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Why American ambulance rides are so expensive

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Re: Why American ambulance rides are so expensive

#91

Post by SpicyLemonZest »

xp84 wrote: post #71
semiquaver wrote: post #47

Earlier quoted context omitted.

> discovered the "life hack" of having an extremely inadequate network The article covers this. Ambulance providers are strongly incentivized not to join insurance provider networks, and as a result more than 80% of ambulance rides in the US are “out of network”. So the inadequacy of the network is probably not the insurer’s fault.

Be that as it may, the law in California forbids the insurance company from refusing to pay at the in-network rate in an emergency. As evidence, I'd submit the claim they immediately paid when called out on this. If the insurance company weren't cynically exploiting people's lack of knowing their rights, they'd at least send a form letter to the patient saying "Please send us whatever proof from the hospital that you…

But isn't the California law requiring the insurance company to act as a sin-eater here? They seem to be the only people you were frustrated with, even though they are not the ones who charged you $1000.

Re: Why American ambulance rides are so expensive

#92

Post by gruez »

spicymaki wrote: post #46
Hnrobert42 wrote: post #36

Earlier quoted context omitted.

But do they really? Can you point a real, evil villain saying that?

I think we are all villains here. Good healthcare coverage is just another status symbol to be attained. If the poor have it then it becomes less of a value. To some degree we are all wired this way and we all suffer because of it.

>I think we are all villains here. Good healthcare coverage is just another status symbol to be attained.

Seriously? How many conversations have you been in where people were bragging about how good their health coverage is and trying to one-up each other? The extent I've experienced is stuff along the lines of "thank god I had my health plan, because otherwise it would have cost [6 figures]", but it didn't give the impression that they'd be mad if everyone didn't have to suffer that fate.

Re: Why American ambulance rides are so expensive

#93

Post by jjav »

pclowes wrote: post #79
cogman10 wrote: post #69

Earlier quoted context omitted.

It's very often not a choice. But also, those rural areas are often the breadbaskets of the united states. Taking care of our farmers is important. Trying to frame it as a choice also misses a lot. It technically is, but you have to recognize there's a huge cost in uprooting your entire life and moving to a new location.

We give our farmers absolutely insane subsidies already. It is not the government’s job to “take care of” anybody. Everything has a cost, staying has a cost, leaving has a cost. The question is how much should the public be taxed to pay for individuals suboptimal decision-making? Or conversely, why am I subsidizing some billionaires remote horse ranch to have daily Postal Service and an ambulance standing by? Can I m…

> It is not the government’s job to “take care of” anybody.

That is actually the only legitimate function of government.

Re: Why American ambulance rides are so expensive

#94

Post by joe_the_user »

darth_avocado wrote: post #7

We’re all pretending this is an unsolvable problem when really most of the world has solved it by making ambulance (EMS) funding similar to fire and police departments. Somehow in any emergency I’ve seen, all three show up, often EMS before police or fire dept, and somehow that’s a service that has to be supplemented by insurance billings. The blog mentions it, but it’s one of those obvious things that somehow isn’t…

Health care in general has been solved by state sponsored medicine in most industrialized nations. And when it isn't solved by directly state sponsored medicine, it's solved by formally and informally regulated monopolies. In fact, US health care in the 1960s was made reasonable by the Blue Shield regulated monopoly.

The thing about unfettered private health is that it finds "profit centers" and pumps them ruthlessly. But the problem when scheme/scam gets reigned in (say out-of-plan doctors), another appears (out-of-plan ambulances) and there's no end to the situation. Only actual state sponsored health care can end this.

Re: Why American ambulance rides are so expensive

#95

Post by deathanatos »

jfim wrote: post #12
josefritzishere wrote: post #3

TLDR: private equity

The article argues the exact opposite: > The standard answer is greed: rapacious ambulance operators, owned by villainous private equity firms, exploit patients at their most helpless. But I don’t think that’s actually what’s going on. Ambulance providers are chronically unprofitable businesses; margins are thin, crews are underpaid, and operators exit the industry every year.

That paragraph is somewhat incoherent at that point in the article: margins are razor thin — at a price tag of $12,000 per 6 miles or $2,000 per mile.

