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Insured price $2,758, cash price $521

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Re: Insured price $2,758, cash price $521

#191

Post by GordonS »

johnwheeler wrote: post #25

I took my 4 year old to the ER because he had a 103 fever. The doctor put an ear thermometer to him and told me to give him some childrens ibuprofen. The visit lasted all of 5 minutes. The cost: $756.00. I refused to pay it. It was the first time I did not pay a debt and the first time I was sent to collections. I refused based on principle, and not because I couldn’t afford it. Collections called me for about 3 mont…

First, a disclaimer of sorts: I'm really not trying to take away from your central argument, that ER bills are way too high.

Second, another disclaimer: if you were a 1st time parent, I kind of understand!

103F/39.4C is unquestionably a high temperature, but it's almost always part of a viral infection, and ibuprofen and/or paracetamol will almost always reduce it. It's really not particularly unusual for kids to get a high temperature while they're ill, and I literally can't fathom why you'd take a 4yo to the ER for a high temp.

Here in the Europe, we give ibuprofen and/or paracetamol, and wouldn't dream of taking our kids to the ER without a very good reason, such as the meds not bringing the temperature down, or there being a rash, or anything else that raised alarm bells; I'm assuming of course that were there any such circumstances, you would have mentioned them.

At worst in Europe, we'd take them to the GP the same or next day. And the GP would, without doubt, assume you were a 1st time parent and say "it's viral" and (somewhat) politely kick you out. I've literally been there with a child having a 40C temp, and they weren't arsed. I've been there myself with a temp of 41C, and they weren't arsed.

Re: Insured price $2,758, cash price $521

#192

Post by entee »

drblast wrote: post #107

Insurance is not supposed to make routine things more affordable. It's supposed to spread the risk of catastrophic loss from unlikely events around to a large group of people so you don't have to worry about losing your house if you get struck by lightning. Everyone needs routine medical care at some point so an insurance model doesn't work there. You don't have gas or grocery insurance, do you? If that were a thing…

There's no reason an insurance provider can't manage a guaranteed cost every year. It's basically just an offset on the risk curve.

You could look at health insurance like a buyer's club (we negotiate prices for a large group of customers) plus a true insurance (the unexpected happened, is expensive). The buyer's club portion can be useful in mitigating expenses for the unexpected.

That said, nowhere in here is there a strong incentive to reduce costs (I go into this in more detail in a different comment on this topic). If you really think about it, an insurer just wants predictability, the actual cost is somewhat irrelevant as long as people can pay it. Because insurance is usually "purchased" and subsidized through your employer, you're somewhat disconnected from that price.

Even if you weren't, you don't really have good alternatives. You can choose the private market (often less good plans without as strong a network) or you can choose no insurance at all. These aren't great choices, and frequently when you're making the "purchase" it's very very hard to know what you're buying.

I've shopped around for insurance, it's quite difficult for them to answer, "I think I might need this thing, how much will it cost me with your plan?"

The whole system needs to be rethought. Likely through a combination of forced transparency, mild price controls, breaking up monopoly-like consortia within the industry and forced standardization of some products to make them understandable.

Re: Insured price $2,758, cash price $521

#193

Post by this2shallPass »

programmertote wrote: post #139
heymijo wrote: post #86

Earlier quoted context omitted.

> Various doctor associations (AMA et al) have strangled supply side of healthcare To add more details to this here's something I recently read about the supply constraint and its origins. > Then as now, Medicare reimbursed hospitals for a significant share of residents’ salaries. The Balanced Budget Act established limits on those reimbursements, effectively fixing the number of funded residents at 1996 levels. (In…

This a hundred times! The shortage is real and urgent. My gf, who is in her second year of a low-tier residency program, received many offers from various hospitals promising her $300K/year to work for them. This is well known among residents that once you survive residency (which is not a high bar to begin with), you will make at least $250K/year.

From the the people I know and know about, getting into medical school is a very high bar. Getting through is hard though doable if you could get in and devote your entire life to it. You probably won't get the specialty you want if it's one of the more generally desired ones, but you might.

What is an isn't a high bar is all relative.

Re: Insured price $2,758, cash price $521

#195

Post by romwell »

Spooky23 wrote: post #183
function_seven wrote: post #174

Earlier quoted context omitted.

So why doesn't the triage nurse hand out the Benadryl, tell the patient to wait in the lobby for an hour, and see if that resolves it? They could charge $75 for the single pill, and still avoid using a bed or the services of additional staff.

That’s not how the process works for an ER. A doc in a box urgent care would essentially do that. An ER handles everything from bee stings to shootings or strokes. They’re optimized to deal with those emergencies, not optimize cost for minor dings, especially when most of the minor issues are uninsured people who won’t pay anyway. Emergency medicine is not a profit center, and is often mandated to exist. You’re payin…

>A doc in a box urgent care would essentially do that.

Yeah, and urgent care facilities usually have working hours like 8AM-8PM. Because, you know, those are the only hours people every get minor sicknesses.

