Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

The cost of two weeks in an pediatric/infant ICU

kingsley.sh

Post reply on HN
Print view View original

251–260 of 294 posts

Re: The cost of two weeks in an pediatric/infant ICU

#251

Post by cloverich »

inglor wrote: post #100
rakmos wrote: post #52

This hits home for me.. my son (now 4 years old) was born very premature at 29 weeks and some change. He spent 7 weeks and 4 days in the NICU. The total hospital bill that was charged to insurance (before settling it between themselves) was roughly 960_000$. If you include the additional services and whatnot in the few months following being discharged from the hospital he was a million dollar baby. Complete insanity…

In Israel we have public healthcare. I was born at week 32 and spent about 6 weeks in the NICU - everything was free. It's not always great and I do pay for private insurance in case I need something urgent - but everything emergency is absolutely covered. I believe it's this state in most developed places that are not the US?

It depends quite a bit on what happens in that NICU. Our daughter was 32 as well and had a relatively uneventful stay. Same for many other infants. Our (insurance) bill was ~30-40k and out of pocket was minimal. Other's were not so lucky, having all manner of procedures including bowel resections / repair, heart surgery, etc. Many things look routine but I can assure you pediatric heart surgery is anything but.

So, not to defend the (out of control) prices, but only to say no two NICU stays are exactly alike. We can run the gamut from "a nurse could handle 100% of their care" to "we need 4 different specialists with decades of experience each to keep this person alive" and the costs fluctuate accordingly.

Re: The cost of two weeks in an pediatric/infant ICU

#252

Post by tyingq »

whocares2345 wrote: post #247
tyingq wrote: post #215

Earlier quoted context omitted.

>Maybe, just maybe it also includes the cost of actually administering it by a professional Nope. That's a separate line item. Appreciate the weird sarcasm though, as if I thought it would be magically administered for free? > resp tx initial or subsequent qty 33@$318 total $ 10,494 (note: "tx" == therapy) Also, 3ml takes 5 to 15 minutes to administer. So, even if I'm generous, that respiratory therapist costs $1272/…

No it’s not a separate line item. The administration part includes getting the instruction to do so, retrieving medicine from storage, going to the patient, administering the drug, going back to nursing station and filling in the paper work for the action (there are actually several forms to be filled out). So in reality it takes more like 40 min per IV.

You seem confused. This is saline for a nebulizer. It would be pretty weird to do that with an IV :)

The line item is for the saline ampoule only, NHRIC item 0487-9003-60. It's in the "Pharmacy" category on the page. The respiratory therapist charges, I already mentioned, are separate.

Re: The cost of two weeks in an pediatric/infant ICU

#253

Post by JeremyNT »

refurb wrote: post #234
shados wrote: post #76

Earlier quoted context omitted.

Because in the US, if you're reasonably healthy, employed, live in a city with good hospitals and have private insurance, it "feels" better. It's easier to get better care. I'm Canadian, now living in the US, and I'll be honest: for the first couple of years, where I had some medium sized health issues, the US system felt so much better. The hospital I was treated at was leagues better than anything I saw in Canada.…

Having experienced both system as well, the Canadian system is much less burdensome, but if I had serious cancer I’d take the US system any day. They throw the kitchen sink and more at you in the US and insurance will pay for most of it. My grandmothers neighbor is in her 70’s and not great health. She needs a hip transplant and the doctor is basically like “nope, you don’t have many years left, better to prioritize…

> Having experienced both system as well, the Canadian system is much less burdensome, but if I had serious cancer I’d take the US system any day. They throw the kitchen sink and more at you in the US and insurance will pay for most of it.

Of course this means they'll also push incredibly expensive but dubious interventions for all patients (even those that are clearly terminal).

I have no idea whether Canada etc are better in this regard, but all the incentives line up to treat all patients in the most expensive way possible to the "bitter end." I've seen this personally with terminal patients, resulting in them squandering their final months on brutal and ineffective treatment as they follow that "false hope" to gain some "extra time," but it also means expensive (and high risk) surgery is encouraged way more often than e.g. physical therapy for minor issues.

I guess if you're a very savvy consumer this system could work for the better, because you would only opt for the truly necessary and likely to be effective expensive procedures, but it's incredibly difficult to make clear-eyed decisions in moments of health crises.

Re: The cost of two weeks in an pediatric/infant ICU

#254

Post by oliwarner »

arethuza wrote: post #160
skeletal88 wrote: post #109

Earlier quoted context omitted.

The obligatory comment about how crazy this is on many levels. 1. You are being charged prices that you are not expected to pay, but need to negotiate on 2. When you go to a doctor to have a procedure or have an emergency then you don't know what you are paying. In normal countries there is A price list, which is THE price list for all hospitals that are part of the national health care system. If they want to have a…

"In normal countries there is A price list" I've never even heard of such a thing in the UK NHS - i guess some kind of cost accounting must occur but I don't think it goes anywhere near patients or care givers.

If you're not UK resident or otherwise excused, the NHS charges and therefore does have a price-list. https://www.england.nhs.uk/publication/overseas-patient-upfr...

And even residents are charged prescription fees for drugs given in A&E.

Re: The cost of two weeks in an pediatric/infant ICU

#255

Post by rakmos »

alexktz wrote: post #134

In 2018, age 31 I emigrated from the UK to the USA. I'd spent my entire life under the NHS and taken it for granted. In Jan 21 my first child arrived, 8 weeks early. This led to a lengthy 49 day NICU stay spread across two hospitals. Ask me to put a price on the work those doctors did to save my families lives (8hrs in the OR and both nearly died several times) and I'd give you all I could. In the end, the bills we'v…

Interesting perspective from someone who can legitimately compare the experience…

I disagree with how it is characterized that Americans are rationalizing healthcare costs as a result of being wrapped up in emotions. While emotions certainly influenced most decisions being made at the time, the costs didn’t feel even remotely in the realm of something that can be controlled. The nature of emergencies (such as the birth of a child in this context), the fact that the costs aren’t even communicated until months go by, and the fact that healthcare coverage is tethered to your employer (resulting in a spectrum of experiences) are all aspects that I believe serve to maintain the status quo.

