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Bringing transparency to ER prices, one hospital bill at a time

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Re: Bringing transparency to ER prices, one hospital bill at a time

#81

Post by masonic »

Waterluvian wrote: post #78
outworlder wrote: post #10

Earlier quoted context omitted.

I got an abdominal ultrassound, because some of my bloodwork was off and the doctor wanted to confirmed my liver was ok. Very routine. So I agreed. 15 minutes from the time I got to the reception desk to the time I was out of the door. Hospital billed $6000 (already negotiated down with insurance). Insurance paid around $4000. They wanted me to pony up 2k. Told no. Went to collections, negotiated to just under 1000.…

My wife is scheduled for ultrasound #4 because of pregnancy irregularities. The fact that it's covered by universal healthcare gives me peace of mind in a few ways: I don't have to worry about affording it, I can just worry about keeping my family healthy. I don't have to doubt if the medical experts have my family's interests at heart or if it's just a cash grab. First pregnancy we had a scare about genetic issues.…

  There's simply no room for capitalism in healthcare
Yet the very technologies you specifically required in both cases (ultrasound and genetic screening) are direct results of capitalism in healthcare.

Re: Bringing transparency to ER prices, one hospital bill at a time

#82

Post by masonic »

wonderwonder wrote: post #45

Anecdotal story, a few years ago my dad had a heart attack. He was self employed, living the american dream so no insurance. He had to stay 2 nights plus ambulance ride. Total bill ~80k. I kid you not, 3 days after he got out my mom shattered her wrist and was taken to emergency surgery. ~40K. They wracked up a bill slightly less than their mortgage in under a week. Of course they could not pay and the hospital dropp…

  living the american dream so no insurance
Since when does "living the dream" mean choosing to go uninsured?

Re: Bringing transparency to ER prices, one hospital bill at a time

#83

Post by jolmg »

> If you are bitten by a raccoon, you can’t really decide not to get the rabies vaccine. It’s literally a life-or-death situation. But the price is incredibly high. We had a bill from someone who had gotten a rabies vaccine at an emergency room

What the... I'm pretty sure vaccines only work to prevent illnesses and are very much useless to treat them. I mean they're supposed to be small quantities of the virus or bacteria that causes a given illness to train the immune system to defend itself. Why would you add more of the rabies virus when you might potentially already have more than you can handle after being bitten? I thought she was just giving a bad imaginary example, but she says she "had a bill from someone who had gotten a rabies vaccine at an emergency room". Could she have misinterpreted why the vaccine was administered? but why would anyone need a vaccine in an emergency?

Re: Bringing transparency to ER prices, one hospital bill at a time

#84

Post by nsillik »

jolmg wrote: post #83

> If you are bitten by a raccoon, you can’t really decide not to get the rabies vaccine. It’s literally a life-or-death situation. But the price is incredibly high. We had a bill from someone who had gotten a rabies vaccine at an emergency room What the... I'm pretty sure vaccines only work to prevent illnesses and are very much useless to treat them. I mean they're supposed to be small quantities of the virus or bac…

The rabies vaccine is usually only given post-bite, unless you’re unusually likely to be bitten (e.g. veterinarian).

If you don’t get the rabies vaccine shortly after being infected, you will almost certainly die.

Re: Bringing transparency to ER prices, one hospital bill at a time

#85

Post by Sniffnoy »

jolmg wrote: post #83

> If you are bitten by a raccoon, you can’t really decide not to get the rabies vaccine. It’s literally a life-or-death situation. But the price is incredibly high. We had a bill from someone who had gotten a rabies vaccine at an emergency room What the... I'm pretty sure vaccines only work to prevent illnesses and are very much useless to treat them. I mean they're supposed to be small quantities of the virus or bac…

No, that's how rabies vaccines are typically used. You get them after (potential) exposure but before the disease kicks in. You can also get it in advance -- they last about 10 years -- but this isn't typically done, presumably because most people don't expect to get bitten by wild animals very often.

Re: Bringing transparency to ER prices, one hospital bill at a time

#86

Post by mintplant »

jolmg wrote: post #83

> If you are bitten by a raccoon, you can’t really decide not to get the rabies vaccine. It’s literally a life-or-death situation. But the price is incredibly high. We had a bill from someone who had gotten a rabies vaccine at an emergency room What the... I'm pretty sure vaccines only work to prevent illnesses and are very much useless to treat them. I mean they're supposed to be small quantities of the virus or bac…

This is referring to postexposure rabies prophylaxis (PRP); see https://www.cdc.gov/rabies/medical_care/ under "Postexposure Vaccinations":

> Rabies postexposure prophylaxis consists of a dose of human rabies immune globulin and rabies vaccine given on the day of the exposure, and then a dose of vaccine given again on days 3, 7, and 14.

