Why American ambulance rides are so expensive • Hacker News Board

Re: Why American ambulance rides are so expensive

#481

Post by throwaway2037 » Sat, Jul 11, 2026, 5:18 AM UTC

xp84 wrote: post #447

throwaway2037 wrote: post #339

Earlier quoted context omitted.

> I immediately filed a complaint with the insurance company's California regulator (at the time it was the Dept of Insurance for this one, but it seems most or all now are under the Department of Managed Health Care) since insurance companies are by law obligated to pay at the in-network rate in the case of an emergency (which presumably is why you call an ambulance in the first place). Within 2 weeks I received a l…

Agree. I would be utterly shocked if this exact same scam didn't play out for every ambulance call in San Francisco (And according to this article, it's actually completely normal that the "networks" are nonexistent, so multiply that by every city and town!) What percentage of patients are likely to be taking ANY action that leads to insurance paying? Either spending (as someone else shared) 5 phone calls trying to c…

Another solution: Each year, require health insurance companies to self-report (via third party auditor) the number of violations. Then they need to refund all illegal collections with penalty and pay a large penalty to the regulator. This kind of shitty illegal behaviour would disappear overnight. After the Global Financial Crisis in 2008/2009, some new laws were passed to regulate trading by investment banks. Many of the rules work this way and they work!

Re: Why American ambulance rides are so expensive

#482

Post by Symbiote » Sat, Jul 11, 2026, 5:35 AM UTC

refurb wrote: post #401

bestouff wrote: post #296

Earlier quoted context omitted.

I think only the US consider the US Democrats as leftists.

The Democratic Party spans from slightly right to ragging left that even European leftists look at with confusion.

What's the name of the far left grouping?

Re: Why American ambulance rides are so expensive

#483

Post by wisty » Sat, Jul 11, 2026, 5:39 AM UTC

nkrisc wrote: post #379

wisty wrote: post #240

Earlier quoted context omitted.

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…

Most doctors and nurses are not overpaid. Certain specialities probably are overpaid (orthopedics), but others like pediatricians or general practitioners usually aren’t. And nurses!? From the nurses I know they are underpaid for what they deal with. The ones making loads of many are willing to travel around the country and uproot their life once or more every year. Not exactly a lifestyle without its drawbacks.

Everyone is gonna say nurses are underpaid. It's a caring, female dominated profession, it's a motherlove sentiment. And they are not paid as well as doctors.

Yeah, most pink / blue collar workers in the US are badly underpaid, but IIRC ones in the health sector are some of the best off, relative to medium salaries.

Compare teachers and nurses. In most countries they make about the same AFAIK (and I'd say nurses do deserve more, telling a parent Billy did badly on a math test has got to be easier than explaining a bad medical test). But in the US it's about 75k vs 95k. There's a huge premium for working in health in the USA, EVEN in the underpaid blue collar end.

Doctors make out even better in the US, and the c suite in health can have salaries that are just insane.

Re: Why American ambulance rides are so expensive

#484

Post by wisty » Sat, Jul 11, 2026, 5:43 AM UTC

refurb wrote: post #400

wisty wrote: post #240

Earlier quoted context omitted.

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…

The US healthcare system just upsells on unnessessary crap. It's junk volume or at best it's heroic high tech solutions mostly making up for the fact that people stay away from hospitals until it's too late.

Life expectancy shows that while the US is the best place to have stage 4 cancer, it's probably not the best place overall. Most places do the 80/20 stuff better.

But yeah, you are right that the US does some stuff well. Just not efficiently.

Re: Why American ambulance rides are so expensive

#485

Post by fragmede » Sat, Jul 11, 2026, 5:44 AM UTC

DoesntMatter22 wrote: post #195

duskwuff wrote: post #38

Earlier quoted context omitted.

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

Let me just schedule in plans for my future heart attack and car accidents.

Re: Why American ambulance rides are so expensive

#486

Post by refurb » Sat, Jul 11, 2026, 6:55 AM UTC

Alpha3031 wrote: post #479

refurb wrote: post #475

Earlier quoted context omitted.

Strawman. Ask any ER about “frequent flyers” who use ambulances as taxis

It's not a strawman. Ruining entire countries is literally what the parent comment said would happen if we do something as outrageous as making ambulances free. > But those same people, through one false rationalization or another, are more than happy to ruin the entire country. You may not have agued it yourself but your two sentence comment is rather lacking in alternate arguments, so I can only interpret you as su…

What do you consider financial ruin? Last time I checked most of those countries are desperately trying to contain their healthcare spending.

Re: Why American ambulance rides are so expensive

#487

Post by lostglass » Sat, Jul 11, 2026, 6:56 AM UTC

refurb wrote: post #476

dghlsakjg wrote: post #417

Earlier quoted context omitted.

