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

171–180 of 592 posts

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

#171

Post by bluGill »

drak0n1c wrote: post #63
stdplaceholder wrote: post #38

Earlier quoted context omitted.

Even if you ask for the price and even if you get it in writing up front you will still get a different bill later.

Legislation requiring up-front presented costs to be honored and any additional procedures/costs to be cleared with patient consent as they happen (or a consent waiver obtained from the patient with a promised limit or incentive such as overall discount) might be an improvement. Or it may increase costs for the worse. Who knows.

Careful there though. If a surgeon is operating on cancer and discovers that the tumor is much larger than expected the operation will take longer - be more expensive - or the surgeon does the operation as planned and then charges even more for the second surgery to remove the rest. Or maybe all operations are estimated as the worst case and so you end up with no more clue about what you will pay than today - in some imaginable worst case this could be a five million dollar operations, so even though 99% are only fifty thousand you get that high estimate.

Which is to say don't propose something until you understand the unintended side effects. You can get your desired result but while making everything worse. (this paragraph applies to everything in politics)

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

#172

Post by jwr »

rhexs wrote: post #124
daniel_iversen wrote: post #77

It makes me sad that there are places in the world where people have to pay to go to an emergency doctor. I know it’s a political hot topic but all that aside doesn’t most people deep down inside think that every fellow human should have the right to free doctor?

Okay, sure, I agree in general, but how far do we go with this? Does every other human have the right to extraordinarily expensive, often unproven cancer treatments only available at research institutions in the United States? Are we willing to start making cost based decisions on who should die (i.e. should we really be spending hundreds of thousands of dollars keeping those above 90 alive for age related illnesses?…

Those are red herrings. Many (if not most) countries somehow figured it out without having to deal with absolutes and black/white decisions. You can (and should) draw a line somewhere, and this can be done reasonably.

As a European living in the US I find it mind-boggling that the richest country in the world does not consider universal healthcare to be a fundamental right of its citizens.

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

#173

Post by MattGrommes »

darawk wrote: post #149
ncallaway wrote: post #117

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.

If you read the article you'll find that the problem is that while the hospital may accept your insurance, a particular doctor won't. Also for some reason some doctors don't even know what insurance programs they'll bill.

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

#174

Post by newyankee »

keithnz wrote: post #71

It would be interesting to compare prices with countries with free government sponsored medical care. In NZ I know they work out the cost, and if you aren't a resident/citizen you have to pay the bill.

Is NZ healthcare decent? Asking because i am trying to decide between NZ and Canada as my future destination for immigration after living in US for 10 years.

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

#175

Post by otikik »

manfredo wrote: post #83
serg_chernata wrote: post #11

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.

In my country, yes: Cero. Because we have Universal Health care.

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

#176

Post by jayess »

I don't see the situation changing in the US anytime soon. In order for us to have single-payer healthcare, doctors would need to accept drastic pay cuts, pharma companies would get far less for drugs, and insurance companies would go out of business. None of that will happen. Instead we'll have more and more and more regulation until it just stops working.

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

#177

Post by SilasX »

manfredo wrote: post #167
SilasX wrote: post #159

Earlier quoted context omitted.

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.

A terrorist attack is an extremely low frequency event to the point is being nearly non-existent. The same cannot be said of birth complications. Baggage handler rates don't change on a dime. Labor rates do affect ticket prices, but they're drastically more predictable.

Yes, but the same logic applies: you either negotiate prices out with a network in advance, or insure against the major complications. None of that is different for a health care operation.

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

#178

Post by dv_dt »

heavyset_go wrote: post #66
UnpossibleJim wrote: post #26

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…

The history of private firefighting is a particularly dirty one. In the past, fire companies would show up and demand payment before putting out fires. If a payment couldn't be made, the company might negotiate the purchase of the burning property at a steep discount. Later, insurance companies hired brigades to only put out fires on insured properties. Fire companies might have fought or sabotaged one another in ord…

With our level of inequality, this is coming back. In the last Southern California wildfire, there were reports again of private firefighting groups operating in the Malibu area.

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

#179

Post by cwkoss »

y-c-o-m-b wrote: post #28

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…

Maybe I should write "I do not consent to any out of network services" across my forehead in sharpie before any operations.

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

#180

Post by tivert »

cabaalis wrote: post #57
UnpossibleJim wrote: post #26

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...

>> You simply don't get to "shop around" for emergency services

> You do actually, by where you choose to live

That's wrong on so many different levels:

1) The emergency service provider is unlikely to tell you how much anything costs in reality ahead of time.

2) Not all emergency services providers offer the best price for all services, or are even equipped offer all services.

3) Many medical emergencies are completely unexpected, you have no idea what kinds of services you'll actually need in an emergency.

4) You're not really talking about "where you choose to live," but rather "where you choose to be at all times." Do you really have a choice of ER if you have to stay within a couple miles of it at all times to make sure you'd always be taken there in an emergency?

5) etc.

Post reply on HN