comment><USER13> > This is not correct, as I understand it. Under the ACA (Obamacare), health > plan providers had to ensure that at least 80% of premiums were paid out for > patient services. That leaves 20% for overheard, including profit and > compensation.

Doesn't this imply that it's in the interest of health plan providers for patient services in general to be as expensive as possible? That means premiums will have to be correspondingly high, and the 20% available for profit and compensation will be larger.

<comment><USER14> That's been one of the biggest complaints about Obamacare, yes. Other than the "I shouldn't have to pay for my neighbor's wellbeing" complaint

<comment><USER15> How is an 20% cap worse than no cap? Obviously if this scam works it would also work with less regulation.

</comment></comment></comment></comment></comment></comment></comment><comment><USER16> _After a reporter made inquiries, St. David's said collection efforts were put on hold, and a hospital representative called Calver, offering to help him apply for a discount based on his income._

I refuse to believe that the US medical system is run by humans, and not trolls we pulled from under a nearby bridge.

<comment><USER17> No, it's run by people like George Shultz, who himself pays for an on-call boutique physician, while the plebs can get their medical testing for cheap from Theranos. When the grandson, who was a Theranos intern, becomes concerned because Theranos' numbers are not better than throwing darts on a board the grandfather becomes enraged, arguing that his investment and his reputation are being threatened.

</comment></comment><comment><USER18> How is a regular person who has other things to do than to read and understated all the details and traps of his health insurance supposed to navigate this insane system?

From what I read going to a hospital is pretty much a gamble that has a certain probability to bankrupt you and there is pretty much nothing you can do about it.

There should be bipartisan agreement that these practices are just not acceptable and that there must be a way for a patient to get binding information upfront.

<comment><USER19> Yes, I demand full and final information about what the heart attack I am currently suffering is going to cost me to be treated at this hospital.

If I think you are trying to extort me, I am just going to go to another hospital.

<comment><USER20> I'm actually not sure if you are being serious. If the information on costs for emergency services were clear and available up front people could shop around ahead of time and basically write up a living will saying, if I have a heart attack, take me here.

Insurance companies are the reason the costs are not clear and up front.

<comment><USER21> Are you serious? You think every American should be required to write a living will for them and their children listing every conceivable illness and injury by individually researching all the medical options in their area? And what, update it weekly as they follow the markets? Should they keep up with the latest medical research so they know what the newest drugs and treatments will cost? What about vacation, do you need to do a week of research to prepare for a weekend trip to NYC?

<comment><USER20> "listing every conceivable illness and injury"

No. Just the ones that are true emergencies where you won't have time to do any shopping around ahead of time. Why is this such a hard concept? Think of all the times you've seen a doctor in your life. How many of those were super time critical? Big accidents and heart attacks are. Having a cold or flu isn't. Heck, even cancer isn't super time critical, you could take a few days to shop around treatment centers. Shopping around for most medical care shouldn't be that weird of a concept.

Another option would be to only have insurance for those critical time sensitive events, then you don't have to be super price sensitive for those, and the free market could drive down prices of all the other medical care we get.

<comment><USER21> Ok, here's one list, I'm sure it isn't comprehensive: [http://ourmed.org/wiki/List_of_medical_emergencies](http://ourmed.org/wiki/List_of_medical_emergencies)

So for each item on this list you'll need to find out every possible treatment and drug and what they cost at every hospital within ~50 miles. Make sure you look up allergies and any side effects when combined with medication you regularly take, you don't want to be in a situation where you listed Hospital X for meningitis, but their cheap drug can't be combined with your asthma medication, or whatever.

And again, how often do you update this will? And what about travel?

Is there anything else in your life that you shop around for in case of emergency?

<comment><USER20> Your google skills are strong. How many things on that list need treatment within minutes?

"Is there anything else in your life that you shop around for in case of emergency?"

Have you never heard of Preppers? But seriously, yes, I shopped around a little for a fire extinguisher in my home, I shopped around a bit for a good first aid class so I'd have some skills. I have spare batteries around the house in case the power goes out and shopped around for a flashlight. I have practiced changing a tire for my car just in case. I have a little food stored up in my house.

Why is preparing ahead of time completely off the table for people when it comes to medical care?

<comment><USER22> >How many things on that list need treatment within minutes?

Let's go down the list for things that don't need treatment in minutes:

\- Malaria

\- Rabies

\- Salmonella

\- Lyme disease

\- Malnutrition and starvation (though you'd rather have this taken care of fast if possible, in severe cases minutes would count)

\- Attempted suicide, non fatal (though only if you aren't up for anything else as a result of said attempted suicide, you'll be fine if you don't get immediate treatment)

\- Psychotic episode (under supervision)

\- Suicidal ideation (if you're under supervision)

\- Smoke inhalation (in very very minor cases)

\- HELPP syndrome (doesn't seem to be very dangerous in the minute range though you'll want treatment either way)

\- Priapism (although it is very painful)

\- Sexual assault (before you downvote consider that sexual assault is generally not fatal itself and you don't need urgent medical attention, though urgent psychological attention is, in general you'll survive if you need more than a few minutes to the hospital)

Most of these come with a few ifs, notably that no other medical emergency coincides and some depend on severity, the rest of the list is to my knowledge pretty deadly if you don't get it taken care of as quickly as possible and for half the list it is likely you'd be either in extremely severe pain, unconscious, non-responsive, dying or a combination of the previous in any order.

</comment></comment></comment></comment></comment></comment></comment></comment><comment><USER23> Looking at the bill, here is some ridiculous: NaCl (basically salted water) costing around $300/liter.

That's outrageous. These guys are protected by your politicians and make use of mercenary tactics. Villains in doctors clothing.

I'm for free markets but we are kinda going over the limit here. Maybe have fixed rates for emergency where you can't get the approval of the patient. Maybe give the patient the possibility to pay for these ridiculously priced items after.

I mean if I get you 1l of NaCl we'd be cool. And fix the rates for emergency.

<comment><USER12> Retail cost for Lactated Ringer's solution, injectable (basic saline fluid for IV) was over $40/liter in qty 12 liters about 3 years ago. I can imagine it has gone up since then.

The use of the health care system to extract every single excess dollar from the middle class extends to many, many layers of the supply and service chain. It may be that the saline was "merely" marked up by a factor of 2x.

<comment><USER23> Seems like the problem is broadly in the medical sector (including pharmacological). There is 0 reasons why it would cost over $1. Maybe $2. $40 is still way ridiculous. I mean in a competitive market.

<comment><USER12> The problem is there will never be a truly competitive market in most health care products and services. Necessary regulation creates too many barriers to entry and competition, and the ultimate consumer has very little demand flexibility or even choice of provider.

What is needed is a monopsony buyer who can negotiate in this arena on a more even footing. In other words, single-payer.

</comment></comment></comment></comment><comment><USER24> The US is proof that a free-market system for healthcare does not work. This is also illustrated by all the stories here.

For free-market to work, a consumer needs to be able clearly understand what he is buying and how much it will cost before he consumes whatever he buys. This allows him to shop around, and find the best seller and price.

The current system just drives prices up instead of down, as the seller, who is in it for the profit, can set his prices after the goods have been bought. Ofcourse prices will go up, there's no competition anymore, as the buyer has already consumed the goods.

Trying to make this transparent before an operation would not work. It would just turn healthcare into another IT project, where seller will offer you the lowest prices, and then come up with extra-work that also needs to be done. Image being operated on, and the surgeon informs you they've discovered some required extra work, asking you if you will agree with the additional cost...

