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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

#201

Post by christophilus »

nameunimportant wrote: post #154
coldtea wrote: post #140

Earlier quoted context omitted.

We have more "regulatory factors" in Europe, and much cheaper treatment... Like 1/40 or so as much in this case...

WHen I stopped living in the USA, I realized that there is only one reason the USA is behind the rest of the developed world when it comes to healthcare, a social safety net and education. The USA likes it that way. The American culture is one of rugged individualist pioneering cowboys who won't be told what to do, even if you're warning them that if they take another step they'll fall off a cliff.

I don’t think it’s the rugged individualism that’s at fault, so much as an emergent, insane incentive structure that has grown out of control. The confluence of big insurance, big hospitals/ practices, and regulatory capture have given us a completely warped system.

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

#202

Post by gitfan86 »

atdrummond wrote: post #87
gitfan86 wrote: post #57

Earlier quoted context omitted.

Another big inefficiency is the margin of error allowed due to malpractice lawsuits. If a patient is at a 1 in a 10,000 risk for a problem, the Doctor will order a test to rule that problem out. Because if the Doctor doesn't order the test and the person ends up having the problem, the Doctor could be sued for malpractice. In other countries the Doctor would say this is very unlikely so I'm not going to run the test.

I don’t buy this. If this were true, Texas would have much better health outcomes than most other states, as med mal payments are capped and basically nonexistent relative to other states given the low cap/incentive for lawyers to pursue. Instead of any kind of dramatic increase in patient results, this system instead protected truly terrible doctors like the murderer Dr. Christopher Duntsch.

You are actually proving my point. Incompetent doctors are incentivized to come to Texas because there is a low cap on malpractice. That makes healthcare worse. Also, the extra tests that are being run just to cover someone's liability in other states don't make outcomes better because they are overwhelmingly unnecessary. They just add extra cost to the medical system to avoid lawsuits outside of Texas.

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

#203

Post by willcipriano »

JshWright wrote: post #180
willcipriano wrote: post #152

Earlier quoted context omitted.

I don't see how it's fee for service if nobody can tell you what it's going to cost upfront.

The uncertainty comes from not knowing exactly what services will be performed, who will be performing them, and how much the insurance company will cover (which has a ton of variables, many of which aren't known until everything is settled). In my opinion, getting away from the fee for service model is one of the routes we ought to be taking to address healthcare spending in the US (if you're charging per service, y…

In other professions if you make a bid and fail to capture required work, you eat it generally speaking.

Contractors, many of whom are small businesses or individuals, do this all the time. They also give estimates like "If we find mold behind the wall, it will be an extra ten thousand".

Medicine is also odd in that you have to pay for the doctors mistake. If the doctor prescribes a less effective drug, it has no effect and then after doing your own research find a better drug and get the doctor to prescribe that instead. You still have to pay for the first visit. If a plumber decides to go from plastic to copper pipe mid job, he doesn't get paid for the work he ripped out.

Multi billion dollar hospital groups, full of highly educated professionals apparently can't pull this off but the guy who poops in a bucket on the job site can.

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

#204

Post by mabbo »

hamilyon2 wrote: post #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 any…

This is the same in Canada. My wife is due to give birth in 3 months. The biggest bill we're concerned about is the parking lot. I think it's $20/day.

And if the parking fee was too much, I've heard that one can go talk to the reception desk and they'll open the gate for you.

I would rather pay very slightly higher taxes and let all of my fellow Canadians have this benefit than be very sightly richer and live in a society that doesn't have this.

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

#205

Post by trixie_ »

jjoonathan wrote: post #129
trixie_ wrote: post #116

Earlier quoted context omitted.

Free market works fine, unfortunately like tuition prices the government got involved and prevented what the free market is good at and driving down prices. Fortunately now there a new price transparency laws which the full the effects haven’t been felt yet and are a step in the right direction.

