Live data from Hacker News

The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

npr.org

301–310 of 339 posts

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#301

This is absurd. Even in a country with liberal economics and "free choice" health system (however with universal care, and state regulation), the same stitches in a world-class private clinic in Santiago, Chile would cost 400 USD, before insurance . The clinics there are not the ones Americans imagine from a middle-income country, most of them have better infrastructure and doctors than the ones I know in Europe. And…

> example of the benefits of free market economy Healthcare is rarely a good example of the free market. Medical decisions aren’t made by comparing costs between providers. And if you’re in rural America, you’re lucky if you have any provider. Price transparency would be nice, but maybe not as helpful as you’d like. Let’s say you’re in the middle of a rural area and the ER says you need stitches — but they cost $6000…

Healthcare is ripe with market failures - everything you are describing is well studied. Those who argue for a completely unregulated market, in my limited interactions, have not usually studied economics or the concept of market failures. Market failures are generally associated with public goods or government regulation.

To name a few with healthcare:

Information Asymmetry. It should be expected that a patient does not know what a Level IV emergency is and the complete ins and outs of how they are going to be charged. I'd argue that the industry has intentionally amplified this market failure. Furthermore, patients are often left with the final decision, but who is going to disagree with a trained professional on their required treatment? It's like going to a mechanic when you have no idea what's wrong with your car. You kind of are trusting the mechanic isn't taking advantage of you (and that is regulated). Or you have to reduce the asymmetry by learning about the basics of cars.

Medical research has the attributes of a public good: Non-excludability and non-rivalrous - when something is discovered it's generally known to everyone without dropping in supply and the information is available to everyone (yes the product which results is rivalrous and excludable in the same country, hence it works as a private good - but then that product has non-competitive markets).

Non-competitive markets with respect to rural areas are also mentioned in the article. Much like the issue with utility companies and broadband providers (the latter of which was shown to be a partial public good in the US with the infrastructure bill).

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#302
post #275

Earlier quoted context omitted.

And you get into an accident (fall in the bathtub/stairs) cannot work for few weeks, your boss fire you easily... Where you is excellent health insurance coming from now? COBRA? That will not be $750/year.

This is completely wrong for many people. In the US we have something called FMLA and then I also have short term disability and long term disability. I have seen coworkers with cancer or even their family members with cancer and they take six months off with pay and come back like nothing happened. Be a valued employee at a large company. It’s a completely different situation in the US. It’s actually really good fro…

If everyone is a valued employee at a big company, who:

Handles trash

Landscapes

Makes our shit dissappear

Maintains society

Digs ditches,,makes roads

Prepares food

Etc...

Do those people just not deserve health care?

Reconsider your own life. Picture it with you, yourself doing those things. When I look at mine, the worth of those people is obvious and I am happy to have them doing what they do so I can do what I do and we all meet at the park and let our kids play together.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#303
post #287

Earlier quoted context omitted.

Free market brings prices down and quality up. The government tried to ‘help’ 50 years ago and now the prices have become so distorted that without government help you would need to be rich to go to school. People like you think the government should solve a problem that they themselves created.

> Free market brings prices down and quality up In theory, but in practice there are many markets where that simply doesn't work, mostly due to natural monopolies, such as any type of infrastructure, healthcare or education, where competition is impractical or impossible, equal access for everyone is extremely important, and costs are high.

I think free market could work with education. It is really a question how to verify the results. That is how should degrees be granted. Which is rather complicated issue as there is way too many ways to cheat.

Still, nothing really stops competing methods and prices for teaching to competing levels.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#304

Earlier quoted context omitted.

How much did you pay in the end?

Well, I haven't paid yet ;) but the adjusted amount charged to my insurance was about $12.5k. I have a highish deductible plan but I have an HSA so after meeting deductible and maxing out my out of pocket limit the HSA is going to cover much of what remains (it's been accruing for 5 years and I never have medical expenses). But I think it's completely insane we have to play these games with healthcare. Why does it ha…

What I find most insane in the USA system is the initial price and then some "adjusted" amount that can be nearly 90% discount... Why isn't there only one single price for everyone? Why isn't it mandated that you can only charge single price for everyone and you can't give discounts?