It's clear to me that healthcare and free-market are an incompatible combination, it needs to be heavily regulated, and probably single-payer.

</comment><comment><USER25> "Calver asked whether his health insurance would cover all of this... The hospital told him not to worry and that they would accept his insurance."

From my experience, it is completely legal for any medical practitioner to say they accept an insurance even though they really do not.

<comment><USER26> From my experience, no human at the hospital has any idea whether they will accept your insurance or not. The doctors certainly don't. They just report things into the bill-processing system which occasionally delivers patients a crazy $100,000 bill.

<comment><USER27> They have no idea if the insurance company will pay. I know this from personal experience where the hospital explicitly called insurance co to ask if a procedure would be covered, received confirmation that it would be, AND the hospital recorded the call. But coverage was subsequently denied.

</comment></comment></comment><comment><USER28> I feel like whenever I hear crazy stories like this about healthcare it usually involves these weird in or out of network issues. I'm certainly not an expert on healthcare, but is there no way to attack the problem from this angle?

If you have a hospital with a certain list price for a particular procedure, why is it legal for them to charge one insurance company 5% of that price and charge another insurance company or someone without insurance full price? It seems like exactly the kind of scenario that price discrimination laws are meant to prevent.

Similarly for the insurance plans themselves, why can you sell basically the same plan to employees of a large company for much cheaper than you sell it to employees of a small company? (This one might need to be a new law specific to insurance companies, because clearly there are many other products that give group discounts when selling to large companies, but I think health insurance should be treated differently).

I'm sure I'm missing what some of the downsides might be, but it seems like making these kinds of backroom network-based deals illegal in health insurance would go a long way in making prices more understandable/predictable, and that might allow for more fair competition on price to emerge.

<comment><USER29> > I feel like whenever I hear crazy stories like this about healthcare it > usually involves these weird in or out of network issues. I'm certainly not > an expert on healthcare, but is there no way to attack the problem from this > angle?

Because hospitals, and physicians, have decided that, for the most part, it is better for each of them for physicians to be "independent contractors", so the situation of "your hospital is in network, but your physician was not".

Or for me, most recently, going to my doctor for a checkup on my hypertension at an Urgent Care/Family Practice hybrid. Facility? In network? Physician/Assistant? In network? Lab in the same building (to be clear, it wasn't a multi-tenant complex, this was a medical practice) that they sent me for CBC draws? Out of network. Boom, hundreds of dollars in lab bills.

</comment></comment><comment><USER30> All this is a bit surreal (Canadian here), but it prompts the question: why won't people sue in a class action to refund money they gave to the insurance in the first place?

I realize it's a complex subject, but at the end of the day, the insurance companies advertise and sell: insurance.

<comment><USER11> Any insurance policy will have clearly stated the difference between out of network and in network benefits.

<comment><USER31> But you can't always pick your providers. Example: You go to emergency room that is in-network. A month later you get the bill for the doctors that treated you - who aren't in-network.

 _" A new study that looked at more than 2 million emergency department visits found that more than 1 in 5 patients who went to ERs within their health- insurance networks ended up being treated by an "out-of-network" doctor — and thus exposed to additional charges not covered by their insurance plan."_ [https://www.cnbc.com/2016/11/16/many-get-hit-with- surprise-o...](https://www.cnbc.com/2016/11/16/many-get-hit-with-surprise-out- of-network-bill-after-emergency-rooms-study.html)

</comment></comment></comment><comment><USER20> Here's the deal. Insurance is a simple concept. Take house fires. They are fairly rare, but they do happen. We could all just save up enough money to cover a house fire ourselves, or, since we know that house fires are rare, we can pool our money together as friends and neighbors and when one of us in that pool gets unlucky and has their house burn down, it can be covered by insurance. A lot of us pay a little money for peace of mind that if a rare catastrophic event does hit us, we'll be OK.

This same concept applies to some medical issues, but there are a lot of medical issues it does not apply to. Getting a routine infection and needing antibiotics? _Everyone_ is going to need that. It makes no sense to pool our money and pay out for the rare person that needs money for that. How many other medical expenses are like that? Even things that are rare for a group of 20-year olds like heart attacks are actually a lot less rare (more common than house fires, probably) for an older age group. So while it might make sense for a group of 20-year olds to pool money together to pay for the rare heart attack amongst that group, it might not make any sense for an over-50 group of people to do that same. It definitely doesn't make sense for a 20-year old to join that group. Yet this is exactly what we do. We all pool our money together and use it to pay for _every_ medical expense that comes up. Minor infection? Use insurance! Need a couple stitches? Use insurance. Routine screening? Wow, didn't see that coming, good thing I have insurance.

This is insane, and this is the root of all our problems.

<comment><USER32> I completely disagree. The reason insurance pays for the small things is to encourage people to seek treatment early because it's cheaper in the long run. Almost nobody would pay hundreds for a cancer screening like mammogram or colonoscopy that they don't believe they need, but catching these things early is orders of magnitude better both for health and financial outcomes.

Insurance covering a minor infection prevents needing to handle a major infection. Your system assumes humans are rational and a good judge of risk, something that has proven to be untrue countless times.

<comment><USER20> Yes, humans are shortsighted and stupid. That's why we need state-sponsored medical care. Run by humans.

<comment><USER33> Not sure if you're joking, but that's a pretty lazy fallacy of composition there.

Ex: Human memory sucks, but you can generally trust the immutability of books, despite them being written and copied and bound and distributed and sold by humans.

It's all about using strengths in the right direction and order to sidestep weaknesses.

<comment><USER20> Fallacy of composition says I look at a few stupid humans and decide that all humans are stupid. That's what the person who I was replying to was doing in reply to my original post. I was trying to point out that if their supposition is true then we are all screwed no matter what.

Fortunately their supposition is false. Humans are not generally shortsighted and stupid, if you give them a chance.

<comment><USER33> > Fallacy of composition says I look at a few stupid humans and decide that > all humans are stupid.

No, a fallacy of composition would be "the organization is stupid because its employees are stupid", or "metal boats are impossible because metal sinks in water." It involves something which is _composed of_ the smaller pieces.

What you're describing is more like a hasty generalization, where individual- qualities within a sample lead to a conclusion about individual-qualities shared by the entire population.

> I was trying to point out that if their supposition is true then we are all > screwed no matter what.

And -- even if their supposition is true -- I disagree!

Metal boats _can_ float on water, even though individual metal pieces sink. Institutions _can_ solve problems, even ones that individuals humans suck at.

</comment></comment></comment></comment></comment></comment><comment><USER34> From outside of the US, it baffles me ( and I'm sure others ) why the US doesn't embrace governement based healthcare. We pay the same kinds of tax rates etc and don't have to pay for health insurance on top of that(though you can get extra health insurance for pretty cheap if you want). It's kind of like governement education which the US does pay for up to a certain point. Not only is it worth educating your population, it's worth looking after their health as well.

The amount of misery and unpayable debt it seems to cause people who live in the US seems really unecessary. Not to mention nearly everyone in good heealth has a certain level of anxiety about whether their insurance is good enough and will cover them.

Mind you guns also seem unecessary yet the general response to that seems to be, It's ok, we will live with our fear and everyone should be carrying guns and make it so everyone needs to be prepared to kill other people in gun fights. If you get wounded of course, then prepare for living the rest of your life in medical debt.. :I

<comment><USER35> > From outside of the US, it baffles me ( and I'm sure others ) why the US > doesn't embrace governement based healthcare.