Our mostly private health care system is twice as expensive as the social systems in other developed countries because the government got involved? By what fraction will the new set of tweaks have to shrink costs to pay for the last 30 years of the private health care market's failure to deliver on its "more efficient" promise? Remember, it has to cut them by 50% just to break even, and it'll have to go further to ma…

There already is a massive public healthcare system in America called Medicare and Medicaid which is the root of distorted prices. The lack of price transparency adds fuel to the fire and allows those prices to stay high without any upfront awareness given to the end consumer.

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

#206

Post by dredmorbius »

spodek wrote: post #185

I've heard positive reviews of Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win https://www.penguinrandomhouse.com/books/635536/never-pay-th... . I've only read as far as the free preview allows, but it looks good. It teaches the system and how to fight back by a Propublica investigative journalist who had to fight the system himself.

Your library may have a copy:

https://www.worldcat.org/title/never-pay-the-first-bill-and-...

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

#207

Post by [deleted] »

Broken_Hippo wrote: post #84
nyamada wrote: post #18

My daughter here in France had a bike accident two months ago which requires 14 stitches in her foot. We received 3 follow-up visits from nurses to clean and redress her wounds -- We pay about 100€ a month for supplemental private insurance on top of the public health insurance here -- Total cost for us? about 40€. We would have had to pay about 100€ more for the nurses' visits, but the mutuelle covered it. These are…

These are some of the reasons why my wife and I moved from the US to France -- she's French, I'm American; but I can't imagine returning to the nightmare complexity of billings and profiteering that the US system has become... I'm American and live in Norway. I feel the same. My out of pocket here is around $300, after which a lot of things simply become free. I don't have to consider whether or not I can afford to t…

[deleted]

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

#208

Post by alisonkisk »

edgyquant wrote: post #68
aerodog wrote: post #22

Washington Hospital in the Bay Area charged me $2,010 for a COVID test when I went to their ER. Later I was told I was stupid for having gone to the ER to do the test there. I just never suspected they would charge that much.

In this case it seems like the steep price is to prevent frivolously using the emergency room. You can get covid tests dirt cheap (or free) if you schedule and appointment at a hospital or one of the testing sites. Emergency room has to have capacity to take on actual life threatening emergencies.

If the ER was rewlly so busy, they'd hand out brochures for non-ER clinics instead of fleecing minor patients, because they'd be too busy for minor case patients.

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

#209

Post by briHass »

hogFeast wrote: post #78
throwaway09223 wrote: post #16

Earlier quoted context omitted.

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 a…

The US conducted the experiment to limit insurance companies' profits. A component of the ACA (Obamacare) was the 80/20 rule, where at least 80% of all premiums collected by health ins. companies had to be paid out for care. That was a failure. In the 10 years or so since that rule, premiums have increased dramatically.

Your reply is well-stated. There isn't one single 'bad guy' in the US system; it's more a function of a bunch of little factors that nobody wants to change: the US has the best, highly trained doctors (expensive), best equipment/hospitals (expensive), subsidizes much of the drug development for the rest of the world (for better or worse), and a weird public/private system where the private insurers make up for lower payments from public insurance like Medicaid/Medicare.

In talking with a number of physicians, my biggest concern is that they're starting to feel like most of the 'reforms' and changes the US is making are impacting them the most. None of my physician friends recommend their children go into the profession, and many are leaving poorly-run hospital systems to focus on boutique, private practice (catering to the rich.) We have a huge healthcare provider shortage coming, and I'm terrified the system is straining hard as I get older and will need to start relying on it.

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

#210

Post by [deleted] »

refurb wrote: post #46
helloguillecl wrote: post #8

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 plastic surgery and vision correction industries work pretty well in the US. You see price competition and patients have the ability to shop around and make choices that are important to them (references from other patients, doctor personality, etc). Now contrast that with going to a hospital for a procedure where you have time to shop around. Can you get a price? No. Can you easily get appointments with doctors…

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