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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

#471
post #289

Earlier quoted context omitted.

Why is this dirty? If you don't pay for fire protection, not even through taxes, why does anyone owe you incredibly hard & extremely dangerous labor saving your house? Firefighting is not a safe profession. (I certainly prefer publicly funded fire service)

>Why is this dirty? Sabotage and physical fights broke out between fire companies while fires burned. That's a pretty gritty situation. Allowing fire sales gives way to perverse incentives, like the profitability of arson and predatory pricing of fire fighting fees such that certain portion of victims will always have to sell their property at a discount.

In theory, all of this also applies to a public "firefighting department", no? They too could do a really, really poor job. If this is the culture in a society, where people want to screw each other over, you are likely to get this poor outcome regardless.

But suppose that you have an honorable firefighting department run by an honorable man. Why could he not have set up a private firefighting company instead, doing pro bono work when required? Given the honorable behavior of his company, why would consumers not want to prefer him for insurance than shady competition, which may be cheaper but is also more likely to screw you over when you most need them?

Government-run agencies can be good or bad; private companies can be good or bad. There is no silver bullet and much depends on the prevailing culture. But government can use the threat of force to compel you to pay for their services. If a private company attempts the same, we would call it an organized crime group.

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

#472

Earlier quoted context omitted.

"Don't let The Perfect be the enemy of The Good." We are overspending on the quality of health care we get today. Further there is a lot of fear mongering about socialized medicine. I've experienced medicine in both the UK and the US. I can tell you, there isn't a difference in quality. Further, when I got a cold and went in, wait time wasn't 6 hours or whatever other BS people claim. Wait time was ~10 minutes. In fa…

I've had different experiences from you. My experience in the UK was wait 90 minutes in a waiting room and when it was finally close to my turn I was told I could only see a nurse and she wasn't allowed to proscribe any medicine so if I wanted to see a doctor I should go down the street to the private doctor. This was in London near Soho. In Japan the first time I went to a doctor it was for stomach pain. He gave me…

Was this with your GP or did you just turn up at the A&E with minor ailments - turning up at the A&E with something you should be seeing a GP with will mean you got the back of the queue.

I have never had a problem getting a appointment to see my GP.

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

#473
post #381

Earlier quoted context omitted.

That assumes that the desire for health care is unbounded like other consumables. In reality most healthy individuals want a limited amount of care, sick individuals want the least amount of care required to return them to health - and there are fundamental limits on the amount of care that can be provided to those who are beyond the help of current technology. As such you would expect a finite level of demand from t…

No, the demand for healthcare is basically infinite. I got a cold yesterday with a crazy bad sore throat, I thought of maybe popping into the doctor. But it turns out to be just a regular cold. My mother would have 100% gone to the doctor. The clinics here in Canada are chock full of kids with the flu and people coming in 'because'. Maybe that's beneficial due to the risk 'it could be something bad'. Or maybe the eco…

That’s finite demand as the effort of going to the doctor is non zero. People in good heath are not going to waste their time.

Assuming the average doctor’s visit is 15 minutes and the average person goes to the doctor every month. That’s only 1 GP per 640 people. After that point they might send you to a specialist some fraction of the time, but it’s still finite.

Consider dental insurance is ~15$ a month and most people go to the dentist twice a year. That’s about what GP side of heathcare costs. It’s the care after that point from people with actual issues that gets expensive. Yet, without the vast overhead of insurance you cut the costs of providing actual heath in half. Which more than covers the costs from people that are currently turned away.

PS: And yes billing is ~50% of current US costs when you include Doctor time dealing with paperwork. Remember the entire insurance industry and their profit is pure added cost, but so is the medical billing people inside each provider.

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

#474

Earlier quoted context omitted.

No, the demand for healthcare is basically infinite. I got a cold yesterday with a crazy bad sore throat, I thought of maybe popping into the doctor. But it turns out to be just a regular cold. My mother would have 100% gone to the doctor. The clinics here in Canada are chock full of kids with the flu and people coming in 'because'. Maybe that's beneficial due to the risk 'it could be something bad'. Or maybe the eco…

> Maybe that's beneficial due to the risk 'it could be something bad'. I would assume it's detrimental because it results in doctors' waiting rooms full of people with colds (making it a dangerous place for anyone who is immunosupressed and really needs to see the doctor).

Oh yes :-) there is a reason renal units are often in separate areas.

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

#475
post #14

Exhibit A for why "free market healthcare" is an oxymoron. I have yet to hear a coherent explanation for how anyone can reasonably expect for price discovery to even pretend to function in a market where the consumers can't even guess the prices until after they've already purchased and frequently couldn't reasonably be expected to refuse service even if they did believe it was overpriced.