The US has had majority public support for fully-public healthcare for at least ~30 years.

What it has lacked—even among politicians championing "healthcare reform" like Bill Clinton and Barack Obama—is politicians willing to challenge the insurance industry even with the backing of majority public support.

</comment></comment><comment><USER36> > Industry analysts and consumer advocates say St. David's has a reputation > for exorbitant billing and for trying to collect big payouts as an out-of- > network provider.

Sounds just like St. David's Medical Center in Austin, TX is run by crooks. I like the take-home message that "Faced with a surprise bill or a balance- billing situation, don't rush to pay any medical bills you receive."

<comment><USER26> More specifically, it is run by HCA Healthcare, a for-profit company listed on the NYSE.

</comment></comment><comment><USER37> If you owe a 6-figure amount of money because of a health issue, you don't actually have health insurance.

<comment><USER11> You do, it just doesn't cover you at all medical providers in all 50 states.

<comment><USER37> If you send me a bill for anything over $100,000, you might as well send me a bill for $10 trillion. It doesn't matter, I can't pay. I'm bankrupt now. Great, you get my house and my retirement savings.

The point of insurance is to prevent that from happening. I pay a small amount so that if I get unlucky, I'm not ruined. I don't care if "oh the bill was actually much higher before" because the number never mattered- me being ruined is what mattered. If I still am, then the insurance did not do what I wanted it to do.

</comment></comment></comment><comment><USER38> The insurance company is basically saying, you should still choose the in- network provider even if you are unconscious or don't have a choice or we'll fuck you financially. I've had this happen to me, appealed, and after many months, actually won. In my case I was unconscious and the ambulance and hospital were out of network. I was lucky the hospital was willing to wait over a year and not send it to collections. It was hell. Why the fuck isn't there a law against this kind of shit? Do we expect people who are unconscious or having a heart attack to say, "oh no, take me to an in-network provider so I don't go bankrupt?" Fucking absurd the healthcare in this country and the lack of proper regulation. How long are we going to allow these insurance companies to get rich while people die and go bankrupt?

<comment><USER35> > The insurance company is basically saying, you should still choose the in- > network provider even if you are unconscious or don't have a choice or we'll > fuck you financially.

Actually, they are saying if you choose to cut premium costs by selecting a narrow provider network, well, there's a reason _why_ the premium costs are low.

> Why the fuck isn't there a law against this kind of shit?

Because Republicans actively oppose any attempt at health security, and Democrats keep ignoring the majority support for single-payer that polls have shown for close to 30 years in favor of Rube Goldberg solutions that keep private insurers and this type of network-based limitation as central features, despite the fact that hey have less public support and are thus more subject to being politically sabotaged before passage (Clinton) and after (Obama).

Though there's signs of potential for that to change on the Democratic side in the near future...

<comment><USER38> Your first point is simply not true. There is no plan that covers every ER and every hospital. Even on the top plans, there are in-network and out of network providers. So once again, we're back to making decisions while incapacitated or unconscious. No matter how carefully you chose your plan and how much you pay, you're still fucked. Not to mention that almost everyone is stuck with the plans their employers choose. Even the platinum level ACA plans, however, are like this. That's what I'm talking about above, BTW, as well as equivalent plans provided by corporations. It's simply impossible to get a plan that covers everything and therefore prevents you from going bankrupt in all situations.

<comment><USER35> > Your first point is simply not true.

My first point is what the insurance company is _saying_. It's absolutely true that they are saying that. (It's also a true claim; your argument that all provider networks are limited such that the risk of similar problems exists at some level in all insurance plans is perhaps pedantically true, but not necessarily relevant—e.g., it may be that the only reason the care from the profile provider in this particular case was out of network was that the district's individually negotiated narrow network plan excluded providers that would have been included in standard plans this insurer offered in the area.)

> Not to mention that almost everyone is stuck with the plans their employers > choose.

That's factually false; only 49% of Americans are covered by insurance provided by an employer (either their own or as a dependent) health insurance, and not all of them have no other practical option than that plan, so, no "almost everyone" is not stuck with their employer's plan choices.

But, in any case, the employer's plan choice is exactly what the insurance company is highlighting as the issue in this case.

</comment></comment></comment></comment><comment><USER39> There are midterms coming up. Vote for change and don't vote for anyone who took one cent from the insurers.

<comment><USER40> And here's a handy list of all representatives and how much they took from healthcare lobbyists.

[https://www.opensecrets.org/industries/summary.php?ind=H&cyc...](https://www.opensecrets.org/industries/summary.php?ind=H&cycle=2018&recipdetail=S&sortorder=A&mem=Y)

<comment><USER41> whats amazing to me is how little money it takes to sway a politicians vote. yes there are big numbers in the list but most of them are 10s of thousands. its just amazing that they are willing to put their conscience aside and condemn people to bankruptcy or worse for that little. for the worshipers of free market they sure are selling themselves off cheap.

<comment><USER42> The problem isn't that they're bought with $10k. They're approached and told "Take this money or we'll give your competitor $5 million to campaign and take your place". And they know they follow through with the threats, so they take the $10k.

<comment><USER41> but even that should ultimately bid-up the bribes after all its a 'free market'!

</comment></comment></comment></comment></comment><comment><USER43> This is why I plan on moving to Texas: creditor protection.

At any point in time I could require medical services and have medical service providers simply decide that I owe them a truly massive amount of money. The only route I have to mitigate that risk is through creditor protection laws.

In Texas, wage garnishment is limited to child support, unpaid taxes, and some other limited categories that medical billing doesn't have access to. Creditors can sue you, but they can only seize bank accounts, brokerage accounts, and the like - your primary residence is completely exempt, as are employer-sponsored retirement plans and IRAs.

So my emergency medical debt plan is to liquidate all taxable investments and close out bank accounts, send the cash from that to pay down a mortgage, and tell them to pound sand. The only real consequence is having to head to Walmart each month to cash paychecks and mail out money orders to pay bills.

<comment><USER44> You might be better moving to a country with a nationalised health system and avoiding this mess entirely.

<comment><USER43> It's _significantly_ easier to move between US states than it is to emigrate.

</comment></comment></comment><comment><USER45> Another easy solution, file for bankruptcy. No sane judge will kick a family out of their house over a medical bill. That would be counter productive to their recovery and cause undue hardship. If you don't see the utility in bankruptcy, just remember our President has used it several times over decades.

Edit: it's also known as unsecured-debt, which means the worst thing anyone can try to do to you is ruin your credit score. This isn't worth dying over and America is designed to bear the cost.

<comment><USER46> Bankruptcy really is the ultimate medical insurance. In fact, when so many people don't even have $2k in liquid assets, it almost makes more sense to skip paying _actual_ medical insurance, and just declare bankruptcy in the event of massive medical bills.

What that doesn't help with, though, is something like being diagnosed with a chronic condition where pills cost $800 a pop.

<comment><USER45> I've read that it can only be done once every 7 years.

<comment><USER47> What happens when you do it more often? You have no money so...

<comment><USER45> I think it was just from the credit score side, maybe it takes that long for it to be discounted from your credit score.

</comment></comment></comment></comment></comment><comment><USER48> Went to the ER on the advice of my doctor. Went to my insurance's website to find an ER that accepted my insurance.

Got there and asked at admittance, "Do you take my insurance?" Was assured they did.

Got a big bill a few months later and it turned out the doctor working in the covered ER was not covered by my insurance.

