Greg Knauss's 10-year-old son's $23,800 bug bite • Hacker News Board

Re: Greg Knauss's 10-year-old son's $23,800 bug bite

#91

Post by mikeash » Sun, Sep 02, 2012, 1:37 AM UTC

encoderer wrote: post #33

marquis wrote: post #18

Earlier quoted context omitted.

Having experienced emergency care in both Denmark and the U.S., this is also the main reason I won't relocate to the U.S. until this is sorted out. I had what was thought to be a broken ankle in Denmark thanks to icy conditions and I was so well looked after, and charged nothing, I was awe inspired and wish there had been some way to pay it back. I sliced a finger in the U.S. and was made to feel like a statistic, wi…

It's not fair, and not right, but it is a fact that for the most part, most of us here don't have to worry about that. If you're a software engineer or systems administrator or similar type of professional earning a fair living it's not at all uncommon to have completely free health insurance for yourself, and affordable options to cover your family. I haven't worked for a place with an individual premium in 5 years.…

I disagree. It's really common for small software companies not to provide insurance, and of course anyone who wants to strike out on their own, either selling software or contracting, has to deal with the question. I would wager that the average programmer is more exposed to the problem of health insurance than the average.

Re: Greg Knauss's 10-year-old son's $23,800 bug bite

#92

Post by rkischuk » Sun, Sep 02, 2012, 1:38 AM UTC

zaphar wrote: post #79

rkischuk wrote: post #76

This is putting things exactly backwards. The argument is roughly "Treating a minor condition cost $24k, which could wipe people out financially, therefore PPACA is important." Where is the outrage over this price? What part of PPACA does ANYTHING to reduce this cost? PPACA does essentially 2 things: 1) It makes insurance "affordable" for people who previously couldn't obtain it at all. 2) Drastically increases deman…

It wasn't a minor condition. It was a staph infection. Don't let the term bugbite mislead you. His son wasn't in the hospital for a bugbite. He was in the hospital for a life threatening infection from an antibiotic resistant infection. That is far from minor. Disclaimer: I'm not arguing for PPACA in any way but if you are going to base you argument on billing for a "minor" condition then make sure it's actually a mi…

So... MRSA Staph Infection... what is the cost to correctly diagnose? And what is the cost of the antibiotics?

I'm not a doctor, but most non-boutique antibiotics are dirt cheap.

I didn't intend to trivialize the illness. I more meant that this could happen to _anyone_. And if this is the cost for things that can happen to anyone, we have a real problem on our hands. Much like it's a problem that a basic, no-complications, baby delivery costs $15-20k.

Insurance is math, and the math gets scary quickly unless costs are controlled.

Re: Greg Knauss's 10-year-old son's $23,800 bug bite

#93

Post by fernly » Sun, Sep 02, 2012, 1:41 AM UTC

_delirium wrote: post #43

fernly wrote: post #25

Earlier quoted context omitted.

What is your legal status in Denmark, and how did you achieve it? Are you a "resident alien" or an immigrant or what? What restrictions/hoops did you have to jump to get permanent residence status? What did it cost?

Unfortunately it's not the most friendly country for immigration, partly as a result of the right-wing coalition that tightened rules over the past few years (Sweden is better, as far as the Scandinavian countries go). But there are some exceptions: it's easy for EU citizens (due to being in the EU), and it's easy if you have a professional-level job offer (no US-style H1B quotas). I'm a researcher hired by a Danish…

Thanks so much for replying and the links. Actually the third one, permanent residency, is quite encouraging for me as I would be a "pensioner" and thus the 3-year work requirement is waived.

Re: Greg Knauss's 10-year-old son's $23,800 bug bite

#94

Post by mikeash » Sun, Sep 02, 2012, 1:41 AM UTC

rkischuk wrote: post #76

This is putting things exactly backwards. The argument is roughly "Treating a minor condition cost $24k, which could wipe people out financially, therefore PPACA is important." Where is the outrage over this price? What part of PPACA does ANYTHING to reduce this cost? PPACA does essentially 2 things: 1) It makes insurance "affordable" for people who previously couldn't obtain it at all. 2) Drastically increases deman…

MRSA-infected bug bites which require hospitalization are not "relatively mundane".

The PPACA does not reduce this cost. It does prevent it from bankrupting individuals.

