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Why American ambulance rides are so expensive

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Re: Why American ambulance rides are so expensive

#391

Post by culopatin »

lazide wrote: post #274
grogenaut wrote: post #207

Earlier quoted context omitted.

Is this the common cost or is this an outlier blog story that hit it off. Talk real data to me. I don't get excited about any individual anecdote (unless it's me personally of course). No people shouldn't be bankrupted for a short cab ride that's not needed. I'm not arguing that.

Well over a decade ago, it was $6500 for a couple mile ride to the nearest hospital, no emergency medical care necessary (just supervision). This was in the Bay Area, in California. I can’t imagine it’s gotten cheaper.

Yeah my mom got billed 9k a few months ago from SFO to one of the south sf hospitals. Neck brace and supervision was all that was needed. Basically an expensive uber ride.

Re: Why American ambulance rides are so expensive

#392

Post by culopatin »

fuckyah wrote: post #216
onion2k wrote: post #205

Earlier quoted context omitted.

I don't think the question is "Should ambulances be a thing?" though. It's a question of "Should someone in a situation where they need an ambulance have to balance the potentially life-threatening impact of saying no versus the potentially financially ruinous impact of saying yes?" The (fairly obvious) answer to that no one should be in that situation. It's horrible. Society should find a better way to pay for ambul…

[flagged]

Even with insurance all these companies will fight with each other to find excuses to say it’s not their responsibility and send you letters non stop saying things like “oh you paid for the van, I’m just the nurse, it’s separate” or “oh yeah you paid for the hallway in the hospital but the ct scan person is a contractor, you owe them 3k”. System could not be more broken

Re: Why American ambulance rides are so expensive

#393

Post by culopatin »

deepsun wrote: post #208
grogenaut wrote: post #170

He refused to go in an ambulance the first time. He could have refused the second ride. You can refuse transport or medical care at any time as long as you are able to make rational decisions. As an EMT if you're A&Ox4, alert to time, place, person and event, you make the choices. You do sign a release so we have proof we didn't abandon you, but you make the choice. If we move you without your approval, it's kidnappi…

> but you make the choice No US doctor would ever tell you how much any procedure would cost (even though they know, at least "in-network" doctors). But if in your EMT you inform the patient of the potential costs of the ride, then yea, I agree they make an informed choice.

You’re getting in an ambulance, not calling a cab. You’re probably unconscious, maybe at least disoriented, overwhelmed, concerned about what’s happening more than doing math. Also you’re there on the floor bleeding, what’s your alternative? “Nah don’t worry, I’ll figure out this exposed fracture in the uber, I got points with them so it’s cheaper”?

Re: Why American ambulance rides are so expensive

#394

Post by memcg »

I called 911 last year when my wife was unresponsive in Maryland. At least 10 vehicles arrived in under 10 minutes. EMTs worked to revive her for 30 minutes doing what they described as the same care she would have received at the emergency room.

She was transported to the hospital because she had a slight heart beat. Had she been declared dead at home, police and other staff would have helped process the death report and application for death certificate. I did not receive a bill or provide insurance information.

Re: Why American ambulance rides are so expensive

#395

Post by manarth »

pjc50 wrote: post #228
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…

Comparable UK costs: https://www.kingsfund.org.uk/insight-and-analysis/data-and-c... Estimate for an ambulance call is about £450. I suspect the main reason the US costs more is wages.

Wages for which role?

UK – Newly Qualified Paramedics (Band 5): £28,407 – £34,581. USA - $38,000 to $48,000: £28,323 – £35,777

Sure, there's a bunch of different tax treatments and work-benefits between the countries, but I don't think it's the cost-of-labour that is making the USA more expensive.

Re: Why American ambulance rides are so expensive

#396

Post by stasomatic »

xp84 wrote: post #22

I tell this story every time ambulance costs come up because it might be helpful to anyone. I once lived in San Francisco in the mid-2010s. In SF, the SFFD operates the vast majority of ambulances in the city. As in, 80%+. I once had the need to go to the hospital urgently and called 911. The ambulance that showed up was SFFD. They transported me and I recovered safely. I then got a bill from them saying that my insu…

Branded GPL-1s cost $1-1.5K a month in the States without insurance coverage, $25 with coverage. Something's rotten, I doubt big pharma eats the difference, they'll get theirs.

Re: Why American ambulance rides are so expensive

#397

Post by HumblyTossed »

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.

You're getting down voted, but there's substance here. A "job with benefits" is a badge of honor for some. That means they've "worked hard" and "earned it".

Re: Why American ambulance rides are so expensive

#398

Post by HumblyTossed »

gruez wrote: post #92
spicymaki wrote: post #46

Earlier quoted context omitted.

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…

Not a one. But... I have had many conversations with people who feel they have "earned" healthcare because they "worked hard" and finally obtained a "job with benefits".

And this is exactly why those same people do NOT want universal healthcare.

Re: Why American ambulance rides are so expensive

#399

Post by refurb »

otherme123 wrote: post #212
onion2k wrote: post #205

Earlier quoted context omitted.

I don't think the question is "Should ambulances be a thing?" though. It's a question of "Should someone in a situation where they need an ambulance have to balance the potentially life-threatening impact of saying no versus the potentially financially ruinous impact of saying yes?" The (fairly obvious) answer to that no one should be in that situation. It's horrible. Society should find a better way to pay for ambul…

> Society should find a better way to pay for ambulances Society has this figured out, at least a decent solution that works until we find a perfect one. Only the US society seems to be unable to find a solution.

Canada doesn’t pay for ambulances unless it’s truly an emergency. Think you’re having a heart attack but you’re not? Time to pony up hundreds of dollars

Re: Why American ambulance rides are so expensive

#400

Post by refurb »

wisty wrote: post #240
otherme123 wrote: post #212

Earlier quoted context omitted.

> Society should find a better way to pay for ambulances Society has this figured out, at least a decent solution that works until we find a perfect one. Only the US society seems to be unable to find a solution.

And the US also pays a TON of tax dollars to a broken, overregulated system. IIRC if you look at the cost of Medicaide, Medicare, VA, and other federal and state spending it's the same as most other countries per capita or as a percent of GDP. The US taxpayer pays about as much as Canadians to fund their public system, then pays the same amount again for private cover since it's not universal. No I'm not making a typ…

Canadians don’t get the same care as Americans.

McKinsey did a nice analysis of what is driving US healthcare costs. It compares category spending to OECD then compared price and volume.

Turns out the US pays a bit more for drugs (relative to total spend), a little more for inpatient care and a TON more for outpatient care but half of the increase is volume, not price.

As someone who works in healthcare globally, the difference in US care is stark. Americans get much early and more access to new technology than other countries.

If your lymphoma has returned and you have a 20% of living more than a few years the best care is CAR-T with cure rates close to 60%.

Check out CAR-T rates in the US versus Europe, it’s almost 3x. The US started using it in 2014 and Singapore just started paying for last year (11 years later). Even in Europe adopt only ramped up in the last 5 years.

So yes prices are higher, but a big part is more aggressive care with more expensive treatment.

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