Emergency room patients can face steep bills even when treatment is declined • Hacker News Board

Re: Emergency room patients can face steep bills even when treatment is declined

#141

Post by dragonwriter » Wed, May 02, 2018, 2:19 PM UTC

humanrebar wrote: post #54

nicktelford wrote: post #41

Earlier quoted context omitted.

This isn't at all accurate. There was no treatment for his condition beyond palliative care. He was on life support for the rest of his life, no matter what anyone did. His doctors, whose duty is to the patient, determined that it was more harmful to artificially keep him "alive" (he was in a semi-vegetative state due to serious brain damage) than to disconnect his life support and allow him to die. The offer of "car…

> The court case was between his doctors and his parents. The UK government had absolutely nothing to do with it. Is there a difference in terminology here? The courts are part of the government in my mind. And they have the ability to overrule unjust law.

In parliamentary systems, “the government” is often most frequently understood in a sense somewhst similar to the way “the administration” is used in the US, referring to basically the cabinet and their political subordinates who direct policy.

Re: Emergency room patients can face steep bills even when treatment is declined

#142

Post by Keverw » Wed, May 02, 2018, 2:25 PM UTC

Bjartr wrote: post #121

ajross wrote: post #104

Earlier quoted context omitted.

> into thinking paying ~$450 / month per adult for basic health insurance with high deductibles is a bargain because it "saves" them from $100,000+ hospital bills in an emergency scenario It is, though. Insurance is expensive, but it's not a scam. That money tends to go mostly for care, overall. Someone has to pay it. It's true that on the whole, the US tends to overpay for care and that other systems tend to get sim…

Health care has a cost, sure. But you haven't explained why that cost is so much higher in the US if outcomes aren't proportionally better.

I wonder if everyone wanting to sue in America and high malpractice insurance costs might be a reason we pay more with less quality of care in America? I mean sure if you get hurt, you want some sort of recourse but I wonder if that's why American medicine is so high.

A lot of the full time RV community parks and walks over to Los Algodones, Mexico for eye care/glasses, dental and some medicines that aren't a certain schedule they can get and are allowed to take back a certain amount. They pay cash directly, no insurance is needed.

I guess they don't drive because of needing a separate auto insurance policy for Mexico. I believe most US policies cover only Canada, but not Mexico for trips across the border. Plus it might be quicker to just walk back and forth for a day trip. There's a official border crossing back and forth on foot for pedestrians, compared to cars which has a lot longer line.

However I'm not too sure what kind of recourse you have if a dentist or some other doctor messes up. Haven't researched it too much personally. There's some YouTube videos about it though, they have like a entire block of just dental offices back to back. Kinda amazing, but it's a popular area for medical tourism. A lot of them even speak English in that town, accepts US dollars and everything. Some people just visit for lunch and check out the town.

Re: Emergency room patients can face steep bills even when treatment is declined

#143

Post by dragonwriter » Wed, May 02, 2018, 2:26 PM UTC

oldcynic wrote: post #132

makomk wrote: post #84

Earlier quoted context omitted.

From what I can tell, Americans seem to define "government" to include the courts as one of its branches, whereas Brits define it to only mean the legislative branch and maybe part of the executive in US terms. Which makes it interesting when British people accuse Americans of lying for claiming the government was responsible for this, especially since I'm sure some of those people know Americans mean something diffe…

Aren't judges appointed by the president in the US? Reports of Supreme Court candidates every time the US elects a president appears to indicate a lack of judicial independence. I'm not hugely well informed on US law so could be misunderstanding this process. Edit: Wikipedia tells me Article 3 of the Constitution makes the federal courts part of federal government

> Aren't judges appointed by the president in the US?

Appointed by, but not accountable to once appointed, and the appointments are permanent. The President can't direct judges or fire them because he doesn't like how they do their job (Congress can “fire” them by impeachment, but that requires a supermajority in the Senate after charges by a majority of the House, which means it doesn't happen on a whim of the political majority.)

Re: Emergency room patients can face steep bills even when treatment is declined

#144

Post by DoctorOetker » Wed, May 02, 2018, 2:27 PM UTC

humanrebar wrote: post #60

ClassAndBurn wrote: post #35

No other industry entirely hides the end price you'll pay, or even an estimate, until after you have gone through the service. It's a sad state of affairs but not something we have to be stuck with; most of the time we could get these numbers ahead of time. ER visits are difficult in their own ways; you can be brought in unconscious and go through treatment you can't agree to, you can be close to death and the time i…

> I don't have an answer other than universal healthcare. What about requiring published price lists? Maybe you need twelve procedures because you're in bad shape, but at least the bill won't be arbitrary.

something like a chargemaster?

https://en.wikipedia.org/wiki/Chargemaster

That said, mandatory transparency (from both the hospitals as the insurance/healthcare plans on what exactly happens in what scenario (say x-ray for possibly broken elbow), and the current rate/probability of scenarios) should be requisite, but that is only a necessary condition. The behaviours of the medical industry should also be binding.

Re: Emergency room patients can face steep bills even when treatment is declined

#145

Post by corpMaverick » Wed, May 02, 2018, 2:27 PM UTC

Similar thing happened to us.

