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Why American ambulance rides are so expensive

davidoks.blog

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Re: Why American ambulance rides are so expensive

#191

Post by jjk166 »

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…

Replying to myself as a followup:

https://digitechcomputer.com/costs-of-ems-readiness/

Looks like of the $1954 they estimate for a transport (already quite a bit below TFAs $2673), $1582 is salary. Given that we established the crew in the ambulance are taking home about $140 per transport between them, this seems bonkers. Capital, medical supplies, and fleet maintenance are a whopping 6% of the "cost".

Re: Why American ambulance rides are so expensive

#193

Post by mdavid626 »

Anywhere else in the world it’s possible to do this orders of magnitude cheaper.

But yes, it’s because of “options” and not because of greed.

Some group of people tries to extract as much money as possible. You can call this capitalism. I think it’s a big scam.

Re: Why American ambulance rides are so expensive

#194

Post by jjk166 »

jfim wrote: post #142
deathanatos wrote: post #95

Earlier quoted context omitted.

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 …)

The cost isn't about the actual mileage though, it's having two paramedics each earning about 100k/yr per ambulance, while having coverage 24x7x365. So fully loaded, the labor for one ambulance might be in the high six figures to seven figures.

Except the paramedics are actually making mcdonalds wages.

Re: Why American ambulance rides are so expensive

#195

Post by DoesntMatter22 »

duskwuff wrote: post #38
DoesntMatter22 wrote: post #31

Earlier quoted context omitted.

You don’t have to. You do what you want. I’d prefer to hire a company where the workers make more money. Right now they make a pittance.

Someone who's having a medical emergency is certainly in no position to go comparison shopping for ambulance services.

You would do it before hand of course

Re: Why American ambulance rides are so expensive

#196

Post by ButlerianJihad »

wewewedxfgdf wrote: post #37

There should be an "Uberlance" - discount emergency pickups by Uber, at Uber prices.

There is a gigantic business called "NEMT" "Non-Emergency Medical Transport" that has been filled by taxis and rideshares for decades. I first discovered this service when I broke my leg in 2006, and Medicaid was paying for taxi vouchers so that I could travel to far-flung orthopedic appointments over the span of 9 months. Otherwise I'd be on the bus, on crutches: ouch!

So NEMT can cover a lot of use cases where people are stable and just going to PCP or specialist visits. Or even behavioral health appointments. There are now dedicated NEMT providers, like Veyo out of San Diego.

In fact, when I broke my leg, there was talk of calling an ambulance. But I was only about 3 miles from the destination hospital, and there were many wise people nearby, so several of them suggested I just call a cab and take the cab to the E.D. instead, because that was far more efficient. So that's what we did, because really, I didn't need any life support, or blood transfusion, or rescuscitation on the way there.

Since the billing SNAFU last Thanksgiving I also learned about the difference between BLS and ALS. For some reason the ambulance provider billed for ALS even though none of that was necessary. Of course, ALS costs more and bills more and probably profits them more. I should have contested this stupid account trick, but whatever. They haven't even billed me for the "co-pay" yet, so we still need to wait and see how this shakes out.

Re: Why American ambulance rides are so expensive

#197

Post by vineyardmike »

harmmonica wrote: post #117
jjk166 wrote: post #83

Earlier quoted context omitted.

> 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…

Probably an obvious/dumb thing to say on HN, but I just want every medical service to have this exact type of breakdown. And then we can at least somewhat pierce the veil of health care costs. The thing I can't figure out is why this doesn't already exist, or, if it does, why it's not more widely known amongst laypeople. Everything from ambulance rides to MRI's to surgeries can be baselined and then we can talk about…

> I just want every medical service to have this exact type of breakdown

Check out the "No Surprises Act"

https://www.cms.gov/priorities/key-initiatives/hospital-pric...

Re: Why American ambulance rides are so expensive

#198

Post by msftgreed »

ethersteeds wrote: post #43
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…

> most of the world has solved it by making ambulance (EMS) funding similar to fire... About 65% of the more than one million firefighters in the U.S. are volunteers, with nearly 19,000 fire departments being run completely by volunteers.

You know we can have volunteer supported services be very effective, right?

I volunteer to give blood. No one is paying me, and yet, someone's life is saved by that.

Some folks believe (in fact, this is the thesis statement of much of anarchist theory) that people would largely volunteer to care for one another if their basic needs were met.

Not everything has to be transactional, you can have a government setting up a scaffold that supports and encourages and organizes volunteers and run an effective service.

Re: Why American ambulance rides are so expensive

#199

Post by msftgreed »

vlian2088 wrote: post #18
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…

the reverse side of that medal is that in 'most of the world' EMS quality is ass.

Well, here it is often ass AND expensive. I'd take ass and free over ass and expensive.

Re: Why American ambulance rides are so expensive

#200

Post by msftgreed »

dodger-dog wrote: post #152

"On appeal, his insurance agreed to cover $9,967 of the charge—better than nothing, but it still left him on the hook for about $3,000." Tell the insurance company to wait to release the funds until you talk to the ambulance company or to release the funds directly to you. Tell the ambulance company they can take the $9,967 or get zero.

This isn't sustainable. You really want every person who is dealing with this bureaucracy to manage negotiating between their insurance and their EMS? After they've just had a significant accident/health issue?

That seems needlessly cruel to do to people.

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