Re: Bringing transparency to ER prices, one hospital bill at a time

#87

Post by jhinra »

I love that Kliff gives a shout out to Kaiser Health News’ Bill-of-the-Month feature (https://khn.org/news/tag/bill-of-the-month/), which is a really similar project. I wonder if these two projects were independently inspired? Either way, totally a good thing to get more public visibility into medical billing.

Re: Bringing transparency to ER prices, one hospital bill at a time

#88

Post by csense »

halflings wrote: post #4

I moved to the US about a year ago. Went to ER for the first time ~3 months ago. I was charged about $4000 for: - Cleaning a wound (with water/desinfectant). - Some antibiotics. - A band-aid and gauze. I get how, with labor cost and all, that might cost $200. Maybe $300? I have no idea how this can cost $4000.

That's an easy one.

- (1) With an admirable humanitarian intention, the government forces hospitals to treat patients whose life is immediately in danger, and figure out later whether they'll be able to pay. If 1/10 people have the means to pay for the treatment they receive, then you're paying for your treatment, plus the expensive life-saving treatment of nine other destitute people who couldn't pay.

- (2) It's a monopoly. If your choice is letting your daughter possibly lose a finger, or taking her to the hospital, you'll take her to the hospital. Because you don't really have a satisfactory alternative.

- (3) It's opaque. You have no idea what treatment she'll need or how much it'll cost going in. They're loth to make promises about this up-front ahead of a diagnosis.

- (4) Because they can. Why would they ever charge $400 when they could charge $4000? The only surprise here is that it's not $40,000 or $400,000 or $40,000,000.

Re: Bringing transparency to ER prices, one hospital bill at a time

#89

Post by tialaramex »

joe_the_user wrote: post #70
ForrestN wrote: post #2

Kliff's approach to covering healthcare is nothing short of miraculous. She's killing it on all fronts—dominating the beat as far as traditional reporting techniques, innovating new ways (like this) to unearth information, and on top of it, communicating an intricate and sometimes abstract area of public policy in a way that anyone can understand and relate to. In general, I think vox.com is underrated. But Kliff in…

While Kliff's work seems good, the title has the "Helping X, one Y at a time" problem. The actually state of affairs is that arbitrary hospital bills are a problem that won't be solved one hospital at a time but rather are going require regulation, not just on all hospitals but of health care broadly.

The one Y at a time approach brings _transparency_ as mentioned in the title. Once there's transparency the conversation is more likely to be about the facts because that's what everybody can see.

When you don't have transparency what happens is that everybody can bring their own anecdotes, maybe baseless, and you can watch as a group "wins the argument" based on claims _you_ know are spurious, because even though their position is unsupportable on the facts, nobody had those facts.

So, you're right that Kliff's work doesn't itself fix the problem, but what it does is document the problem unmistakeably so that this thread has fewer people saying "I don't think that can be right, my friend's sister knew someone who worked in an ER and they never charge that much".

Back in technology the Certificate Transparency system doesn't itself solve any problems per se. But it delivers transparency, and that has allowed clean-ups to happen in years that would undoubtedly have taken decades to complete without transparency.

It still requires a Will in the right place to solve the problem, for example CT's effectiveness is in good part dependant on Mozilla. Would Google step up to the plate and do the same job if Mozilla didn't exist? Maybe, or maybe for political reasons as a for-profit they would fail. Certainly Symantec's leadership believed that going over our heads to Google management would get them what they wanted, but unless what they wanted was "Get out of this business" that does not seem to have worked.

But the good news is that for healthcare Americans can vote to put that Will in place in your country.

Re: Bringing transparency to ER prices, one hospital bill at a time

#90

Post by trhway »

masonic wrote: post #80
bakenator wrote: post #60

Earlier quoted context omitted.

The US government has put in place extremely heavy barriers to open a medical care facility. If we were to allow people to open facilities that compete with hospitals, we would very quickly see advertised prices and dramatic price drops. The medical cartel and all its bizarre non-market activities are a result of the existing legislation in place.

The US government has put in place extremely heavy barriers to open a medical care facility That's not true at all. The federal government wouldn't gave any reason to intervene unless you end up falsely billing a Federal program like Midicare, Medicaid, or VA. The reason for consolidation in ERs is cost -- uf you run an ER, you are obligated to treat anybody who cones in without regard to ability to pay. It's a money…

Certificate of need. For example:

https://www.vox.com/policy-and-politics/2018/7/31/17629526/m...

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