My 3 year old son hurt his arm. It was after 7pm so we had to go to the ER. We see a nurse, she didn't check anything. X-Rays and then they gave us a hospital room. Immediately I realized we were getting into a spending black whole. After 30 seconds I told the nurse we wanted to leave. My son wasn't crying and he was climbing a chair using his "hurt" arm. They wouldn't let us leave. After hustling with them we left. we got a $1,500 USD bill that we had to pay because we didn't know what to do.

Re: Emergency room patients can face steep bills even when treatment is declined

#146

Post by assblaster » Wed, May 02, 2018, 2:28 PM UTC

clarkmoody wrote: post #82

Plenty of anecdotes in this thread, predictably. Let's talk about why things are so messed up. The thing to realize here is that total government provision of healthcare is probably cheaper than the way the US does it, but that doesn't mean the market has failed. Healthcare in the United States is anything but a free market. It's the worst of all worlds: special interests extract rents through government regulations…

This poster gets it right 100%.

In an ideal hospital, you should only have doctors, nurses, nurse assistants, nurse manager, accounting, pharmacy.

Think of all the unnecessary healthcare MBAs that siphon off enormous amounts of resources to generate as much profit as possible to be shared with other healthcare MBAs.

Think of all the suppliers of healthcare goods that try to patent and profit off of unnecessary medical "inventions" which do not make a difference compared to what was done previously.

Think of all the government bureaucrats paid to ration healthcare resources by underpaying for services which burden hospitals and doctors to raise charges for private insured.

Think of all the patients who don't give a crap about their health and refuse to correct their chronic conditions and rather go to the ER when things get really bad.

Think of all the lawyers who profit off of bad outcomes (not malpractice necessarily) which forces hospitals and doctors to practice defensive medicine.

Making everything single payor won't work, because guess what, there will still be a private insurance system for the people who can afford it vs the system for the rest. It doesn't fix anything.

Re: Emergency room patients can face steep bills even when treatment is declined

#147

Post by darpa_escapee » Wed, May 02, 2018, 2:29 PM UTC

OnMyPhone wrote: post #65

toomanybeersies wrote: post #9

How can people read and hear about stories like this, and even possibly think it's OK or even normal? How do lawmakers in the USA convince people that this is acceptable? I have never directly paid a single cent for healthcare, and neither has anyone I know. When I had to get 6 stitches in my forehead at 2 AM on a Sunday morning, it cost me nothing. When my friend needed to get the tip of his finger reattached, it co…

I hate it all, and would rather pay much more taxes if we had universal healthcare. That aside, I had a few different people give me the following reason why this is acceptable to them. "Why should we pay any of our hard earned money to the government so some drug addict can get their fix?" "Why should I pay for single mothers who made bad decisions?" It is almost always other people making poor decisions or getting…

> There is NO getting through to some of these people until they need the help they refuse to pay for. I have seen one couple change their minds once their insurance refused to cover something for their kid. Immediately they were "raising awareness" for this type of stuff... but whatever at least they eventually came to.

There's a risk associated to the type of thinking that takes root before a breakthrough experience like this: it's the idea that if something bad like were to happen to them, it's because they are exception to the rule, where the rule is plugging your ears and repeating personal responsibility over and over again.

That's to say such a situation gets internalized as, "It's unfair that my treatment isn't covered because I pay for insurance coverage, so of course I expect to be covered when I'm sick. If you don't pay for insurance, you shouldn't expect anything."

Which is a close relative to, "It's okay that I'm benefiting from public assistance, because I'm actually suffering and I'm not cheating the system like everyone else."

Re: Emergency room patients can face steep bills even when treatment is declined

#148

Post by briandear » Wed, May 02, 2018, 2:29 PM UTC

clarkmoody wrote: post #96

21 wrote: post #66

Earlier quoted context omitted.

Does this actually work? Won't they detain you and call the police like a shop or restaurant would if you don't pay the bill?

You forgot the "They must treat you by law" part. You are effectively coercing them into treating you when you walk in the door.

Actually they don’t have to “treat” you per se — only stabilize a life-threatening emergency condition. They don’t have to treat your sore throat.

Re: Emergency room patients can face steep bills even when treatment is declined

#149

Post by usefulcat » Wed, May 02, 2018, 2:30 PM UTC

Ensorceled wrote: post #45

I recently had a spot appear in my vision. Went to my GP same day, the receptionist called around to get me into a local optometrist who determined it was a detached retina, she called and got me into the local hospital as an emergency case. It was busy but I got my first treatment that evening. The entire journey, my green OHIP card was all I needed, no insurance forms, no pre-approvals, no extra charges. 5 hospital…

> 2. The US system is by far the best and that's why it's so expensive

Cognitive dissonance and/or Stockholm syndrome?

Re: Emergency room patients can face steep bills even when treatment is declined

#150

Post by Bootvis » Wed, May 02, 2018, 2:30 PM UTC

spsrich wrote: post #22

Any parent has similar stories. Consumer law does not seem to apply to doctors and hospitals. Imagine if you took your car into the shop - there is no price list, they won't give you an estimate, and for weeks after they send you random bills without indicating what it's for? This affects everybody in the US, and I don't understand why it's allowed to continue, except the medical industry has bought off all the polit…

'Any _American_ parent' has similar stories