<comment><USER49> Exact same thing happened to me. I went last April and just now got it all "fixed". I ended up negotiating with the hospital, the contracting company for the hospital's ER department, and my insurance on the phone at the same time to reduce the cost to what the contracting company's ER doctor on staff would normally bill the insurance company and paid that out of pocket.

I guess you have to ask if the doctor who may or may not see you depending on what you're in for also takes your insurance? I don't even know.

</comment></comment><comment> jim-jim-jim Just cut the gordian knot and nationalize the system already. It's a political no-brainer. There are very few Americans, even conservative ones, who are in love with the intricacies of paying medical bills. The only people beholden to the status quo are those paid to defend it.

</comment><comment><USER50> FTA _St. David's is out-of-network on his school district health plan_

So apparently the "max out of pocket" on the cover sheet of your plan is b.s. and only applies in-network. I guess good luck having in-network coverage if you're on a vacation and have an emergency.

<comment><USER51> Yeah, out-of-network coverage (if provided) is often limited by terms like "the usual, customary, and reasonable amount". When a provider charges unreasonable amount the insurance will not have any contracts that enforce the cost of services. And the patient left holding the bag. ;(

My guess is in a situation like this I'd get the reasonable amounts for services provided from my insurer and use them as a basis to refuse any unreasonable charges.

<comment><USER52> The whole warped part of this is that the consumer has no way to anticipate cost in advance, and often the individual providers (doctors, nurses, etc.) don't either. Shouldn't the burden be on the insurance company to investigate and discourage excessive billing? Or are they too strict as it is, leading providers to play games with billing?

<comment><USER51> I think in this particular case insurance did investigate actual (or within a reason) costs and paid them. But there is no business relationship between the insurance company and an out-of-network provider. Should they go to the court on behalf of the patient? As a customer I'd like this. But it looks like combining health and legal insurances.

Another option is maybe to require that language on the "patient responsibility form" to include the blurb about fair prices. For instance:

In the event that my health plan determines a service to be "not payable", I will be responsible for the complete charge and agree to pay _the usual, customary, and reasonable_ costs of all services provided.

<comment><USER52> Is there an analogy in the car insurance world? Let's say I know nothing about cars and I get in a collision somewhere far away from home. I need a repair th let's say I know nothing about cars and I get in a collision somewhere far away from home. I need some bodywork and a replacement for the flimflam crankslap in the engine. The shop knows that I don't know anything about cars, and they know that I am covered by insurance. What is stopping them from charging me an exorbitant rate for a new crankslap, and then me getting screwed when the insurance won't cover it?

<comment><USER51> > What is stopping them from charging me an exorbitant rate

Nothing. That's why everyone always asks for a good and trustworthy mechanic. Or an HVAC repairman.

</comment></comment></comment></comment></comment></comment><comment><USER53> I just don't see what value private health insurance companies bring to the table anymore. They are not helping get the best coverage for their patients and they squeeze the crap out of the care-givers until its hardly worth their time.

</comment><comment><USER54> Crazy that you need to make national news to pay a medical bill fairly in this country.

</comment><comment><USER55> There must be a better way. I'm in the UK where the NHS is kind of flawed but at least they don't bill you like that. I'm kind of a believer in customer satisfaction as a guide to how to run things and it seems highest in hybrid systems like Singapore.

</comment><comment><USER56> Has anyone in the US considered flying overseas to get treatment done? Many hospitals in third world countries are cheaper and more humane.

Sure, you lose out on the ability to sue them if things go awry but where is the tradeoff between six figure debt at an old age vs paying $10000 to get the whole thing done?

<comment><USER57> Not intentionally but this happened to me. I have bad adult asthma and spent 6hr in an my in network ER (on the advice of my pcp) a couple of years ago. Got some meds a chest X-ray (turns out I had pneumonia!) and got sent home stablized. my bill for the 6h (with BCBS insurance) was ~$3k. Last year I was in Japan for 2 weeks and again got sick. After avoiding it for a few days I again went to the ER and got the same treatments/test (this time it was only the flu). Bill (no insurance at all) $200. Round trip direct flight to Japan from my house is $1300 and takes less then a day. Makes me think what I might want to do next time...

</comment></comment><comment><USER58> *Disclaimer: I'm not attempting to support HCA's billing practices here."

HCA has profit margins around 10%, which do not appear to me to be exorbitant. ([https://investor.hcahealthcare.com/press-release/hca- reports...](https://investor.hcahealthcare.com/press-release/hca-reports- first-quarter-2018-results)) While this patient's experience is clearly out of whack, and the $19k for a $1,500 stent thing is nuts, this points to a larger pricing / business model issue within US Healthcare. Typically, a few medical specialties (Surgery, Imaging, Rad Onc) have high profit margins, but are offset by losses in other departments (ER).

<comment><USER20> Thank you for pointing this out. How many medicaid patients paying below cost does it take to drag down profits from the occasional 1000% markup that the hospital gets away with?

<comment><USER58> Can't tell if you're being sarcastic or not, but yes, there are patients that pay (or are charged) a 1,000% markup, that in turn offsets patients not paying anything. I'm not saying the problem is the patients paying nothing; the problem is that the payment model is broken.

<comment><USER20> I think you just said what I was trying to say. Thanks!

</comment></comment></comment></comment><comment><USER59> Working as intended.

Here is the thing: This hospital is a vampire. They WANT to send you to collections. They WANT to take your house and everything you own.

<comment><USER43> It's Texas, they can't actually take your house.

</comment></comment><comment><USER60> 'We saved your life so that you can spend the rest of it in indentured servitude.'

</comment><comment><USER61> I have a relative sick with cancer right now and I'm seeing this first hand. Hearing stories like this you hope it's a one off, but it's absolutely the norm of how insurance companies operate.

My aunt is still employed, fully insured, and every day is a fight between her and her insurance company. They randomly deny claims for chemo treatments, and put her through invasive procedures to verify the disease after doctors formally diagnosed her.

The list of landmines they strategically place that could cause her to lose her insurance seems to only grow. This payment isn't made on this date? Insurance gets cancelled. This form isnt filed on this day three months from now? Insurance gets cancelled. Forget the fact that she is too sick to work; her insurer is already busy trying to figure out how to not pay.

Unless you are wealthy enough to pay for everything yourself, everyone in the US should expect to be left behind by the health insurance they've paid their entire life for as soon as the insurer can figure out how to do it.

</comment><comment><USER62> I thought this was one of the things the ACA was supposed to prevent, with out-of-pocket maximums?

<comment><USER63> out of max doesnt apply to balance bills since it is not insurance's responsibility.

<comment><USER62> Then what's the point of an out of pocket max? Shouldn't it _make_ the bill the insurer's responsibility?

</comment></comment></comment><comment><USER64> Well, it doesn't have to cost that much to take care of a heart attack. Remove the AMA from the equation and it'll clear up. The real problem is that we restrict the supply of doctors.

Without that, competing hospitals can arise that will compete on price.

<comment><USER18> Why don't they compete now or why can't you even get a price upfront from them?

EDIT: I am responding to a comment that the AMA is the problem. Maybe the AMA is a problem but it has nothing to do with hospitals not competing over prices.

<comment><USER65> You can get a price upfront in my experience. Especially for standard procedures. And definitely for outpatient stuff.

But it isn't reasonable to expect upfront pricing in things as complicated as heart surgery. Or where you are going in for unknown problems. There is no way to know what complications may arise or additional procedures, x-rays or scans may be required.