A good tell that someone is utterly full of shit on Canadian healthcare is that they generalize all of Canada. “Canadian health care” is not a thing. Each province administers its own completely independent system. Someone on PEI is in a healthcare system that has as much to do with Alberta’s healthcare system as it does their neighbours in Maine. As a result, anyone referencing Canadian healthcare is talking about a…

You’re ignoring the fact that provinces can’t fund technology that the federal government hasn’t reviewed and negotiated a price for. So yes there may be differences between provinces in terms of when they fund what restrictions are put on it, the overall trend across Canada is pretty consistent. And as I said Canadians don’t get the same care as Americans so concluding the higher cost is entirely higher prices for t…

I lived in Ontario for 20 years then I lived in Seattle for the next 17, I assure you that the healthcare I receive and received is pretty much the same - except in Ontario it's way cheaper.

You're talking about cutting edge technologies available to the tiniest sliver of people - I'm not even able to get access to much of them with my private FAANG insurance - and drawing a false comparison.

Re: Why American ambulance rides are so expensive

#488

Post by Lio » Sat, Jul 11, 2026, 6:56 AM UTC

Lio wrote: post #218

> a car hit him; he did, in his words, “a little flip” over the vehicle, landed in the road He was lucky he was hit by a car. A slab fronted SUV or pickup would have dragged him underneath and so it goes.

OK for those that seem to dislike the suggestion that pickup trucks and SUVs kill more than cars do here's a study from the BMJ.

Specifically, with regard to the shape of the front of the vehicle:

> A large recent study in the USA found that, as compared with the low and sloping front end of a traditional passenger car, the odds of pedestrian fatality increased by 45% if the striking vehicle had a tall and sloped front end; increased by 44% if the striking vehicle had a tall and blunt front end; and increased by 26% if the striking vehicle had a medium-height and blunt front end.

https://injuryprevention.bmj.com/content/32/1/16

Re: Why American ambulance rides are so expensive

#489

Post by refurb » Sat, Jul 11, 2026, 8:00 AM UTC

wisty wrote: post #484

refurb wrote: post #400

Earlier quoted context omitted.

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…

The US healthcare system just upsells on unnessessary crap. It's junk volume or at best it's heroic high tech solutions mostly making up for the fact that people stay away from hospitals until it's too late. Life expectancy shows that while the US is the best place to have stage 4 cancer, it's probably not the best place overall. Most places do the 80/20 stuff better. But yeah, you are right that the US does some stu…

US care is highly aligned with international guidelines. Saying "it's junk volume" just tells me you're not that close to the data.

Life expectancy doesn't measure quality of healthcare, there are far too many confounding variables like genetics, diet, accidental deaths, etc. No serious study of healthcare quality relies on it.

Look at 5-year cancer survival rates. The US is better (significantly better) in many of them than other countries. A big part of that is access to the latest technology.

https://www.thelancet.com/journals/lanonc/article/PIIS1470-2...

Re: Why American ambulance rides are so expensive

#490

Post by refurb » Sat, Jul 11, 2026, 8:12 AM UTC

lostglass wrote: post #487

refurb wrote: post #476

Earlier quoted context omitted.

You’re ignoring the fact that provinces can’t fund technology that the federal government hasn’t reviewed and negotiated a price for. So yes there may be differences between provinces in terms of when they fund what restrictions are put on it, the overall trend across Canada is pretty consistent. And as I said Canadians don’t get the same care as Americans so concluding the higher cost is entirely higher prices for t…

I lived in Ontario for 20 years then I lived in Seattle for the next 17, I assure you that the healthcare I receive and received is pretty much the same - except in Ontario it's way cheaper. You're talking about cutting edge technologies available to the tiniest sliver of people - I'm not even able to get access to much of them with my private FAANG insurance - and drawing a false comparison.

Nope. I've not only lived in both countries, I work in healthcare so I'm very close to who gets access to what.

And it's not "the tiniest sliver of people", we're talking about disease like cancer. Check out the CAR-T rates in the US vs. Canada, the difference is stark. And CAR-T is standard of care in some types of lymphoma.

Hell, ask parents with autistic kids what kind of early intervention is available to them in Canada. I had a coworker who moved to the US so he'd have much better access for his kid at a time when it had a big impact.

Look at access to the cystic fibrosis therapy that effectively cures it (e.g. Orkambi). It was paid for by insurance (and Medicaid!) from the day it was launched and avaiable to everyone it could help. In Canada some provinces just started paying for it, but only kids, adults are shit outta luck.

And I don't know the details of your FAANG insurance, but my US insurance (typical corporate insurance) pays for all these new technologies.

Canada is great if you have a routine issue. If you need something specialized you're going to be treated with therapies that are a decade or more old. Hell, even the CBC wrote a whole story about 2 friends with breast cancer and the differences in treatment.

https://www.cbc.ca/news/canada/british-columbia/a-tale-of-2-...

"Then I found out that this other country — which I thought had a healthcare system that was so superior to the U.S. — doesn't test for the tumour marker that saved my life, and doesn't cover this drug that is responsible for pushing my cancer into remission after traditional chemotherapy failed to do that."