WELL, if we're talking about INTENTIONALITY then yes the american medical bureaucratic system as evolved obviously singles out the uninsured and proceeds to screw them over.
If we're talking about mens rea, then I doubt it; my wager is tied to how it's in no one's incentive to care that leads to these outcomes. Medical providers are clueless and totally disconnected from administrative functions, hospital billing systems are optimized towards dealing with horrible leviathans that spew sulphur and vomit acid and all of this operates on a scale that makes makes the cost of delivering babies a rounding error.
I'd imagine someone forgot to properly code the procedures/the paperwork isn't set up to give a shit and they were simply charged the default set of procedures.
Blah blah, single payer public systems, blah blah aligning incentives around cost structures, etc. Atul Gawande has a great few articles on this.
My father is close friends with someone who runs a large hospital in Texas -- he told us that it is quite routine to overbill, and that they allow for up to 5% over billing. It's a line item in their balance sheet and they actually rely in this as a predictable revenue source.
For an industry of people who have had to spend over a decade jumping through academic hoops, and whose job seems to require a great deal of precision, it is unbelievable they lack competence in something most high school drop outs master McDonalds - namely, standardized pricing and itemized billing (not to mention customer service).
Wow, I always figured that many hospitals would overbill because they could get away with it, though I'd imagine many would go much past 5%.
I don't think it's incompetence that makes pricing variable; rather, its lack of accountability. It's hard to find out where the price tag comes from, so why not charge as much as you think you could get from each patient? If you ask your doctor for an itemized breakdown of your bill, they (may eventually) give it to. The prices are often exorbitant and arbitrary.
IMO there is a guilty mind somewhere in that hospital. After seeing bill after bill come back wrong and without blowing a whistle / fixing the problem they are obviously accepting that they are lying to a good portion of their client base.
If we're talking about mens rea, then I doubt it; my wager is tied to how it's in no one's incentive to care that leads to these outcomes. Medical providers are clueless and totally disconnected from administrative functions, hospital billing systems are optimized towards dealing with horrible leviathans that spew sulphur and vomit acid and all of this operates on a scale that makes makes the cost of delivering babies a rounding error.
I'd imagine someone forgot to properly code the procedures/the paperwork isn't set up to give a shit and they were simply charged the default set of procedures.
Blah blah, single payer public systems, blah blah aligning incentives around cost structures, etc. Atul Gawande has a great few articles on this.