Emergency room patients can face steep bills even when treatment is declined • Hacker News Board

Re: Emergency room patients can face steep bills even when treatment is declined

#81

Post by ivraatiems » Wed, May 02, 2018, 1:55 PM UTC

humanrebar wrote: post #51

maxerickson wrote: post #19

Earlier quoted context omitted.

The individual mandate was repealed. With the explicit goal of causing the individual marketplaces to implode. In the meantime it's increased the cost to taxpayers of subsidizing marketplace plans!

The individual markets were already a mess.

That was the talking point, and may have been true in a couple of places (especially those states that refused to expand Medicaid or only did the minimum to comply with the law), but I'm aware of no evidence that was true overall.

Re: Emergency room patients can face steep bills even when treatment is declined

#82

Post by clarkmoody » Wed, May 02, 2018, 1:56 PM UTC

Plenty of anecdotes in this thread, predictably. Let's talk about why things are so messed up.

The thing to realize here is that total government provision of healthcare is probably cheaper than the way the US does it, but that doesn't mean the market has failed. Healthcare in the United States is anything but a free market. It's the worst of all worlds: special interests extract rents through government regulations (drug patents, occupational licensing, handouts to insurance companies in legislation); the government effectively controls prices through its own payment programs; the whole system is over-regulated to an absurd degree. There is no price mechanism to help consumers or producers make proper choices.

So when someone says something like, "the free market can't effectively provide healthcare," I would kindly ask where they see a free market healthcare system. This sounds like a No True Scotsman argument, but it's not. You can't label something so ridiculous as US healthcare as "free market" without either total ignorance or intent to deceive.

Re: Emergency room patients can face steep bills even when treatment is declined

#83

Post by eli » Wed, May 02, 2018, 1:56 PM UTC

saalweachter wrote: post #59

Talyen42 wrote: post #39

Hospital corporations and insurance corporations are not your friend. You shouldn't have to do this in a first world country, but: * Go to the ER without ID * (optional) Ask how much it will cost * (optional) They do not give prices, as a matter of policy * They must treat you by law * Afterwards, offer a cash payment you deem reasonable * They will accept or decline it Transaction complete. For non-emergency care an…

Important note on ER care. The job of the ER is to prevent you from dying, not fix you. If you are injured in a way that requires an expensive surgery and therapy to fix but won't actually kill you if left untreated, even if it cripples you, they are not obligated to fix you under the law.

And of course this is bad for everyone involved. We don't pay for someone to get preventative or proactive treatments for a chronic condition, instead choosing to divert very expensive ER resources to treat as a series of emergency interventions. Worse for the patient, worse for the hospital, worse for anyone else paying into the system.

Re: Emergency room patients can face steep bills even when treatment is declined

#84

Post by makomk » Wed, May 02, 2018, 1:56 PM UTC

humanrebar wrote: post #54

nicktelford wrote: post #41

Earlier quoted context omitted.

This isn't at all accurate. There was no treatment for his condition beyond palliative care. He was on life support for the rest of his life, no matter what anyone did. His doctors, whose duty is to the patient, determined that it was more harmful to artificially keep him "alive" (he was in a semi-vegetative state due to serious brain damage) than to disconnect his life support and allow him to die. The offer of "car…

> The court case was between his doctors and his parents. The UK government had absolutely nothing to do with it. Is there a difference in terminology here? The courts are part of the government in my mind. And they have the ability to overrule unjust law.

From what I can tell, Americans seem to define "government" to include the courts as one of its branches, whereas Brits define it to only mean the legislative branch and maybe part of the executive in US terms. Which makes it interesting when British people accuse Americans of lying for claiming the government was responsible for this, especially since I'm sure some of those people know Americans mean something different by that word.

Re: Emergency room patients can face steep bills even when treatment is declined

#85

Post by mfoy_ » Wed, May 02, 2018, 1:56 PM UTC

Ensorceled wrote: post #45

I recently had a spot appear in my vision. Went to my GP same day, the receptionist called around to get me into a local optometrist who determined it was a detached retina, she called and got me into the local hospital as an emergency case. It was busy but I got my first treatment that evening. The entire journey, my green OHIP card was all I needed, no insurance forms, no pre-approvals, no extra charges. 5 hospital…

You forgot:

3. Canadians pay for their health care in tax, anyways.

(However: https://www.investopedia.com/financial-edge/0411/do-canadian...)