<comment><USER66> I was having trouble sleeping for a while; at one point my doctor recommending I go on oxygen for a while until she could figure it out. I called the company that provided the oxygen, and asked how much it would cost. Nobody knew. I called back 3 times, and still nobody could tell me. I called my insurance company; they couldn't tell me either. I ended up electing not to use it (which turned out to be perfectly fine), but it does seem like this was a fairly standard procedure, for outpatient stuff, and nobody involved knew what the prices were.

<comment><USER18> That matches my experience. Or you get quoted $100 and charged $3000 which after some back and forth turns into $50.

</comment></comment></comment></comment></comment><comment><USER67> 40k for four plastic tubes. Why on earth are medical supplies so fucking expensive?

<comment><USER68> Because the markup is arbitrary. An NPR article notes that the average price paid for the stents by hospitals is $1,153.

[https://www.npr.org/sections/health- shots/2018/08/27/6408918...](https://www.npr.org/sections/health- shots/2018/08/27/640891882/life-threatening-heart-attack-leaves-teacher- with-108-951-bill)

<comment><USER69> First reaction: Hmm that's not so bad.

Second reaction: It doesn't seem as bad because it's put in context of "40k" \- in reality that's still pretty bad.

</comment></comment></comment><comment><USER70> The way out of this for the US is to have _lots_ more doctors.

So tax hospital revenues (yes, revenues) to fund residencies and have an objective standard for accrediting medical schools, where meeting the objective standard automatically qualifies the seats.

Of course patients will then be paying for the residencies, but that's fine, it even makes sense.

Having more nurse practitioners and physicians assistants would also help, but doctors lobby against them starting independent practices.

</comment><comment><USER71> Reads like a breaking Bad prequel in the making

</comment><comment><USER72> When you are out of network then you are responsible to submit the claim to insurance. I paid < 1% in the end for a 5-figure bill in similar circumstances.

The scary part is you must carry this risk to your insurance who can then deny the out-of-network claim.

Am I misunderstanding something here, or is everyone else not understanding?

</comment><comment><USER73> How it can be that inefficient? It looks like a monopoly or corruption. In Europe medical costs are way lower (not what the user pays, but the actual cost).

</comment><comment><USER74> Only in US.

<comment><USER75> There are different horror stories from different systems. Bottom line is that access to health care professionals and equipment is a scarce resource, and any resource management process whether through governmental regulation, or individual funding, insurance program, etc will be faced with managing access to that resource one way or another.

<comment><USER76> And in some systems, horror stories are way more common than others.

The simple fact is that I don't know anybody from my European family or friends who would willingly switch their system to the US one. And as a very well insured employee in the US, if, hypothetically, I had the option to use my European health care in the US, I'd switch immediately a well.

<comment><USER77> >> I'd switch immediately a well

I doubt it. _Someone_ needs to pay for it, so this switch would have to imply a 20% tax increase. Unless you're paid peanuts, it's not worth the tradeoff.

<comment><USER76> > Someone needs to pay for it

Or you could pay less for it.

There are many studies that show how the US system has incredibly high overhead that simply isn't needed.

Just an example: in the US, a primary care physician usually has a nurse and somebody who handles paperwork, insurance BS, and what not. Most European countries simply don't have this, mostly because there is no insurance BS to deal with.

There is insurance related overhead every step of the way.

And that's not including the free-for-all pricing of $500 saline bags.

Your 20% tax increase is ridiculous. It doesn't have to be nearly that high (and it isn't.) And even though I'm in the highest tax bracket, I'd gladly pay 5% more if it meant quality medical care for everyone without any risk of bankruptcy.

<comment><USER77> Once again, US share of taxes in GDP is 26%. Denmark: 50.8, Sweden 49.8, Germany 44.5, France 47.9, UK 34.4. So weighted by GDP it does cost quite a bit.

<comment><USER78> Why are you quoting figures for the entire tax take in a discussion about healthcare? To give you some perspective, the healthcare-only figures for those countries are US: 16.8%, Denmark: 10.3%, Sweden: 11%, Germany: 11.2%, France: 11.1% and UK: 9.9%. Data here:

[https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?year_...](https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?year_high_desc=true)

<comment><USER77> Because OP wanted to "switch" to European socialized insurance, without also "switching" to their levels of incomes and taxes as well. Of course their cost of labor is lower: they socialize a bunch of costs that would otherwise need to be recouped through the earnings of doctors, nurses, administrative personnel, etc. On top of that they get US drugs for a fraction of the cost, and don't do any serious pharma research (because there's quite literally no money in it, given the cost of drugs). It's not a valid comparison. My point wasn't that US healthcare is not expensive, anyone with any brain at all can tell that it is. It was that you can't pick and choose, and on balance, even with the more expensive healthcare, the US is a "better deal" for the vast majority of people who comment on this site.

</comment></comment></comment></comment></comment></comment></comment></comment><comment><USER79> I a non-immigrant here in SA's medical/emergency system is fully corrupted and broken. Citizen's of USA are not standing up/protesting this issue which can virtually affect everyone. Why are citizens sleeping? Same surgery with more experienced docs and equipment are done in 10-20 times less in my and the rest of the countries in the world. It's time to wake up USA

</comment><comment><USER80> Propublica [1][2] has done some investigation into the amount of waste, beginning with a 2012 report by the Institute of Medicine of the National Academies. The unnecessary costs amount to roughly 5% of US GDP. For comparison: the defense budget is about 4.5% of GDP, and Social Security Disability Insurance outlays are about 5% of GDP. NASA's budget is about 0.1% of GDP.

A number of other commenters have castigated politicians on suspicion of being in the pocket of insurance companies or health care companies. Sure such things may happen occasionally. More certainly, politicians and bureaucrates are regularly attentive to the budget and financing of the government.

If medical care was cost efficient, it would 1) reduce GDP and the appearance of economic growth, and 2) wreck the back office math concerning whether the federal government can afford the deficit and the interest on the national debt. Elimination of mass incarceration and criminalization would cause a similar dilema. US economic growth has been 2-3 percent in recent years. If that were negated by substantial reduction of waste-masquerading-as- productivity, then the federal budget could not be financed without massive cuts or dramatic manipulation of interest and inflation rates.

There are others who potentially benefit from denial of treatment or claims beside the insurance company. Beside the doctors, medical institutions, and insurance companies are another set of actors: the benefits management and payment processing companies, who often profit per transaction. Some of the calculus in this camp can be seen in [3]. This part of the system (and others) can benefit when a patient is denied or discouraged from or uninformed of curative treatment and manipulated into some ongoing palliatve therapy - despite the possibility of greater overall long-term cost. The cash-flow gets distributed differently than curative treatment, and there are more smaller on-going transactions enabling a higher percentage of skim.

[1] Sep 2012 - [https://www.propublica.org/article/a-costly-equation- medical...](https://www.propublica.org/article/a-costly-equation-medical- dollars-wasted-are-greater-than-the-u.s.-defense)

[2] Nov. 2017 - [https://www.propublica.org/article/a-hospital-charged-to- pie...](https://www.propublica.org/article/a-hospital-charged-to-pierce-ears- why-health-care-costs-so-much)?

[3] Nov. 2017 - [https://www.bnymellon.com/us/en/what-we-do/business- insights...](https://www.bnymellon.com/us/en/what-we-do/business-insights/the- saga-of-medical-claims-payment-processing.jsp)

</comment><comment><USER81> Here is a reminder that in the US, we pay much more and receive far worse outcomes than any other first world nation, by any metric you care about: life expectancy; infant mortality; incidence of chronic disease; obesity; incidence of addiction; etc.