(Yes, there is some other stuff, much, much, much later that maybe cuts into that …)

Re: Why American ambulance rides are so expensive

#96

Post by schmookeeg »

spicymaki wrote: post #46
Hnrobert42 wrote: post #36

Earlier quoted context omitted.

But do they really? Can you point a real, evil villain saying that?

I think we are all villains here. Good healthcare coverage is just another status symbol to be attained. If the poor have it then it becomes less of a value. To some degree we are all wired this way and we all suffer because of it.

I have had VASTLY better free health coverage (OHP, Portland OR via Providence) than the current Kaiser dreck I and employer pay significant sums for.

Healthcare is not a flex, and it my experiences on the west coast, it's an inverse correlation to wealth. :/

Re: Why American ambulance rides are so expensive

#97

Post by Freedom2 »

alistairSH wrote: post #77
Waterluvian wrote: post #11

Earlier quoted context omitted.

The last thing I want at that time is to have to reason about any of this. I think I’m realizing that what I cherish about the healthcare system up here is not just that I don’t pay bills, but that I don’t even see a bill. Not that the bankruptcy inducing costs aren’t wretched, but I just cannot even imagine being put into a fucked up bureaucratic hell while my family is in a life altering crisis.

This applies to other things as well - retirement and education come to mind. Anecdote: my uncle and BIL are auto mechanics. One in the US, the other in Scotland. Similar lifestyles - both own homes, have mechanical hobbies (vintage cars for one, Harleys for the other) - typical working class lives. The uncle in the UK just has much less mental overhead when it comes to major life planning.

Many here will say that that's the cost of the freedom of choice and speech in the US.

Re: Why American ambulance rides are so expensive

#98

Post by xp84 »

SpicyLemonZest wrote: post #91
xp84 wrote: post #71

Earlier quoted context omitted.

Be that as it may, the law in California forbids the insurance company from refusing to pay at the in-network rate in an emergency. As evidence, I'd submit the claim they immediately paid when called out on this. If the insurance company weren't cynically exploiting people's lack of knowing their rights, they'd at least send a form letter to the patient saying "Please send us whatever proof from the hospital that you…

But isn't the California law requiring the insurance company to act as a sin-eater here? They seem to be the only people you were frustrated with, even though they are not the ones who charged you $1000.

They had the duty to pay and they try to trick every one of their customers into not realizing that, so that's why I'm only mad at them.

I acknowledge that the CA law is forcing them to, in the mechanism the article covers, causing them to subsidize other people's care, and this is happening in many areas of healthcare too.

Though those costs are surely accounted for when they set their premiums, which for 2025 amounted to just over $32,000 for my family.

Re: Why American ambulance rides are so expensive

#99

Post by sarchertech »

dlcarrier wrote: post #88
arjie wrote: post #56

Earlier quoted context omitted.

The ambulance that billed me in San Francisco after my accident was run by San Francisco Fire Department.

Many fire departments in the US send bills, whether responding to medical emergencies or fires.

Many makes it seem like this is common. But it extremely uncommon in the US to get a bill after a fire. There are some rural volunteer fire departments that are funded through memberships and they will bill you if you aren’t a member. But these are not common.

Re: Why American ambulance rides are so expensive

#100

Post by Insanity »

jjk166 wrote: post #83
gruez wrote: post #9

As much as I like articles that tries to use economics or finance to explain stuff, the "options" analogy is a bit hamfisted. The article starts off by noting about how ambulance is an "option" for a rescue, but even though the analogy might vaguely work, it's not really needed to answer the question. That can be answered far more simply: "medicare and insurance companies pay them too little, so they have to charge e…

> The average ambulance transport costs $2,673 to provide I think this ignores the 400 pound gorilla in the room. Why does an ambulance transport cost thousands for the operator? This is a short trip in an automobile, essentially a fancy uber ride. At first one might say that's flippant - obviously ambulances are specialized vehicles, and you have paramedics, and they need to get to locations quickly, and so forth, b…

+1. The base price for US healthcare is entirely removed from the cost of the service provided. And you can of course just look at other countries to figure out that the cost is much higher than it should be.
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