For instance, with this pandemic… I was laid off, and while I was incredibly fortunate to be able to have multiple options for new employment, it caused unnecessary stress on ensuring health care coverage was continuous. It also played a role in how I ultimately chose which company I decided to work for despite the difficulty I have generally experienced in getting prospective employers to be forthcoming about their health insurance options. And some things just literally aren’t available such as whether your current doctors / specialists are considered “in-network” —- which really matters when in the context of a helping a premature child get “caught up” in life. Oh, and I don’t want to forget pointing out that changing employers also resets those deductibles and max out-of-pockets…

In any case, thanks for sharing the perspective.

Re: The cost of two weeks in an pediatric/infant ICU

#256

Post by wang_li »

ceejayoz wrote: post #27
wang_li wrote: post #13

Earlier quoted context omitted.

The US has universal care, it passed in 2009 and it establishes that everyone does their part and buy insurance. It establishes help for low income individuals. There are caps on annual expenses. You may not like how it’s structured. You may not like the amount that people are expected to pay. But twelve years later the only people who don’t have coverage are people who are not meeting their civic obligations. And I’…

> But twelve years later the only people who don’t have coverage are people who are not meeting their civic obligations. The folks at the poverty line with a "free" fully subsidized Bronze ACA plan has an enormous deductible that may be $6-12k before that coverage actually starts paying out. The ACA's max out-of-pocket for a family in 2021 is $17,100 . ( https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...…

Out of pocket expenses for any individual is capped $8550 regardless of whether they have family coverage or individual coverage. Additionally, those earning less than 250% the federal poverty level qualify for additional cost sharing reductions (CSR) which dramatically lower the out of pocket expenses, e.g deductibles and copays. Details will vary but a family of four with a household income of $30k with CSR would have their deductible reduced to a few hundred dollars and annual out of packet caps also to the hundreds of dollars range. The same plan without CSR might have a $7000 deductible. But CSR is available in the situation you describe.

http://www.healthreformbeyondthebasics.org/cost-sharing-char...

Regardless, this is arguing over the burden that Obama, Pelosi, et. al. decided was appropriate for Americans. It's not a question of whether there is universal health care in the US. There undeniably is.

Re: The cost of two weeks in an pediatric/infant ICU

#257

Post by jhot »

rakmos wrote: post #52

This hits home for me.. my son (now 4 years old) was born very premature at 29 weeks and some change. He spent 7 weeks and 4 days in the NICU. The total hospital bill that was charged to insurance (before settling it between themselves) was roughly 960_000$. If you include the additional services and whatnot in the few months following being discharged from the hospital he was a million dollar baby. Complete insanity…

Same. My wife gave birth last year at 26 weeks. 3 months in the NICU was over $1MM and that doesn't even include the delivery. We were extremely fortunate that my wife works and has good insurance because I had just been laid off a couple weeks prior. We were big proponents of a medicare-for-all-like system before all that, and even bigger proponents now.

Re: The cost of two weeks in an pediatric/infant ICU

#258

Post by arethuza »

oliwarner wrote: post #254
arethuza wrote: post #160

Earlier quoted context omitted.

"In normal countries there is A price list" I've never even heard of such a thing in the UK NHS - i guess some kind of cost accounting must occur but I don't think it goes anywhere near patients or care givers.

If you're not UK resident or otherwise excused, the NHS charges and therefore does have a price-list. https://www.england.nhs.uk/publication/overseas-patient-upfr... And even residents are charged prescription fees for drugs given in A&E.

I wasn't implying that there isn't a price list - just that for the overwhelming majority of cases it is irrelevant to both patients and medical staff.

Also, as far as I understand it there are only prescription charges in England and not in the rest of the UK. Certainly here in Scotland there are no prescription charges anywhere.

Re: The cost of two weeks in an pediatric/infant ICU

#259

Post by arethuza »

craftinator wrote: post #207
arethuza wrote: post #182

Earlier quoted context omitted.

Free in this context clearly means "free at the point of delivery" - we all know we pay for it in our taxes.

But in the case of the US, we pay for healthcare in our taxes, pay again as companies, and again pay co-pays as individuals.

I think I'd find the uncertainty that seem inherent in your system completely terrifying - its bad enough being sick but then to not know what that would cost seems crazy.

I can't help thinking of the book title by Aneurin Bevan, founder of the UK NHS: "In Place of Fear":

https://www.goodreads.com/book/show/2042463.In_Place_of_Fear

https://en.wikipedia.org/wiki/Aneurin_Bevan

Re: The cost of two weeks in an pediatric/infant ICU

#260

Post by disgruntledphd2 »

gambiting wrote: post #63
xienze wrote: post #56

Earlier quoted context omitted.

> I don't understand how people can be so anti-universal healthcare in the US. Because I have zero faith that it will end up costing me less, and have a similar level of quality. I’m in tech. Combined HHI is something in the $200s. I pay about $300 per month for the entire family, $5K out of pocket max. So in a worst case scenario, let’s say healthcare costs me $9K per year. That’s what, 4% of my HHI? Will a universa…

I....just have no words. Do you really believe everything you wrote? And like....that's probably the worst example of individualism and "me first" attitude I've seen on this website.

My favourite assumption is that people with 200k household income are in the middle.

Mind you, that kind of belief is super common amongst people (like me) who are in the top decile of income.

Post reply on HN