Re: Greg Knauss's 10-year-old son's $23,800 bug bite

#95

Post by tptacek » Sun, Sep 02, 2012, 1:43 AM UTC

abtinf wrote: post #73

For complex reasons, I was without insurance for a couple days last week. I happened to have an appointment schedule. I went into the clinic and, since it was my first time there, I filled out a stack of paperwork. And then they told me my insurance was inactive. So I figured, whatever, I'll pay it out of pocket and file for reimbursement. I asked how much the specific service I was requesting would cost. And they ha…

Last year, my daughter caught a stomach bug and for a few days woke up each morning nauseous. We took her to her pediatrician and were surprised to find out that "waking up nauseous" is a Big Deal; it can be a neurological symptom. We were pretty sure that wasn't it (there were... other symptoms... corroborating our "stomach bug" hypothesis) but the doctor was adamant: if she kept waking up and puking, she'd need to get imaged.

She got better and we cleared her to go on vacation with her grandparents, and were just about to get on a plane to go give a talk at Black Hat, when we got a call from our parents in Michigan telling us she was puking again. We called the doctor, who demanded we retrieve her and scheduled a CAT scan.

We are at this point freaked out for a variety of reasons, some of them logistical (trip to conference, driving back/forth to Michigan, &c) but also from the fact that our doctor knew what an epic inconvenience all was and was absolutely clear "daughter needs CAT scan" --- so in the back of our heads there's gnawing "something could really be wrong" (Adia had seizures when she was 4, which, by the way, GUESS WHAT DING DING DING UNINSURABLE ON PRIVATE MARKET NOW, and now 7 years later I still can't even hear she has a headache without taking an inventory of all other possible symptoms.)

So anyways, we want that CAT scan done now now now yesterday now. We get to the hospital for our appointment and: problem with our insurance card. No big deal, we'll just resched--- fuck that, I'm paying cash.

Head scratching ensues, long story short, very large hospital in Chicago doesn't have any price list for a CAT scan at all. Not even an insurance cost to pass on to me, let alone a cash-basis discounted price. Getting imaging done at a top hospital in Chicago without insurance: unheard of. They ended up just making up a price on the spot; $1000.

Re: Greg Knauss's 10-year-old son's $23,800 bug bite

#96

Post by mikeash » Sun, Sep 02, 2012, 1:44 AM UTC

dollar wrote: post #44

The question no one ever asks is "why is the bill $23,000?". The only question that ever gets asked is "who should pay this $23,000 bill?". I charge $200/hr for my time at a minimum. Did this child really receive an equivalent of 2.8 weeks of my time in services? Or did an unecessary middle man negotiate ridiculous prices with the provider, leaving the consumer out of the equation but responsible for the bill? And ye…

Really? Nobody ever asks? Whenever the subject of American hospitalization comes up, the question of why the bills are so insanely high is pretty much the only question people ask!

Re: Greg Knauss's 10-year-old son's $23,800 bug bite

#97

Post by tptacek » Sun, Sep 02, 2012, 1:48 AM UTC

encoderer wrote: post #33

marquis wrote: post #18

Earlier quoted context omitted.

Having experienced emergency care in both Denmark and the U.S., this is also the main reason I won't relocate to the U.S. until this is sorted out. I had what was thought to be a broken ankle in Denmark thanks to icy conditions and I was so well looked after, and charged nothing, I was awe inspired and wish there had been some way to pay it back. I sliced a finger in the U.S. and was made to feel like a statistic, wi…

It's not fair, and not right, but it is a fact that for the most part, most of us here don't have to worry about that. If you're a software engineer or systems administrator or similar type of professional earning a fair living it's not at all uncommon to have completely free health insurance for yourself, and affordable options to cover your family. I haven't worked for a place with an individual premium in 5 years.…

It's a huge problem if you want to start a company. It's an even bigger problem if you want to hang up a sign and do business as a freelancer.

I agree with your point: the reason the country isn't completely behind health care reform is that they get it from their employer and don't understand how it works. Of course, they're also getting screwed financially in the process.

Re: Greg Knauss's 10-year-old son's $23,800 bug bite

#98

Post by zaphar » Sun, Sep 02, 2012, 1:49 AM UTC

rkischuk wrote: post #92

zaphar wrote: post #79

Earlier quoted context omitted.

