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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

#261

Post by Animats »

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…

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.

Usually credited to Marcus Licinius Crassus, who had a fire brigade for just that purpose. Contemporary of Julius Caesar.

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

#262

Post by dmh2000 »

I'm not saying the ER prices are reasonable, but an ER has to keep a lot of expensive staff and equipment sitting around until they are needed. OK, some ER's they are sitting around. But there is a price to have all that service ready for an emergency.

As for high drug prices like the $60 ibuprofen, you are mainly paying for it to be delivered to you by a nurse.

ER's have an average profitability of 7.8%. Higher than Walmart but lower than Apple. So if they became non-profit in some way, they could cut that percentage of costs. That's some, but still very expensive.

https://www.beckershospitalreview.com/finance/7-things-to-kn...

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

#263

Post by JaggedNZ »

newyankee wrote: post #168
quickthrower2 wrote: post #114

Earlier quoted context omitted.

+1. Moved from UK to Australia and it is very similar here too in that most medical care is free. One difference is that the ambulance service charges for residents, and usually it is reasonable priced (but not cheap) but if it turns out you need a helicopter the bill can be quite large! But insurance covers it. For most professionals insurance is very cheap because of the tax saving you get.

any idea how is it in NZ ?

Pretty much the same as Aus and UK, though I think some level of subsidised healthcare for visitors though surgery, etc. will be charged in full, and full coverage for permanent residents, where as Aus tends to charge full price for everything, I believe (still cheap compared to the states though).

Doctors (GP) visit typically costs me around $40-50NZD, thats likely on the high side, Children are free / fully subsidised.

A&E visit would be $50-100NZD

Most all injury related medical costs are covered or subsidised by ACC.

Specialists Appts typically cost ~$200 per visit

Private health insurance, while in no way "required", is still offered by the bigger employers and will see better outcomes for elective and non-urgent surgery and is priced in the hundreds of dollars per year for "basic" coverage if you wish to purchase as an individual.

Edit: clarified coverage for visitors

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

#264

Post by rootusrootus »

CWuestefeld wrote: post #202
rootusrootus wrote: post #154

Earlier quoted context omitted.

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?

In many cases, Medicare doesn't even cover the actual cost to provide the service. The providers make up the shortfall by charging other patients more - including charging uninsured patients a LOT more. So if everybody was covered by Medicare, either the providers would be going bankrupt left and right, or the Medicare reimbursements would have to rise - i.e., the price to the government would increase, and the only…

That is a pretty bold claim, can you cite someone more authoritative than your wife?

Kaiser, who has a plausible claim to expertise in this field, puts the overhead cost of Medicare at 2%. The raw number is more like 1.4% but Medicare does get to piggyback a lot of the administrative workload on Social Security so perhaps that is why Kaiser's number is higher.

Insurance industry advocates, who are incentivized to provide the lowest number that can be defended, put private insurance overhead at 17%.

The rest of your suggestion -- that Medicare doesn't even pay for the actual cost of service -- is hard to really reason about accurately. Prices and costs are so completely distorted now that I am very skeptical of anybody's estimates of 'actual value.' Things will change dramatically if we eliminate the insurance industry and medical billing field.

Having just experienced first world level healthcare in another country and paying for it out of pocket at 1/20th or less of what it runs in the US, I am certain we are getting shafted.

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

#265

Post by ncallaway »

ams6110 wrote: post #250
ncallaway wrote: post #219

Earlier quoted context omitted.

I don't believe that's true. What serious single payer proposals have been put forward that would eliminate private-pay, private insurance, or private care? I've never seen one. In fact, almost all "single payer" health systems that exist in other countries have private care and private insurance options. For example, such options are available in both the UK with the NHS and in Canada. I've never once spoken with an…

Bernie Sanders, for one, has advocated for the elimination of private health insurance by essentially putting everyone on Medicare.

That's simply false.

Both Medicare for all and Medicare buy in plans wouldn't eliminate private health insurance.

Private health insurance would still exist under both plans as supplemental coverage that people could buy that would cover things that were not covered by medicare.

The markets would be potentially reduced (drastically with medicare for all, moderately with a generally available medicare buy-in), but it's totally false to say they would be eliminated under those plans.

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

#266

Post by dv_dt »

krupan wrote: post #242
dv_dt wrote: post #69

Earlier quoted context omitted.

It works in 36 out of 37 modern OECD nations, with the US paying the most, and more than double all the other nations which have the government negotiate a better price. Even in our own VA system, their negotiated prices are lower for drugs than the Medicare part D program, barred from negotiating (and with large pieces managed by private companies). I think your skepticism should primarily be directed to wondering i…

Is cost the only measure we want to optimize for?

I think the US has better cancer survival rates in areas than other nations, but if that is all-around significant one would think that would reflect out in better life expectancy overall. However, the US is a huge negative outlier in life expectancy and child mortality with universal healthcare nations outperforming on those measures too.

https://ourworldindata.org/the-link-between-life-expectancy-...

The most recent life expectancy numbers are the hardest to interpret, the US has the only three-year-running negative life expectancy growth in the first world nations - but some argue we should separate healthcare from the suicide numbers that are a big contributors. I don't know that I agree with that as there is a fuzzy line between healthcare and social care efforts.

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

#267

Post by Symbiote »

briandear wrote: post #143
rootusrootus wrote: post #80

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.

Depending which side you want to believe, NHS waiting times are a direct result of Conservative government austerity, or excessive immigration.

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

#269

Post by phd514 »

ncallaway wrote: post #110
cabaalis wrote: post #57

Earlier quoted context omitted.

> 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...

> I think there's merit to investigating public health care. That line stops for me in eliminating private care I haven't seen a proposal yet that would eliminate private care (or even supplementary private insurance).

Canada did. It's not that far-fetched.

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

#270

Post by dsfyu404ed »

stdplaceholder wrote: post #37
nightcracker wrote: post #31

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.

Considering how many people have had their lives ruined by absurd hospital bills I'm honestly surprised nobody's shot one up yet.
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