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What I learned from reading a thousand emergency room bills

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

#151

Earlier quoted context omitted.

Exactly. It's the same reason we don't have free market police and fire services. You simply don't get to "shop around" for emergency services, which includes privatized ambulance services (which are outrageously expensive, on the order of $12,000 for the ride I took when I had to take one, and it was a relatively benign one... thank god I had insurance). EMS is covered, but that's the Fire Department. After that, it…

> You simply don't get to "shop around" for emergency services You do actually, by where you choose to live and also by the services as detailed in [1]. I think there's merit to investigating public health care. That line stops for me in eliminating private care. 1] https://www.theatlantic.com/technology/archive/2018/11/kim-k...

"Move to a better market" seems like an argument that some local marketplaces have failed. The whole value proposition of the free market is that it improves the available services and prices through competition. If I have to move somewhere else to find a market where this is true then the local market is clearly failing and the free market idea doesn't work.

Said another way: Should I then also move when I want to find a better price on milk?

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

#152
post #24

Earlier quoted context omitted.

I was not an advocate for gov't health care, but I am now for the same reason you stated. I have a high deductible plan, and have tried to get quotes in advance, but never can. I have been ripped off multiple times, despite trying to do my research, etc. My wife is a doctor, and at this point, I think single-payer is the least bad option.

I find myself in the same boat. I've spent more from my HSA this year than I put into it (and I put in $6900) while I'm nowhere near hitting my deductible ($6K) because for whatever reason the insurance only thinks I've spent $2.7K. During this time I've tried to shop around, find the least expensive option (none of my medical needs this year have been urgent) and it's been impossible. Nobody can tell me. "You'd have…

Do any doctors actively campaign to change these billing practices? Bogleheads.org seems to have quite a few Docs that post there, and the attitude is mostly "I went into medicine to practice medicine / Gee, I don't bill at all, I leave that to the hospital" and other great flippant attitudes. Probably a poor community to judge the standards of medicine by as it's mostly a 1%er forum that happens to have some good advice, but that's the only exposure I have outside of my 5 minute $400 visits with specialists.

You'd think they'd be a bit more invested in the process of healing, but I haven't found much evidence of that. I hope I'm horribly wrong here.

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

#153

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...

Well, in fairness to the hospitals, most of us here are software developers: how many times, early on, did somebody push you to give an "estimate" for a task that was underspecified and then try to hold you to that estimate? How many times did it happen before you learned to sidestep estimates unless you already knew everything that you needed to know beforehand?

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

#154

Earlier quoted context omitted.

I find myself in the same boat. I've spent more from my HSA this year than I put into it (and I put in $6900) while I'm nowhere near hitting my deductible ($6K) because for whatever reason the insurance only thinks I've spent $2.7K. During this time I've tried to shop around, find the least expensive option (none of my medical needs this year have been urgent) and it's been impossible. Nobody can tell me. "You'd have…

The problem with single payer is that it results in shortages. Look at waiting lists for the NHS, especially for mental health or routine surgery. That is a direct consequence of single payer. An unpopular view, but it is a fact.

I am skeptical of a causal relationship there. In the United States, approximately 2/3 of healthcare costs are already borne by the government. My parents are both enrolled in Medicare and they are very satisfied. Why would it not work if we just dropped the eligible age for Medicare to zero? Hasn't this been extensively studied recently?

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

#155
post #67
post #25

Earlier quoted context omitted.

> But it is unfair to have no idea what costs you are facing and whether any of those costs are out of network on your insurance. It's practically impossible to make an informed economic decision about truly emergency medical care without heavy regulation. It's not uncommon to be literally unconscious while all the care decisions for you are being made by others. See this article for an example: some uninsured woman…

I would imagine regulation is a lot of what stops competing on price like everything else.

> I would imagine regulation is a lot of what stops competing on price like everything else.

Say again? Unconscious people don't have the agency to make price competition work, regulation or no.