The problem is that neither models work and both have shortcomings. In the US model healthcare is a profit center which allow those who can afford to get help and those who can't various sub-optimal variations of help. In the ex. Scandinavian model healthcare is a cost center and there is a set budget each year which the providers need to function within. This means that prioritization needs to happen and various ill…

Of course the problem is that the US is such a big country with huge immigration and scandinavian countries arent so it's always hard to compare.

I really don't understand why it being a big country would make things difficult. Any sane person would adjust the needs dependent on state and smaller. Norway's population is about the same as Indiana's, but is more sparsely populated - so some of the same problems as the western states. The benefit of the US being large would be that there are more pools to draw money from. And there are just as many opportunities to save money.

For example, Norway will send a nurse to one's home up to 6 times a day. For free. Even if you live on a cabin on an island or on a mountain. Why? Simply because it is still cheaper than a nursing home, overall. And as a bonus, folks tend to live longer and be happier with life.

As far as immigration goes, it is impossible to compare. But: Not every immigrant gets free healthcare. I get the state healthcare because my immigration status is family immigration - my spouse is Norwegian. If I were here for a job, however, I'd have to pay for health insurance. Of course, they'll still treat someone that pays cash and still treat emergencies. I don't really see how this would be an issue in the US either so long as the laws were set up correctly.

I'll further add that I think the healthcare is a bit different if folks are coming from an EU country - there are agreements in place about health care and things like that. Again, I don't see why this wouldn't be the case in the states.

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

#476

Earlier quoted context omitted.

Price discovery requires pricing some people out of the market. Period. There is no "free market" healthcare system that can or ever will deliver required health services to everyone. Furthermore when the alternative is death or debilitation, the price a "consumer" is willing to pay is effectively everything they possess and can borrow. That is both a massive distortion and non-optimal for the economy as a whole. The…

>Price discovery requires pricing some people out of the market. Period. A well working competitive market doesn't charge the maximum consumers can bear. It charges cost of service plus a profit margin.

No, a well working competitive market reaches a price where marginal revenue equals marginal cost. Unless you are using an unorthodox version of microeconomics.

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

#477

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 br…

Except I highly doubt the staff and doctors are actually being paid in proportion to the charge. I doubt they’re even being paid a significant portion of that bill. We’re not hurting doctors and nurses when people claim to want more efficient healthcare strategies. There are ways to allow moonlighting, such as everyone being in-network to a greater social healthcare system.

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

#478

Earlier quoted context omitted.

Are you saying that the richest country in the world can't accomplish something that already exists in plain view in some of the poorest countries in the world?

You really should get the facts on how those systems actually operate. I'm currently living in an european country that has a national health service that supposedly ticks all the socialist talking points, including free (in theory) access to emergency care, but not only is the service largely inoperational with year-long waiting periods for surgeries, including cancer treatments, but also has a disgruntle workforce…

And yet, it's the US where 25 year-olds die of diabetes [1]. Not the "socialist hellholes".

https://www.snopes.com/fact-check/shane-patrick-boyle-died-a...

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

#479
post #470

Earlier quoted context omitted.

To get an absence note for school/work? To make sure it's a common cold?

For a cold, just wait a week or two. There's nothing medicine can do for you anyway. If it's still there, then it's worth checking. Also, you shouldn't need a sick note unless you are off for more than a week (your legislative framework may vary).

It depends entirely on the employer. Some places will require a doctors note if you miss more than two shifts. So in places like that, people typically go to work sick, and just spread the disease. This includes most fast food restaurants so think about the implications of that.

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

#480

Earlier quoted context omitted.

"Don't let The Perfect be the enemy of The Good." We are overspending on the quality of health care we get today. Further there is a lot of fear mongering about socialized medicine. I've experienced medicine in both the UK and the US. I can tell you, there isn't a difference in quality. Further, when I got a cold and went in, wait time wasn't 6 hours or whatever other BS people claim. Wait time was ~10 minutes. In fa…

> I've experienced medicine in both the UK and the US. I can tell you, there isn't a difference in quality. My experience was very different. In January-February this year I had to visit (unfortunately) both the Emergency Room in NYC and the A&E in London. While the quality of the medical equipment in London matches the one in NYC, the understaffing is much more severe. In neither place was my wait time only 10 minut…

In Boston I recently had to wait in an emergency room for 5 hours with multiple broken bones. This was at one of the best rated hospitals in the country.

I recently moved to a new state and I’m trying to get set up with a new primary care provider. I’ve been trying to get an appointment for six months, but they keep bumping my appointment back. Did I mention that I had to settle for a nurse because none of the doctors in my area are accepting new patients?

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