Then consider we are the only first-world nation in which medical bankruptcy is not just a thing, but a profound source of anxiety and genuine risk.

What do we get in exchange for worse care, worse lives, and risk of financial ruin...?

A "free market" like the one functioning in OP's case. Oh, and in the time _since_ the ACA passed? Record private industry profits.

It's not just Trumpism sh-tcanning this country.

<comment><USER82> This is why it's good to be English - our national health service fixes you up and sends you on your way without providing you with a bill.

<comment><USER83> Unless the NHS has no approved treatment, in which case you die instead of being able to go abroad for care.

<comment><USER84> If the NHS has no approved treatment you can go abroad or you can pay privately in the UK.

What conditions are you thinking of that don't have "approved" treatments?

<comment><USER83> Within the NHS specifically, there was the recent case of Alfie Evans[0], where the medical practitioners said there was no hope for him and the family wanted to take him abroad for care. The NHS and the UK legal system decided that his best interests were to die in the UK. His family was not allowed to take him for additional care.

0\. [https://en.wikipedia.org/wiki/Alfie_Evans_case](https://en.wikipedia.org/wiki/Alfie_Evans_case)

<comment><USER85> That isn't really an issue with the NHS. If it's an issue it's with the UK's family law which recognises that the parents of a child doesn't always act in the child's best interest and allows the state to intervene.

</comment></comment></comment></comment></comment></comment><comment><USER86> Our system is an ongoing tragedy.

</comment><comment><USER87> .

<comment><USER88> I agree, but why no credit cards? Just keep them on autopay and get free points right?

<comment><USER89> This is what I do. I did reach a point in my life though where I could manage this.

</comment></comment></comment><comment><USER90> I curious to know the details of his health. He just did an IRONMAN 5 months before. Why was he unaware of the status of his clogged "widow-maker" artery? Why was his artery clogged? high cholesterol? What does his diet consist of?

Use of ultrasound imaging to measure the thickness of the inner walls of the carotid arteries that supply blood to the brain. Increasing carotid artery intima-media thickness, or CIMT, indicates a build-up of fatty deposits, known as plaque, in crucial arteries to the heart and brain. Plaque build-up in the arteries, which is usually affects adults, can restrict the flow of blood, causing heart attacks or stroke.

<comment><USER91> There's not always a lot in the way of warning signs, and people tend not to get casual arteriograms just for kicks. The apparently-healthy suddenly dropping dead isn't exactly a rare phenomenon, and "being in shape" can be misleading. Jim Fixx[1] was kind of the poster child for this sort of thing; his death pretty much kicked off the over-40 checkup routine.

[1][https://en.wikipedia.org/wiki/Jim_Fixx](https://en.wikipedia.org/wiki/Jim_Fixx)

<comment><USER92> Unfortunately you can't really get a heart arteriogram done as a checkup and anything else is actually guesswork.

Both MRA and CTA are really expensive.

Bloodwork can point to problems but there is still a plenty of differential diagnosis involved... You need a bunch of history (main factors are currently age and family history) to reasonably evaluate risk using e.g. European joint guidelines.

You can perhaps guess better based on local doppler USG of some big extremity artery or of carotid. Doppler of heart is not precise enough to show anything useful.</comment></comment></comment>


Users fear social media is making them ill, but they still can't stop - <AUTHOR> http://www.independent.co.uk/news/world/americas/smartphone-social-media-apps-mental-health-negative-check-plugged-in-communication-technology-a7600686.html <comment><USER2> This will be the cigarettes of our generation. Our conscious minds don't like it, but the lizard part keeps us from doing something else. Parents will talk to children about social media. Some will want to regulate its use by minors. Evidence will stack up against it as congressional hearings point fingers. But after the hearing, all the Congressmen will open their iPhones check Facebook.</comment>


Münchhausen Trilemma - <AUTHOR> https://en.wikipedia.org/wiki/M%C3%BCnchhausen_trilemma <comment><USER3> The way that Mathematics and approaches this is, using the Axiomatic way.

You can view this as a game:

        Let's make some assumtions / axioms, and see what we can build with it.

The most popular axiom set is Zermelo-Fraenkel-style Set Theory [1], but there are other choices which have been explored.

Note that, there a no claims about absolute truth or reality here. We just play a game in our minds.

The most fundamental question about the game, that we can ask is "Is this game consistent". Goedel found out, somewhat unfortunately, we are not able to answer that question from within the game [2]. However, sofar no intrinsical inconsistencies (paradixies) have been found.

Now, it turns out, that the ZF-Mathematics game is a very useful game, since it allows us to model certain aspects of reality. E.g. Newtons Mechanic, allows us to forecast how planets move in space.

The Natural Sciences (Physics, Chem., Bio) and Engineering are essentially about how to model reality with mathematics. The way to do that is the empirical scientific method [3], where hypothesis are formed, experiments are designed and evidence is collected.

So the question of "truth" does not really arise. It's just:

(A) Mathematics is an interesting mind-game to play.

(B) Mathematics has been used very successfully to model and predict our preceived reality.

That's all you can ask for.

[1] [https://en.wikipedia.org/wiki/Zermelo–Fraenkel_set_theory](https://en.wikipedia.org/wiki/Zermelo–Fraenkel_set_theory) [2] [https://en.wikipedia.org/wiki/Gödel%27s_incompleteness_theor...](https://en.wikipedia.org/wiki/Gödel%27s_incompleteness_theorems) [3] [https://en.wikipedia.org/wiki/Empirical_evidence](https://en.wikipedia.org/wiki/Empirical_evidence)

<comment><USER4> More on this point of view ("formalism") and a provably unfixable issue (incompleteness) in these notes of mine: [https://iblech.gitlab.io/bb/multiverse.html](https://iblech.gitlab.io/bb/multiverse.html)

<comment><USER3> Just realized you are a student of Marc Nieper-Wißkirchen in Augsburg.

Extend my greeting when you see him! He introduced me to Category Theory around 2006 in Mainz.

</comment></comment></comment><comment><USER5> If you understand, things are just as they are; If you do not understand, things are just as they are. — Zen Proverb.

</comment><comment><USER6> If you can demonstrate the possibility of proving any truth, you just proved it, you are done.

If you can demonstrate the impossibility of proving any truth, then you just demonstrated that you can prove some truth, thus it is false that it is impossible to prove any truth.

Finally, if you can neither disprove nor prove the impossibility of proving any truth, you just don't know whether it's possible or not; in which case the honest posture is agnosticism. Oh, and if you admit that an honest posture is desirable when pursuing truth, you just bootstrapped a ground that allows to growth (relative and sound) truth allied to virtue.

That might not be as satisfying as "acquiring some absolute truth", but personally I feel that for my humble human capacities and needs, that's not too bad.

<comment><USER7> This argument is a classic example of the vicious circle principle [1]. The self-referential nature of this interesting argument makes it somewhat meaningless (from a logical perspective).

[1]: [https://en.wikipedia.org/wiki/Vicious_circle_principle](https://en.wikipedia.org/wiki/Vicious_circle_principle)

<comment><USER8> > The self-referential nature of this interesting argument

Self-referential symbolic statements are at the core of Gödel's incompleteness theorem.

<comment><USER9> Yes, but that self-reference happens outside the formal language, not within it. Gödel encoded formal statements in the language as integers, and thus turned the question of provability into statements of arithmetic. If the formal system is powerful enough to let you reason about arithmetic, you can thus trick the system to be self-referential, but only via this mechanism external to the system itself.