Re: Insured price $2,758, cash price $521

#196

Post by perspective1 »

Stratoscope wrote: post #9

Beyond opaque and variable pricing for the same service, there is also the question of whether something simpler would do the trick. Some years ago, I thought I might have broken my finger. I went to the doctor and it was actually the physician's assistant who saw me. I'd explained at the front desk that I had a high-deductible policy and I would be paying in full for the visit. The PA said "Usually we would send som…

FYI, even if you had broken your finger the treatment is almost always splinting and time. Most doctors wouldn't do an x-ray or a vibrating test. Does it hurt? Splint it, come back in a week. Next.

Re: Insured price $2,758, cash price $521

#197

Post by khuey »

Nextgrid wrote: post #157
Spooky23 wrote: post #140

Earlier quoted context omitted.

Generally speaking, that’s an example of a fundamentally wasteful ER visit, and why the lack of universal coverage is so dumb. That’s why ERs cost a fortune. If you’re not bleeding, have a broken limb or other trauma or an expectation of being admitted, you don’t belong in the ER. Take a benadryl.

The ER is more like insurance. In this case she was fine and got better more or less on her own but what if she deteriorated quickly? The ER would have the appropriate skill and equipment in-house to save her, whether if she was at home it might’ve been too late to make it to the ER when things actually became critical.

Reminds me of this: https://www.vox.com/health-care/2019/5/10/18526696/health-ca...

"Clark had to decide: Should she take Lily to the emergency room?

She called a poison control hotline and the answer was yes ...

But Clark knew that the emergency room can be expensive.

...

“I’m weighing my options,” Clark says. “She could have a seizure at any moment. It felt terrible, as a parent, to be in the position of having to do that.”

Clark and her husband decided to give Lily some activated charcoal at home and drive to the emergency room. But they wouldn’t go inside.

Instead, they pulled their car into the second row of the parking lot, about 100 feet from the entrance. They start playing The Little Mermaid on the car’s TV screen for Lily to watch. And they waited.

“We were just sitting there, facing the door and watching Lily,” Clark says. “We chose the second row because we wanted to be close to the entrance, but also trying to look inconspicuous.”

The Clarks waited in the parking lot for a few hours, and Lily didn’t show any symptoms. They drove home without setting foot in the emergency room."

Re: Insured price $2,758, cash price $521

#198

Post by JohnTHaller »

aianus wrote: post #29
astrodust wrote: post #8

Wouldn't it be nice to have an ultrasound and not know the price, nor care? That's what countries with single-payer are like. America needs to give up on this nonsense. There should be riots.

As mentioned below, the price doesn't matter when nobody is available to see you. Also, the opportunity cost of sitting around with a broken hip waiting to be seen can be higher than going to a privatized country/province and paying for the surgery, in which case you're a super-sucker who paid extra taxes for decades just to end up paying out of pocket for surgery anyways. Anyways, the US system is probably worse ove…

From most of the folks I talk to here and abroad, waiting times for the things you're thinking of are longer in the US. I just spent 3 months waiting to see an ankle surgeon here in NYC and it cost over $1,500 to have x-rays in the office and be told I'm a bad candidate for surgery. A friend had to spend the better part of a month waiting for a mammogram and ultrasound to diagnose breast cancer.

Someone in the dorm next to me in college died of an asthma attack because he couldn't afford the ambulance and took a cab.

The system is still the way it is in the US because of money.

Re: Insured price $2,758, cash price $521

#199

Post by entee »

rossdavidh wrote: post #154
habitue wrote: post #136

Earlier quoted context omitted.

There's still a benefit in insurance for routine procedures to balance costs between the young and old. (As long as young people are required to have insurance)

...but the fact that the median income of young people (at the beginning of their career, whatever it is) is much lower than old people, pretty much nullifies this. If you want to balance out the costs over a person's life, there are much better ways than making the coffeeshop barrista subsidize the middle-manager's health costs.

The reason this logic fails is because income and healthcare costs are on different curves but of similar (or far greater in the case of healthcare) magnitude.

Say you start out your career making $30K as a barrista and end up making $150K as a middle manager in your 60s. A single surgery can be $150-$300K and you're more likely to have them when you're older. Cancer patients can cost millions in a given year, again you're more likely to have that as you get older. I don't have the number for a diabetes patient off the top of my head but I think it's 10s of thousands a year.

The income growth curve is far shallower than the healthcare cost curve, and the healthcare cost curve is essentially unbounded whereas for most people income doesn't go all that high. Remember median income in the US is something like $55-$60K. Most people won't ever see 6 figures and if they do, they'll see the very low end of that.

Re: Insured price $2,758, cash price $521

#200

Post by dataflow »

Balgair wrote: post #106
johnwheeler wrote: post #25

I took my 4 year old to the ER because he had a 103 fever. The doctor put an ear thermometer to him and told me to give him some childrens ibuprofen. The visit lasted all of 5 minutes. The cost: $756.00. I refused to pay it. It was the first time I did not pay a debt and the first time I was sent to collections. I refused based on principle, and not because I couldn’t afford it. Collections called me for about 3 mont…

I have a similar story about vaccinations in grad school, religious waivers, and a racket that the medical school's insurance was running here: https://news.ycombinator.com/item?id=19760317 TLDR: Single payer, yesterday!

Wow. There's just too much irony in a medical school telling students to use religious vaccination exemptions because the insurance they provide doesn't cover their mandated vaccinations.
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