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The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

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Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#71

This is absurd. Even in a country with liberal economics and "free choice" health system (however with universal care, and state regulation), the same stitches in a world-class private clinic in Santiago, Chile would cost 400 USD, before insurance . The clinics there are not the ones Americans imagine from a middle-income country, most of them have better infrastructure and doctors than the ones I know in Europe. And…

The US is not a market-led economy in healthcare; I currently live in a country with universal healthcare and I make clear to people that when I disagree with universal healthcare it is not because I think it should be more like the US.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#72

This is absurd. Even in a country with liberal economics and "free choice" health system (however with universal care, and state regulation), the same stitches in a world-class private clinic in Santiago, Chile would cost 400 USD, before insurance . The clinics there are not the ones Americans imagine from a middle-income country, most of them have better infrastructure and doctors than the ones I know in Europe. And…

$400 still sounds high, to be honest.

Marginal vs fixed costs.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#73
post #2

Somehow everybody in this system claims they're not the ones making bank on this swindling. The doctors say they're underpaid. The hospital admin says they're underpaid. The insurance companies say they're barely covering their payouts. So who is lying?

My understanding is that the ER system is especially expensive because paying customers are subsidizing non-paying customers (homeless) who use the ER as primary care. That said, I don't think this excludes the possibility that the insurance companies and the hospitals are also not telling the full truth.

Hospitals publish data on overall non-payments. There's a significant amount of cost there but not enough to be driving prices.

https://www.aha.org/fact-sheets/2020-01-06-fact-sheet-uncomp...

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#74
post #51
post #2

Somehow everybody in this system claims they're not the ones making bank on this swindling. The doctors say they're underpaid. The hospital admin says they're underpaid. The insurance companies say they're barely covering their payouts. So who is lying?

Well UCSF charged my brother in law $20,000 for an MRI a private standalone MRI clinic charges $3,000 for. Insurance paid UCSF $16,000 after discount. So I’d say the hospitals definitely are a part of the problem. You can imagine what he did with a fund raising letter he got from UCSF asking for a donation so they could continue to help the community…

Meanwhile, the most expensive MRI I’ve ever gotten in Japan was $300 before insurance.

Even the private clinic is making bank like there’s no tomorrow.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#75
post #48

Earlier quoted context omitted.

Some people somewhere, with cigars, in $5,000 suits. "Look at all those schmucks! $400 per shot and $1,000 per stitch." The whole healthcare system needs to be regulated by the government end-to-end. All procurement must be transparent. Every cent traced. Pharma mafia dismantled - on a federal level.

Who are these people? Where are they? Not really convinced they exist.

They don’t exist. They’re the imagined scapegoat for what is actually just a much harder to comprehend creeping bureaucracy cost.

The human mind loves clear enemies but Hanlon’s Razor almost always applies. Almost no one ever actually has malicious intent, but our brain evolved to watch for enemies and loves seeing patterns where they aren’t.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#76
Most of the time I restrict myself from this kind of comments, but here is what experience is typically like in Russia.

You are sick or even probably sick, like biten by tick and worry about it is infectious. You go to the neatest hospital, local ER, register yourself (no documents needed). Any time of day. You get triaged immediately, if your situation is not life-threatening, there is a queue. Waiting times are anywhere between nothing and two hours. Doctor sees you, you get medication, procedures, tests as needed. Everything is typically done in professional manner, quick and no bullshit. There are sometimes signs hospital is understaffed, like single nurse doing everything.

In Moscow, treatment is world-class. In rest of Russia, your milage may vary.

You typically leave diagnosed, fixed, with documents. Nobody ever asks you about payments or bills. What bills? The state-provided health care is free

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#77

My mother is on Enbrel for her rheumatoid arthritis. The price? $6,500 per month.

If I'm reading the NICE site correctly, the NHS appears to pay a around 20% of that: https://bnf.nice.org.uk/medicinal-forms/etanercept.html

£715 (approximately $950) for 4 doses, almost a month's worth with 1 dose per week coming out around $1k/month.

Even ignoring the fact that patients here don't pay, just having NICE and a system which will fight drug companies over costs appears to massively bring down the costs of these medications.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#78
post #2

Somehow everybody in this system claims they're not the ones making bank on this swindling. The doctors say they're underpaid. The hospital admin says they're underpaid. The insurance companies say they're barely covering their payouts. So who is lying?

My understanding is that the ER system is especially expensive because paying customers are subsidizing non-paying customers (homeless) who use the ER as primary care. That said, I don't think this excludes the possibility that the insurance companies and the hospitals are also not telling the full truth.

The only thing that is particularly unusual about the US is that private insurance companies are probably not very efficient (admin costs are multiples of similar mixed healthcare systems).

But if you look at healthcare spending as a % of GDP: the US has the largest public healthcare system in the world, and it has a private healthcare system that invests very heavily in people's health (I think people get confused about this because US life expectancy isn't much higher but that is largely a function of things like obesity that, ultimately, aren't solvable without people eating less...the US does very well with quality of life and difficult to treat stuff like cancer, I am in the UK and a lot of cancers are treated properly, there is just no money to do so).

So, imo, the US is more expensive than similar systems like Germany. But incomes in the US are much higher, people are willing to spend more (particularly on quality of life stuff like joint replacements), and a lot of the additional cost is not in treatment but admin. Maybe moving to a public insurance system would help but look at France: public healthcare system, and doesn't spend that much less than the US (and in the US, public healthcare prices are cheaper than private but private does subsidise the public...and the gap isn't huge)...doctors don't work for free, medicine isn't free, nurses aren't free, you just pay the same but in taxes (btw, I think a public healthcare system would reduce costs by removing admin...would they like it when they couldn't get a knee replacement? No. Would they like it when a parent got cancer or their kid has a rare type of epilepsy and they can't get medicine? No...there are trade-offs, fully public healthcare systems generally do not perform as well as mixed systems like Germany or Netherlands...making insurers non-profit might be a good first step).

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#79
post #49

Earlier quoted context omitted.

What are you talking about? As long as you are not private insured - which is not difficult to do usally - if you have a job you are insured (a percentage of your pay is used for insurance, if you study you are insured (90 eur) or you can join on your own for 200eur/month depending on your income if you are working on your own. You pay nothing for ER, 10eur/day for the hospital and a few eur for medication - but noth…

Did you actually read my comments in this conversation? Are you aware that in Germany clinics have different prices than the ones you pay after insurance? I have always talked about prices before insurance , which is what I'm arguing looks completely out of place. I'm public insured in Germany and no, dental is not really covered, I had to pay my routine treatment last time at the praxis, and it was not cheap. Do you…

I misunderstood your comment then. Sure what is billed is a different thing. Sorry.

For the dentist: They often bill you for stuff that is covered but it lucrative to add something to the bill.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#80
post #2

Somehow everybody in this system claims they're not the ones making bank on this swindling. The doctors say they're underpaid. The hospital admin says they're underpaid. The insurance companies say they're barely covering their payouts. So who is lying?

I'm curious, are there just more staff? How many admins / doctors does the US system employ compared to other health systems?

I'm willing to believe addicted's[0] rationale, but maybe most people are getting paid poorly, there's just more of them in the system?

- [0]: https://news.ycombinator.com/item?id=29287371

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