Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

What I learned from reading a thousand emergency room bills

vox.com

Post reply on HN
Print view View original

11–20 of 592 posts

Re: What I learned from reading a thousand emergency room bills

#11

Post by serg_chernata »

codemusings wrote: post #7

Despite the fact that in my opinion this could be fixed by Universal Healthcare I'm left wondering: how is it legal to be billed these insane amounts of money without even getting a quote beforehand? Like just waiting in the ER is worth more than buying a first class airplane ticket and getting treated in another country.

> without even getting a quote beforehand

Reminds me of this really good article. TLDR: Man tried to call a number of hospitals to find out how much childbirth is going to cost him and received no answers.

https://www.vox.com/2016/5/5/11591592/birth-cost-hospital-bi...

Re: What I learned from reading a thousand emergency room bills

#12

Post by lolsal »

corybrown wrote: post #8
lolsal wrote: post #3

I know $60 Ibuprofen can seem like a lot, but is anyone arguing that you're literally paying for only the pill(s) with that $60? Aren't you paying for the instant availability, the insurance that it's not expired (do they even expire? I really don't know), and confidence that your healthcare provider has signed off that XXX mg of Ibuprofen is a.) OK to have with your current medications and conditions and b.) suffici…

> I charge clients similarly. I overbid projects that I don't really want to do. If you want me to setup Wordpress for you, I'll charge you out the nose. Granted, you get to accept my fees before I ever send you a bill. It's not a perfect analogy. One can always forgo setting up WordPress, which is not always the case with healthcare.

Totally understood; that's one of the ways that it's not a perfect analogy.

Conversely if someone told me to setup Wordpress and that I could only charge $50, I'd change industries in a heartbeat.

Re: What I learned from reading a thousand emergency room bills

#13

Post by scrollaway »

lolsal wrote: post #3

I know $60 Ibuprofen can seem like a lot, but is anyone arguing that you're literally paying for only the pill(s) with that $60? Aren't you paying for the instant availability, the insurance that it's not expired (do they even expire? I really don't know), and confidence that your healthcare provider has signed off that XXX mg of Ibuprofen is a.) OK to have with your current medications and conditions and b.) suffici…

> Isn't some of that cost the healthcare provider's expertise and service?

In theory maybe. Usually I would say these things are not exactly top priority and you are not getting your money's worth in the premium there. At best, of your list, you're paying for the instant availability, but what about the times where it's not instantly available? You're not paying for a guarantee of it.

Re: What I learned from reading a thousand emergency room bills

#14

Post by vec »

Exhibit A for why "free market healthcare" is an oxymoron.

I have yet to hear a coherent explanation for how anyone can reasonably expect for price discovery to even pretend to function in a market where the consumers can't even guess the prices until after they've already purchased and frequently couldn't reasonably be expected to refuse service even if they did believe it was overpriced.

Re: What I learned from reading a thousand emergency room bills

#15

Post by mikeash »

lolsal wrote: post #3

I know $60 Ibuprofen can seem like a lot, but is anyone arguing that you're literally paying for only the pill(s) with that $60? Aren't you paying for the instant availability, the insurance that it's not expired (do they even expire? I really don't know), and confidence that your healthcare provider has signed off that XXX mg of Ibuprofen is a.) OK to have with your current medications and conditions and b.) suffici…

I'm guessing you tell your clients, "I'm not really the right person to set up WordPress for you. I can do it, but it'll be incredibly expensive. You can probably do it yourself with a good online tutorial."

Hospitals aren't telling their patients, "We're not really the right institution to give you ibuprofen. We can do it if you really want us to, but it'll be incredibly expensive. You can just go buy some at the store for like ten cents." In fact, I bet that even if you have the presence of mind to decline their ibuprofen because you'd rather get your own, they'll strenuously argue against it, or even start treating you as not following medical orders.

In any case, it would be a lot more palatable if they'd charge marginal costs for marginal items, and charge overhead separately. It may well cost them something on the order of $60 to give someone ibuprofen, on average, but it does not cost them $60 more to give one more person ibuprofen. It would be more honest to charge two cents for the pill, and separately charge your fair share of the cost of the staff that obtains, vets, distributes, and administers that pill along with everything else you're getting.

Re: What I learned from reading a thousand emergency room bills

#17

Post by dbt00 »

lolsal wrote: post #3

I know $60 Ibuprofen can seem like a lot, but is anyone arguing that you're literally paying for only the pill(s) with that $60? Aren't you paying for the instant availability, the insurance that it's not expired (do they even expire? I really don't know), and confidence that your healthcare provider has signed off that XXX mg of Ibuprofen is a.) OK to have with your current medications and conditions and b.) suffici…

> I know $60 Ibuprofen can seem like a lot, but is anyone arguing that you're literally paying for only the pill(s) with that $60? Aren't you paying for the instant availability, the insurance that it's not expired (do they even expire? I really don't know), and confidence that your healthcare provider has signed off that XXX mg of Ibuprofen is a.) OK to have with your current medications and conditions and b.) sufficient to do the job? Isn't some of that cost the healthcare provider's expertise and service? Would it be better if they prescribed morphine and charged you a magnitude more when ibuprofen would have done the job?

It's hard to argue the 600x markup is there to cover overhead when they literally have a facility charge there to cover overhead.

You also have separate line items for each of the things you mentioned -- doctors, nurses, staff, etc. You are paying for that expertise, often many times over, in addition to a $60 pill that retails for $0.10 at the local Walgreens (who also manages to make sure that it's not expired).

Re: What I learned from reading a thousand emergency room bills

#18

Post by lolsal »

I wonder what healthcare bills would look like if they were itemized so that things like Ibuprofen were literally billed at cost ($0.25 per?) and there were line items for services/labor that captured the real cost of being a medical professional:

- Emergency room wait: $0.10 for lights

- OTC eyedrops (4 drops): $0.20

- Triage by on-duty nurse: $100 (@ $300/hr)

- Consult by on-duty physician: $220 (@ $600/hr)

- Late-night convenience fee: $100 (between 7pm and 7am)

etc. I made up all the numbers, I have no idea how healthcare professionals calculate their hourly rate.

Re: What I learned from reading a thousand emergency room bills

#19

Post by [deleted] »

vec wrote: post #14

Exhibit A for why "free market healthcare" is an oxymoron. I have yet to hear a coherent explanation for how anyone can reasonably expect for price discovery to even pretend to function in a market where the consumers can't even guess the prices until after they've already purchased and frequently couldn't reasonably be expected to refuse service even if they did believe it was overpriced.

[deleted]

Re: What I learned from reading a thousand emergency room bills

#20

Post by cronix »

lolsal wrote: post #3

I know $60 Ibuprofen can seem like a lot, but is anyone arguing that you're literally paying for only the pill(s) with that $60? Aren't you paying for the instant availability, the insurance that it's not expired (do they even expire? I really don't know), and confidence that your healthcare provider has signed off that XXX mg of Ibuprofen is a.) OK to have with your current medications and conditions and b.) suffici…

If they told me it would cost $60 for a simple Ibuprofen, I'd get out of bed and walk myself down the pharmacy on the first floor where they are regularly priced (in the SAME building), or send a family member down for that 10 minute walk to save $50 times how many you need to take. The pharmacists know the drugs I'm taking and interactions, yet the Ibuprofen isn't marked up a couple hundred percent.
Post reply on HN