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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

#331

Post by vidarh »

splix wrote: post #292
saiya-jin wrote: post #138

Earlier quoted context omitted.

Exactly the same situation is in rest of the world, no patient is shopping around. just goes usually to closest/biggest hospital. Yet we don't have this tragic mess US has. So its not about shopping around, rather some other reason like regulations, wrong dynamics between hospitals and insurances etc. You don't have better equipment nor doctors in US compared to biggest hospitals in Switzerland for example. Yet we ha…

I believe that "closest/biggest hospital" is a choice in emergency. Or when it's something unimportant. Otherwise people tend to choose a doctor and clinic based on reviews or recommendations, or maybe years of experience. Even with a free healthcare you still have a paid private medicine and a free public one. And they have to compete which leads the price going down, because one side is always zero or close to it.…

Even in relative emergencies. I'm in the UK. Years ago, my ex fell towards a glass door, and trust her arm through a thick glass pane, getting a nasty cut down her lower arm that exposed her tendons (I saw them... Not a pleasant anatomy lesson). After she was stabilised by the ER/A&E, she was told to come back in the morning (her arm was still open, but bandaged) to get properly patched up. Instead of going back to the nearest hospital, the following morning we went to the A&E of one an hour away with a good reputation for cosmetic surgery.

A&E can't turn you away. It gave her a few days of waiting in hospital (she was not a high risk patient, but they did want her available and under observation), but it gave her a leading specialist on hand surgery. And we walked out with no bill.

(and you're right - there'd still be the private options too, but in this case the NHS option had some of the best surgeons in the country in that field anyway)

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

#332

Post by vidarh »

Symmetry wrote: post #298
mbreese wrote: post #162

Earlier quoted context omitted.

> example of the benefits of free market economy Healthcare is rarely a good example of the free market. Medical decisions aren’t made by comparing costs between providers. And if you’re in rural America, you’re lucky if you have any provider. Price transparency would be nice, but maybe not as helpful as you’d like. Let’s say you’re in the middle of a rural area and the ER says you need stitches — but they cost $6000…

You've also got the Certificate of Need system, introduced in the Nixon years on the theory that if allowed hospitals to compete with each other it would lead to redundant capacity and thus higher costs. And then there's the Medicaid reimbursement rates, decided by a committee using the labor theory of value rather than something sensible like cost benefit analysis and negotiation. And since it's illegal to charge so…

The way Medicare is artificially restricted from driving down cost is atrocious. Medicare + Medicaid combined costs about as much per capita - NOT per patient - as the UK NHS. Except the UK NHS provides universal cover.

Now the NHS is an aberration and under severe pressure, but it is a good indication of just how inefficient Medicare and Medicaid are - and it's not that they can't do better, it's that they're legally prevented from using their market power.

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

#333

Post by vidarh »

melenaboija wrote: post #218
brobdingnagians wrote: post #71

Earlier quoted context omitted.

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.

It is not uncommon in US going to the hospital and they giving you a list of options and prices. I don't know how to call that but definitely feels like a market. BTW, I come from from a European country with universal healthcare and have been living in US for almost a decade and the feeling of someone making money of your health is at least weird. If I ever have some severe health issue no doubt I will go to treat m…

> EDIT: Also tired to hear about the problems of universal health care, specially with wait times. It is true that less important treatments could take some extra time but I have never seen a case where a fast intervention was needed and did not happen. I would say that common sense is something that works for universal healthcare. At least where I come from.

Almost all countries with universal care also have private options (Norway used to be an exception where offering private options for services available from the public healthcare system used to be practically impossible, but even Norway has relented on this though). Often the private options are also cheaper than the US.

E.g. for elective surgeries Americans might want to check London hospitals - many world-leading private hospitals for various conditions that are used to targeting foreign patients - especially wealthy ones - but still often charging much lower prices.

It's also not that unusual for those of us in the UK who can afford to go private to do so when we have some condition that the NHS certainly will treat but where there's a waiting list because it's not important.

And there are plenty of private insurers - only because the NHS offers a baseline, they're far cheaper than most US plans because almost all of them rely on the NHS as a first line and instead of picking up the bill for everything they only pick up the bill to accelerate care whenever there's a wait to see certain NHS specialists.

People need to consider the universal care to be the baseline. How much people are prepared to pay for the baseline over taxes will affect how fancy the baseline is, so if you want something better you'll need to pay. But at least it ensures everyone gets the baseline.

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

#334

Post by hsbauauvhabzb »

dheera wrote: post #329
hsbauauvhabzb wrote: post #308

Earlier quoted context omitted.

You realise there’s medical professionals who deal with poop right? There’s also the whole ‘all your clients are sick, some are contagious’ thing. I’m not saying america isn’t insane, but to try and pretend plumbers have it far worse isn’t quite accurate.