You need to be conscious to comparison shop. You also need lots of time to do so, time you don't have when you're having a heart attack or bleeding out from a severe injury. Regulation isn't the problem here, it's the lack of the right kind of it.

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

#156
post #60

Earlier quoted context omitted.

Emergency situations are exactly what insurance is for. Emergencies account for a minority ( Nobody advocating for free market healthcare is expecting people to shop around in emergencies. People are expected to shop around for good insurance plans which will cover emergency situations to their satisfaction. That is why many free market healthcare supporters also support removing the incentives for employer-provided…

> That is why many free market healthcare supporters also support removing the incentives for employer-provided insurance plans Among people who support "free market healthcare", who specifically is seriously pushing a plan like this? It is not something I've seen before.

I'm doing it, and a few other libertarian type people. I agree with your statement though: we are a minority. Most who call themselves free market do not see how employer provided plans make things worse.

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

#157

Earlier quoted context omitted.

Considering she was unconscious she could not possibly have consented to those transactions. What laws exist that allow these companies to unilaterally create these transactions, and what limitations do they have?

They have literally no limitations. The reason that an advil at the hospital costs $200 is because they were afraid if they made it cost $20000 people would burn down the hospital.

This is the first comment on the page that has something other than "more government regulation" as a solution. Just sayin'.

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

#158
post #149

Earlier quoted context omitted.

But, as described in the article that system does not function . Acquiring insurance does nothing to ensure that the facility you visit will accept that insurance. Further, even if the facility you visit does accept the insurance, that's no guarantee that all doctors within that facility accept that insurance. Even further, there's no guarantee you'll be conscious to validate that you go to a facility that accepts yo…

> Acquiring insurance does nothing to ensure that the facility you visit will accept that insurance. Does acquiring a credit card ensure that businesses will accept it? When you select your insurance plan, check who accepts it. Problem solved.

And only have emergencies around there and don't lose consciousness! It's simple math people!

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

#159

Earlier quoted context omitted.

> 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...

Realistically, no hospital is going to give out a price. They don't know what unexpected complication may arise that requires additional services.

Realistically, no airline is going to give you a price for transit to a destination. They don't know if there will be a terrorist attack or if the baggage handlers on the other end will jack up their rates.

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

#160

I was a victim of the surprise out of network bill in the Portland, OR area. I did all my research before hand: hospital in network, surgeon in network, etc. but ONE person in that operating room was not in network and SURPRISE i'm out thousands of dollars. The worst part about this is my state passed a bill to stop this prior to my surgery, but the bill's effective date was roughly 3 months later. Talk about bad tim…

Yes, moonlighters (the surgeon in that room) are expensive (to both you and the hospital). Why do you think that person wound up there?

Otherwise underpaid, overworked surgical residents leave either due to truly catastrophic burnout, mental illness, family emergency or pregnancy.

They are replaced by moonlighters, because the economics of the surgery are that the nurses and other unionized employees get mandatory breaks, so the seemingly 1-2 hour delay waiting for a different resident to be free balloons into a multi-staff scheduling fiasco. We could amortize all those costs into "surgery minutes" which are paid whether or not the literal room is in use or whatever.

It's a math problem if by saving surgery minutes, the hospital saves real economic money for itself, the patient or the state, so I'm not sure if that is or is not the case in your particular case.

What's interesting isn't that there's legislation one way or another, or that you feel like you got a raw deal. The legislation isn't going to change what it says it will, because it will still make sense to hire moonlighters. And motivated people like you will still somehow still wind up paying the cost.

The real test of your merit is whether or not you think in the grand scheme of things, this is fair. Are you frustrated that there may have been a pregnant resident, and that's why there's a moonlighter in the operating room?

What does justice look like there? Cut you a check for thousands of dollars? That never happens. Retribution on residents who might get pregnant? That's what happens.

Your situation is shitty. I know in most movies, books and the press, the doctor is usually the antagonist. We live in a world that resents their disproportionately immigrant backgrounds, disproportionately even gender balance compared to other professions, and most of all their pay, despite their hard work. How do you feel?

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