It wasn't a minor condition. It was a staph infection. Don't let the term bugbite mislead you. His son wasn't in the hospital for a bugbite. He was in the hospital for a life threatening infection from an antibiotic resistant infection. That is far from minor. Disclaimer: I'm not arguing for PPACA in any way but if you are going to base you argument on billing for a "minor" condition then make sure it's actually a mi…

So... MRSA Staph Infection... what is the cost to correctly diagnose? And what is the cost of the antibiotics? I'm not a doctor, but most non-boutique antibiotics are dirt cheap. I didn't intend to trivialize the illness. I more meant that this could happen to _anyone_. And if this is the cost for things that can happen to anyone, we have a real problem on our hands. Much like it's a problem that a basic, no-complica…

It's more than just diagnoses and antibiotics. It's monitoring the child for 2+ days. And broad spectrum antibiotics than can kill resistant staph infections I imagine aren't cheap either. Not to mention you can't just administer them. You have to monitor their effect continuously to make sure they actually are having an effect.

As to happening to anyone yes in the same way that anyone could get hit by a car. It's a rare occurrence. most people will not be getting staph from a bug bite. It's totally possible that 23k is an egregious amount to bill for his treatment but I think you are going about making that argument from the wrong position.

Are you capable of diagnosing an MRSA Staph infection? What all exactly is involved in diagnosing it? Looking at it? or do you need complicated lab tests? Does it require a consult with someone who specializes in infectious diseases or can just anyone do it? How do you dispose of medical waste from treatment? Are there any complicated regulations that increase the cost there?

All of these questions should be what fuels the debate around medical billing. The fact that you as a patient have very little visibility into all of that is in my mind the issue.

Arguing about how anyone could be hit with life threatening illness or injury is a potent and emotional distraction.

Re: Greg Knauss's 10-year-old son's $23,800 bug bite

#99

Post by _delirium » Sun, Sep 02, 2012, 1:53 AM UTC

tptacek wrote: post #89

_delirium wrote: post #75

Earlier quoted context omitted.

I agree, and I feel it used to work even better in that respect, when educated Americans typically had lifetime employment. I would guess that's one reason the debate is growing louder lately. The West basically solved the healthcare problem via collective coverage, but in different ways: the European countries did it nationwide, but the US did it with employer group plans. That was almost equivalent, for people with…

It's not hard to get insurance for a 10 person company, but it is expensive.

Interesting. I mostly know people trying to buy individual health insurance, whose difficulty really varies, depending on age and health history. Is even a 10-person company big enough that buying it isn't a problem, if you're willing to pay the "10-person company" premium? In particular, do they inquire into the distribution of health among those 10 people? I would've guessed that if 1 of your 10 employees happened to have some disqualifying condition you'd be SOL.

Not entirely a theoretical question, b/c one of my friends has a congenital heart defect, and is himself not 100% sure how his condition would impact a small company. They aren't allowed to inquire into such things when hiring, but could it possibly tank their group health-insurance plan, if 1 of [small-N] members had a major preexisting condition?

Re: Greg Knauss's 10-year-old son's $23,800 bug bite

#100

Post by neurotech1 » Sun, Sep 02, 2012, 1:53 AM UTC

javert wrote: post #78

marquis wrote: post #18

Earlier quoted context omitted.

Having experienced emergency care in both Denmark and the U.S., this is also the main reason I won't relocate to the U.S. until this is sorted out. I had what was thought to be a broken ankle in Denmark thanks to icy conditions and I was so well looked after, and charged nothing, I was awe inspired and wish there had been some way to pay it back. I sliced a finger in the U.S. and was made to feel like a statistic, wi…

Having experienced emergency care in both Denmark and the U.S., this is also the main reason I won't relocate to the U.S. until this is sorted out. LOL. Go to the emergency room now in the US, with a real emergency, wait for hours. After this is sorted? Wait for days, maybe? Our health system is completely broken in every way, and building up more bureaucracy is just going to make it worse. I am counting on hospital…

It seems that most people get confused between ER & "trauma" service. If it was a "real emergency" (chest pain/stroke etc) the patient would go straight to the trauma service. Not so critical emergencies are treated in the ER, and that can involve 3-4 hour wait.

Quite a few hospitals with ERs also have a 'urgent care' or 'express care' clinic attached which are quite effective as they can a lot of things a ER can do, and expedite transfer to the ER if can't be treated there.