<comment><USER6> The thing is, as far as we have to deal with in the real world, there is nothing such as an absolutely isolated system. To my mind, self-reference only occurs in an interpretation, thus in the frame of some actions, which are only possible in a world where changes happen, most likely changing the frame of interpretation itself.

</comment></comment></comment></comment></comment><comment><USER10> So in short: if you are being truly logical, every statement of fact is just a statement of belief, it seems.

<comment><USER11> No, this is not the conclusion that analytic epistemology has come to. Have a look at coherentism, foundationalism and reliabalism for example. The view you describe is skepticism and is held by a very small minority of modern philosophers.

[https://plato.stanford.edu/entries/justep- coherence/](https://plato.stanford.edu/entries/justep-coherence/)

[https://plato.stanford.edu/entries/justep- foundational/](https://plato.stanford.edu/entries/justep-foundational/)

[https://plato.stanford.edu/entries/reliabilism/](https://plato.stanford.edu/entries/reliabilism/)

[https://plato.stanford.edu/entries/skepticism/](https://plato.stanford.edu/entries/skepticism/)

<comment><USER12> Counterargument: skepticism is kind of boring compared to the other positions. There's just not much to build on if you flatly reject the ability to build things. People who're inclined to take that route are likely to avoid modern philosophy, so of course they would be a small minority of philosophers.

<comment><USER13> > Counterargument: skepticism is kind of boring compared to the other > positions. There's just not much to build on if you flatly reject the > ability to build things.

Skepticism doesn't demand that you "reject the ability to do things." See Hume.

</comment></comment></comment></comment><comment><USER14> Thanks to Karl Popper, the scientific method asks that hypotheses be falsifiable. When a scientist makes a claim, she then does everything she can think of to disprove it.

Stage II clinical trials of novel drugs are like this. The hypothesis is "this stuff cures baldness and is otherwise harmless." The experiment is an elaborate attempt to disprove the claim, with enough subjects to avoid the small "n" effect and control-subject randomization to avoid the wishful- thinking effect.

Science tries to avoid claims that things are true. "Not false" gets us a long way. That avoids the Münchhausen logical trap.

<comment><USER15> There are problems with falsificationism, as well. You don't really reject theories based on a single falsifying data point. Sometimes you reject the data point as fake or misinterpreted. Sometimes you modify your theory and replace it, but it's unclear that that's different from the goalpost-moving of astrologers and homeopaths.

Falsification is a good stake in the ground that allows scientists to work, but it's unclear if it's actually a step towards the epistemology represented by the Munchausen trilemma. Scientists have a notion that it allows them to work "toward" Truth-with-a-capital-T, a notion which both feels right and has produced high standards of living. Those may be better goals than Truth-with- a-capital-T, which may be unavailable.

</comment></comment><comment><USER16> I don't think all axioms are "merely asserted rather than defended". For example, one axiom is the existence of existence, which cannot be denied, because any question, doubt, skepticism, reason, point, or imagined counterargument is something that exists and is within existence.

Another is consciousness. To grasp that existence exists, or make any attempt to reason either way about the proof or truth of anything, is itself an expression of consciousness.

Existence exists, and so does consciousness capable of conceiving that. Start there and work down.

<comment><USER17> > one axiom is the existence of existence, which cannot be denied, because any > question, doubt, skepticism, reason, point, or imagined counterargument is > something that exists and is within existence

You argue that the denial of the axiom of "existence of existence" is self- refuting. But don't all arguments that something is self-refuting depend on the acceptance of the law of non-contradiction ("for all A, not (A and not-A)"?) If your argument for the axiom of "existence of existence" depends on the axiom of non-contradiction, is the axiom of "existence of existence" truly axiomatic any more?

What about the axiom of non-contradiction? Do we have to believe that? Well, dialetheism [1] denies that the axiom of non-contradiction holds (in the most general case), and yet the whole system doesn't fall apart. The secret is to allow contradictions, but limit their consequences, by rejecting the classical principle of _ex contradictione quodlibet_ (ECQ, _from a contradiction anything follows_ , aka the _principle of explosion_ ). An unlimited allowance for self-contradiction destroys all possibility of non-trivial reasoning, whereas a more limited allowance for self-contradiction leaves open the possibility of non-trivial thought. So, if we have a choice whether to accept the axiom of non-contradiction, maybe your attempt to escape Münchhausen's trilemma has not succeeded.

[1] [https://plato.stanford.edu/entries/dialetheism/](https://plato.stanford.edu/entries/dialetheism/)

<comment><USER18> Fair point, but how do you determine when to stop following the consequences of the contradictions? Furthermore, from the point at which you stop, you are then re-enforcing the principle of non-contradiction, so why not enforce it from the start and call it a day? To me, dialetheism has always seemed very arbitrary, but maybe that's exactly the point of it. If that's true, then it's just another flavor of extreme relativism where anything can be true or false and any reasoning is meaningless.

On top of that, it seems to me that even in denying the principle of explosion, one must follow it if they want to be consistent in the denial. Otherwise the denial itself won't hold, because if you allow contradictions, by definition you must also allow their opposite, which is the principle of non-contradiction. And as far as I'm aware there is no proof in logic that allows for an exception to ECQ. Because once you allow any contradiction, you implicitly allow anything, which makes thought impossible.

<comment><USER17> Well, one approach is to start with an assumption that the law of non- contradiction is true in most cases, and then look at specific cases in which it might be worthwhile to make exceptions to that generalisation - <USER2> example, the liar sentence (This sentence is false), Gödel sentences, Russell's paradox ("this set both is and isn't a member of itself"), etc. Dialetheism in which every contradiction is accepted is trivial. In non- trivial dialetheism, you argue that there are good reasons for accepting certain contradictions that do not apply in the case of others.

<comment><USER18> My questions still remain unanswered. Regarding the examples you raised: the liar paradox can be solved without breaking explosion by observing that all assertions carry the implicit ending "and this sentence is true". The liar sentence then becomes "This sentence is false and this sentence is true", which is simply false. As for Russell's paradox, as far as I know this has been solved in ZF theory, although admittedly with a few extra axioms needed. Not sure about Gödel's sentences.

It just doesn't seem worth it to me to suspend the fundamentals of thinking just to solve some paradoxes that can anyway be solved within our current model of logic.

<comment><USER17> > Regarding the examples you raised: the liar paradox can be solved

There are various proposed solutions, but they all have drawbacks. You have to compare the drawbacks of the different options. (From my limited memory, your proposed solution is not one of the standard solutions proposed in the literature.)

> As for Russell's paradox, as far as I know this has been solved in ZF theory

ZF theory pays a price – the restriction of the axiom of comprehension. The point is you don't solve Russell's paradox for free, every solution has its price, every solution involves giving up some component of naïve set theory; ZF chooses to partially give up the axiom of comprehension; inconsistent set theory (part of inconsistent mathematics [1]) chooses to partially give up the axiom of non-contradiction instead. If we have to give something up, how do we decide which part to give up? You think that giving up the axiom of comprehension is a smaller price to pay than giving up the axiom of non- contradiction – but is that a subjective value judgement? Or, can it be objectively justified? (And if so, how?)

A good argument for paraconsistent logic is that relevant implication is a more accurate model of natural language than material or strict implication, and relevant implication is paraconsistent. (That said, dialetheism goes beyond mere paraconsistency.)

I'd suggest (if you have the time/inclination) reading Graham Priest's book _In Contradiction_. It explains the arguments for all this far better than I can from memory. (I read that book 15 years ago.)