Okay, so pay those poop-doctors double salary? They're basically gastrointestinal plumbers.

doctors are paid roughly equivalent, and the cost of healthcare is substantially lower in other companies, so I’m not really sure what you think you’re solving here, but I don’t see your plan ever working either.

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

#335

Post by js2 »

jac241 wrote: post #220
js2 wrote: post #103

Earlier quoted context omitted.

Meanwhile, Congress passed a bill that's supposed to help with surprise billing. The Biden administration has started to implement it, but doctors and their representatives (Democrats and Republicans alike) claim the administration is not implementing the bill as intended and they are favoring insurance companies over medical providers by trying to keep costs down. > “The Administration’s recently proposed regulation…

Those greedy doctors trying to protect their livelihoods from a bill that gives insurers an easy path to drive down their reimbursement when an alternate method of doing the same thing (New York's law on surprise billing) exists that does not have that same feature. I for one know that software engineers would certainly support bills that would reduce their pay for the greater good! Physicians are the only group that…

In the states that use benchmarks similar to what doctors are suggesting HHS use instead of the agency's current proposal --such as New York and New Jersey — the report found costs rising. New York, for example, has a "baseball-style" system in which the arbiter chooses between the offers presented by the provider and the insurer, although the arbiter is told to consider the offer closest to the 80th percentile of charges. "Since the amount providers charge is typically much higher than the actual negotiated rate, this approach risks leading to significantly higher overall costs," the report finds. In New Jersey, billed charges or "usual and customary" rates are considered.

"When the arbitration process is wide open, no boundaries, at the end of the day health care costs go up, not down," Becerra says of the methods doctors prefer. "We want costs to go down. And so we want to set up a system that helps provide the guideposts to keep us efficient, transparent and cost-effective."

The system chosen by the Biden administration is expected to push insurance premiums down by 0.5% to 1%, the Congressional Budget Office estimates.

https://www.npr.org/sections/health-shots/2021/11/22/1057985...

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

#336

Post by edgyquant »

sjogress wrote: post #150
edgyquant wrote: post #68

Earlier quoted context omitted.

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.

It seems like you've done the research here: how do you know how you are supposed(?) to do the test in the US? Here in my municipality in Norway the media keeps repeating how/where/when to get tested, and if anything important changes the municipality will literally send a SMS to all its citizens to ensure as many as possible are up to date. From my admittedly limited experience with the US (NYC/tri-state area) I get…

It may be hard to find if you aren’t use to it. Normally you would call your doctor/clinic and schedule a test for the next day or so. A lot of times you can get into an office for a test same day (this is how you get sick notes for school) although it may not be with your preferred doctor and may just be a nurse giving the test. For covid, since it’s so widespread, there have been testing centers setup almost everywhere and a quick Google should give you a list of the closest ones. Again you can always go to a regular clinic for testing but they may not have same day service.

The emergency room is the last place you’d go for a simple test. The only reason you should go to the emergency for a test is if it’s heart related or you think you may die (an emergency.)

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

#337

Post by boplicity »

refurb wrote: post #262
boplicity wrote: post #216

Earlier quoted context omitted.

> Insurance paid UCSF $16,000 after discount. There you go. The insurance company is actually incentivized to not negotiate a lower price. What if they refuse a ludicrous price? Their customers will complain -- what, what? go without MRIs? Worse -- the insurance company gets to keep 20% of the costs as profit. For a $16,000 bill, that's $3,200. For a $3,000 bill, that's just $600. So why, again, would they fight for…

Not really accurate. The insurer did negotiate the price down - from $20,000, so a 20% discount. But yes, UCSF just leverages their name and the desire for insurers to have them in network. Their attitude is basically “no, I won’t go lower, and you’ll pay anyways”. No, insurance companies don’t keep 20% as profit. They can keep 20% in reserve , the rest has to be paid out as benefits that calendar year . United Healt…

> The insurer did negotiate the price down - from $20,000, so a 20% discount.

I've just got to point out that they're adding back 20% -- to keep in "reserve," as you say. So what's the advantage of insurance? The "premiums" force the scam pricing on everyone! (And not just the direct victims of this type of fraud.)

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

#338

Post by Hakashiro »

FearlessNebula wrote: post #171
Hakashiro wrote: post #126

I always find interesting to read these stories because nowhere else but the US can you make over 300k USD a year as a senior engineer of some kind. In Europe, 200k EUR is already ridiculous, and most countries take away half your salary in taxes anyway so... Would you rather make 300k and pay 4k for the occasional ER visit or make 50k after tax and pay 100 for the occasional ER visit? I suppose this comment will get…

$300k salaries are top tier engineers, not the norm. The vast majority of people regardless of job are making closer to $50k.

50k is what you make in Europe as a top tier engineer.

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

#339

Post by danlugo92 »

mkl wrote: post #156
danlugo92 wrote: post #42

Earlier quoted context omitted.

You can probably import that from somewhere. Dm me if you want help

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