Re: Emergency room patients can face steep bills even when treatment is declined

#86

Post by emodendroket » Wed, May 02, 2018, 1:56 PM UTC

OnMyPhone wrote: post #65

toomanybeersies wrote: post #9

How can people read and hear about stories like this, and even possibly think it's OK or even normal? How do lawmakers in the USA convince people that this is acceptable? I have never directly paid a single cent for healthcare, and neither has anyone I know. When I had to get 6 stitches in my forehead at 2 AM on a Sunday morning, it cost me nothing. When my friend needed to get the tip of his finger reattached, it co…

I hate it all, and would rather pay much more taxes if we had universal healthcare. That aside, I had a few different people give me the following reason why this is acceptable to them. "Why should we pay any of our hard earned money to the government so some drug addict can get their fix?" "Why should I pay for single mothers who made bad decisions?" It is almost always other people making poor decisions or getting…

In addition to being cruel, this kind of penny-pinching is often penny-wise and pound-foolish. It's easy to lose more money verifying that people are not shiftless than you save by denying them benefits.

Re: Emergency room patients can face steep bills even when treatment is declined

#87

Post by [deleted] » Wed, May 02, 2018, 1:56 PM UTC

avs733 wrote: post #47

chapium wrote: post #40

Earlier quoted context omitted.

“Brainwashed” is a bit harsh. We put up with this because it’s necessary to work within the constraints of the system.

I grew up on the coasts and for a long time would have believed that. People might hate the system but they will comply and work within it. Living in the midwest has changed my mind, here people need the system to be true because it is the basis for their entire way of seeing the world. They listen to Rush adn to Fox News...and they accept it at a philisophical level. They rely on being told it because otherwise they…

[deleted]

Re: Emergency room patients can face steep bills even when treatment is declined

#88

Post by okreallywtf » Wed, May 02, 2018, 1:56 PM UTC

toomanybeersies wrote: post #9

How can people read and hear about stories like this, and even possibly think it's OK or even normal? How do lawmakers in the USA convince people that this is acceptable? I have never directly paid a single cent for healthcare, and neither has anyone I know. When I had to get 6 stitches in my forehead at 2 AM on a Sunday morning, it cost me nothing. When my friend needed to get the tip of his finger reattached, it co…

We do it for the illusion of freedom which is used to trick unfortunately ignorant people out of services that would cost the wealthy a bigger percentage of their income.

"Choose what X is right for you and your family"

This allows the wealthy the chance to choose a better level of healthcare, schools, and basically everything else leaving the rest of the nation to choose only what they can afford (guess what, its not much). By patronizing the nation by saying "You're so smart, you know better what you need than a stupid Washington bureaucrat like me!", they stroke our ego's just enough to convince people that they are able to get a better deal (ie, beat the system).

It infuriates me that the people who ran for office and chose to "represent" us in a lot of cases completely abdicate their responsibility to do anything. Not to be partisan, but one party is a lot worse about this than another, to me if you go through all the trouble to put yourself in government and enrich yourself handsomely while you are there, at least fucking pretend you are going to try and solve something rather than this self-deprecation that comes out of the Republican party.

Re: Emergency room patients can face steep bills even when treatment is declined

#89

Post by lstamour » Wed, May 02, 2018, 1:57 PM UTC

chapium wrote: post #49

toomanybeersies wrote: post #9

How can people read and hear about stories like this, and even possibly think it's OK or even normal? How do lawmakers in the USA convince people that this is acceptable? I have never directly paid a single cent for healthcare, and neither has anyone I know. When I had to get 6 stitches in my forehead at 2 AM on a Sunday morning, it cost me nothing. When my friend needed to get the tip of his finger reattached, it co…

Why should stitches be free? Of course they arent, its being paid for under your country’s healthcare model. The cost is harder to see to the individual but its there. I’m all for universal healthcare but comparisons like this are deceiving.

I disagree. It’s a universal form of insurance that everyone contributes too. It’s free in the same way a public library or road is free to use. It just becomes another societal cost which frankly, no one notices. It’s not perfect either, if you want something unusual or not common, it’s possible you’ll have to pay for it if it can’t be arranged at the right price. Certain vaccines for example. So there’s still a need for health benefits but without a system charging high prices by default, even those costs tend to be more reasonable.

Re: Emergency room patients can face steep bills even when treatment is declined

#90

Post by emodendroket » Wed, May 02, 2018, 1:57 PM UTC

ivraatiems wrote: post #81

humanrebar wrote: post #51

Earlier quoted context omitted.

The individual markets were already a mess.

That was the talking point, and may have been true in a couple of places (especially those states that refused to expand Medicaid or only did the minimum to comply with the law), but I'm aware of no evidence that was true overall.

Costs in Massachusetts did not go down when an analogous plan was enacted. Obamacare may have been better than nothing but it was not good.