[1] [https://plato.stanford.edu/entries/mathematics- inconsistent/](https://plato.stanford.edu/entries/mathematics-inconsistent/)

<comment><USER18> I was referring to Arthur Prior's solution to the paradox.

As for dialetheism being a better model of natural language, I'm familiar with the claim but I think its main argument fails to grasp that contradictions in natural language do not happen "in the same sense and at the same time". For instance, the sentence "This sentence is false" is true and false in natural language, but in succession and not at the same time. Moreover, dialetheism does not seem to be able to explain hierarchies and cause-effect relationships, which are key constructs of language.

I think that when it comes to logical systems such as mathematical theories, the point is not necessarily to come up with a theory that is true (that would ultimately be impossible due to Agrippa's trilemma), but to have a theory that has predictive power and is self-consistent, and this is what ZF is. Self- consistency seems to be the minimum requirement for any theory, lest it falls into triviality.

The little I know about paraconsistent logic is that it suspends consistency in a few select cases. But generally, consistency still holds, otherwise, as you said, the system would become trivial. I guess my question was: would paraconsistent logic claim to be true? Or, at least, identical to itself? If yes, then if would itself be subject to consistency and identity. And if it chooses to temporarily suspend those, then in that time it can no longer claim to be true. But if in general it complies with consistency (lest it becomes trivial), then it must reject the subsets that are not true, otherwise it could no longer be self-consistent.

I guess my point (and I could be wrong) is that paraconsistent logic is entirely non-consistent, unless it chooses to redefine what consistency means, in which case, we're back to triviality.

Thanks for the book suggestion, I'll definitely read it and hopefully find some answers.

</comment></comment></comment></comment></comment></comment></comment><comment><USER19> Mathematicians peddle in absolute truths, under contract. The truths are not facts: they're logical fabric between axioms and conclusions. You can change the rules of logic, you can change your base axioms, but doing so only changes the set of reachable conclusions.

</comment><comment><USER20> Once one accepts that no rational argument is more true than its axioms, this seems unremarkable.

<comment><USER21> Through the thicket of your stacked negations I find it difficult to make out what it is that you intended to say. I guess nobody could deny that no thing isn't really nothing that doesn't fail to exist, don't you disagree?

<comment><USER20> Ha! I tried to resist saying that no-one should attempt parody without bearing in mind the caveat that one should avoid making the target look less deserving of it than one's counterpoint, but failed, no?

<comment><USER21> I was by no means my intention to make my counterpoint look less deserving of the same parody, and it seems I succeeded?

</comment></comment></comment></comment><comment><USER22> Belief does not necessarily come from provability. Wittgesnstein's _On Certainty_ contains some interesting thoughts in this regard. Quoting a few extracts:

"If you tried to doubt everything you would not get as far as doubting anything. The game of doubting itself presupposes certainty."

"Giving grounds, however, justifying the evidence, comes to an end."

"At the foundation of well-founded belief lies belief that is not founded."

"The child learns to believe a host of things. I.e. it learns to act according to these beliefs. Bit by bit there forms a system of what is believed, and in that system some things stand unshakeably fast and some are more or less liable to shift. What stands fast does so, not because it is intrinsically obvious or convincing; it is rather held fast by what lies around it."

</comment><comment><USER23> Where there are gaps in your own knowledge, truth becomes about trust and relevance. I don't know that e = mc^2 but I trust scientists that it is the case but it doesn't matter to me much either way; I would not participate in any argument about this subject because although my level of trust is strong, I personally have nothing at stake whether this fact is true or false (it is not relevant to me).

People who have a huge ego tend to think that every fact they know is a crucial part of their personal identify; these people tend to avoid saying "I dont' know" because doing so would be an admission that their information sources (which they see as extensions of themselves) are not trustworthy and are therefore low value (which would bring down their own self-worth).

<comment><USER6> Well, it doesn't matter to you if it's true, but at least if it's true that it sufficiently adequately models the world to allow all the technologies derived from it. Of course, most human don't care about it directly, but it impacts their live nonetheless.

</comment></comment><comment><USER24> It reminds me a bit of Godel's Incompleteness Theorems [https://en.wikipedia.org/wiki/Gödel%27s_incompleteness_theor...](https://en.wikipedia.org/wiki/Gödel%27s_incompleteness_theorems)

</comment><comment><USER25> In this article, Zizek brings the Munchhausen story to show how he differs from Nietzsche on deep philosophical grounds.

[https://thephilosophicalsalon.com/the-fall-that-makes-us- lik...](https://thephilosophicalsalon.com/the-fall-that-makes-us-like-god- part-i/)

It's been my mind for a while now, and I'm still not sure with whom I stand here. Roughly, Zizek says : Any kind of mental breakdown that changes you will be related to your subsconscious. Nietzsche : Lol, when you reach my level of psychosis, you really have to pull yourself out all by yourself.

</comment><comment><USER26> Y'all it's best to understand the universe for what it is an immense perpetual motion machine

We often think of perpetual motion as set it and forget it once it's set in motion it continues forever but of course this isn't feasible

Have you ever considered that a truly perpetual motion is one that never needs to be set in motion that always is in motion?

This is precisely the bootstrapping argument in essence so a small measure of faith is needed

We can rely on our perception to be reality for all intents and purposes and begin reasoning with base assumptions and not over analyze the starting conditions too much

</comment><comment><USER27> A parallel in defining words. A word dictionary has to be self referential, or you need an ever increasing vocabulary, or just accept some axioms that don't require verification (you know what a word like cat is by some interaction escaping out of the context of word descriptions)

Another parallel [https://www.youtube.com/watch?v=X8aWBcPVPMo](https://www.youtube.com/watch?v=X8aWBcPVPMo)

we were computationally evolved to make sense of the world... and making sense is a computation

</comment><comment><USER28> I'm going to stop paying my bills. We'll see how far this "demonstrate the impossibility of proving any truth" really goes.

</comment><comment><USER21> Gottfried Benn once said, style is superior to truth because it carries proof of its existence in itself (other than truth which always requires external proof). For someone who wasn't a logician or a mathematician, I find this remarkably insightful.

</comment><comment><USER29> Given it took Whitehead and Russell 300 pages to logically prove that 1 + 1 = 2, I think we can all go ahead and assume any supposition stated in less detail is naturally flawed and incomplete, including this one.

<comment><USER30> In foundations of math that mathemati ians actually use (such as ZF), you don't need 300 pages to show 1+1=2.

<comment><USER29> Logically, that makes sense, but since this thread is about logic, not math, it doesn't. (Unless you're saying logic and math are the same, in which case I would need to see a rigorous proof in order to believe you.)

</comment></comment></comment><comment><USER31> Pyrrhonism. n. An ancient philosophy, named for its inventor. It consisted of an absolute disbelief in everything but Pyrrhonism. Its modern professors have added that.—Ambrose Bierce, The Devil's Dictionary

</comment><comment><USER32> Isn't a circular argument just an axiom with (unnecessary) extra parts?

</comment><comment><USER33> Related from 2018: [https://news.ycombinator.com/item?id=17043954](https://news.ycombinator.com/item?id=17043954)

</comment><comment><USER34> "You would never attempt to _prove_ that 1+1=2, as 2 is _defined_ as the value of 1+1."

</comment><comment><USER35> The whole discussion here is quite depressing.. in an enjoyable way.

</comment><comment><USER30> This is basically a simple theorem about graphs.

</comment><comment><USER36> Not to be confused with Munchhausen syndrome...</comment>