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#305
post #279
post #252

Earlier quoted context omitted.

When the state or its delegates decide who can offer what service to whom it cannot be free market. What's preventing you from opening a clinic and stitching people for $300?

Laws that say I must have completed some state certification. That limits supply. I don't understand why they can't limit price.

If the supply gets artificially limited isn't it then logical that they can charge whatever they want?

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#306

Earlier quoted context omitted.

The US conducted the experiment to limit insurance companies' profits. A component of the ACA (Obamacare) was the 80/20 rule, where at least 80% of all premiums collected by health ins. companies had to be paid out for care. That was a failure. In the 10 years or so since that rule, premiums have increased dramatically. Your reply is well-stated. There isn't one single 'bad guy' in the US system; it's more a function…

Premiums haven't increased any faster post ACA (maybe a bit slower even). https://www.ncsl.org/research/health/health-insurance-premiu... We are already in the midst of a provider shortage.

They didn't stop increasing or go down, was my point. One would expect that if insurance company profits were a large component of the premium cost, limiting that to 20% would lead to some beneficial reduction in premiums.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#307

This is absurd. Even in a country with liberal economics and "free choice" health system (however with universal care, and state regulation), the same stitches in a world-class private clinic in Santiago, Chile would cost 400 USD, before insurance . The clinics there are not the ones Americans imagine from a middle-income country, most of them have better infrastructure and doctors than the ones I know in Europe. And…

Eso solo aplica si tienes Isapre, seguro, etc etc Los gringos están mal pero en chile tampoco estamos bien bien

En mi comentario, estoy hablando de precios sin seguro, o sea que para cualquiera, con FONASA ISAPRE o sin seguro.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#308
post #285

Earlier quoted context omitted.

What do you think doctors do? My last visit involved their fingers, a glove, and my butt.

Okay, so a $200 surcharge every time they have to deal with butts. $100 for urine, $50 for vomit. Charge it to the insurance anyway, they're used to paying $40000 a day for a hospital bed, they can pay $200 for dealing with a butt. Plumbers have to deal with the aftermath of butts MUCH more often and they don't have the luxury of someone's insurance they can just throw arbitrarily high charges to.

You realise there’s medical professionals who deal with poop right?

There’s also the whole ‘all your clients are sick, some are contagious’ thing.

I’m not saying america isn’t insane, but to try and pretend plumbers have it far worse isn’t quite accurate.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#309
Why is it that poor, third-world countries can afford a single-payer health system that treats all patients equally and economically, and the so-called richest country on Earth makes sure its citizens get bankrupted for the most minor medical issues?

I had triple-bypass in 2005. Cost to me? Zilch! If I lived in the US, I'd be dead for the last 16 years.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#310
post #204

Earlier quoted context omitted.

This is the same in Canada. My wife is due to give birth in 3 months. The biggest bill we're concerned about is the parking lot. I think it's $20/day. And if the parking fee was too much, I've heard that one can go talk to the reception desk and they'll open the gate for you. I would rather pay very slightly higher taxes and let all of my fellow Canadians have this benefit than be very sightly richer and live in a so…

Exactly! For me it is the peace of mind: not having to worry about deductibles... will it be covered? What hospital can I go to? Ambulance or uber... so much stress. On top of your ailment. I prefer to pay 35-40% in taxes and not have to worry about that. I worry about my work and my systems. They pay me for that. I pay my money so that I dont have to worry. Paying (a private insurer) to get additional worries? No th…

> I prefer to pay 35-40% in taxes and not have to worry about that

The biggest irony is that’s in line with the taxes we pay in the US (probably more if you’re in tech and live in CA or NY), so it’s not like you pay lower taxes in the Land of the Free anyway.

Post reply on HN