Any parent has similar stories. Consumer law does not seem to apply to doctors and hospitals.
Imagine if you took your car into the shop - there is no price list, they won't give you an estimate, and for weeks after they send you random bills without indicating what it's for?
This affects everybody in the US, and I don't understand why it's allowed to continue, except the medical industry has bought off all the politicians
It’s predicated on the HMO model where you pay a copay and your insurance company negotiates the rates. Under the guise of consumer choice insurance companies have expanded copays and coinsurance to shift the burden to the insured. Out of network Hospitals and doctors balance billing needs to be outlawed. They should only be able to balance bill up to the Medicaid rate.
Medicaid is already at the lowest payment rate, so balance billing to that would be a net negative actually.
Why should hospitals and doctors be forced to accept contacts from insurers that underpay for services rendered for nothing in return (being part of limited network)?
> so balance billing to that would be a net negative actually
If the regulated standard treatment costs were somehow lower than the actual delivery costs, sure. But how on eath could that happen? It's in everyone's best interest for hospital administrators to be heavily involved in setting these costs, and they have no interest in losing money.
Hospital administrators are the problem. They don't contribute to medical care, and their job is to increase profit that goes to higher salaries of themselves and other administrators.
Regarding balance billing:
If Medicaid pays $100 for a $500 procedure, and private insurance pays $400 with the expectation of a 20% coinsurance from the patient but patient refuses to pay, who is going to pay the other $100? Is the expectation that hospitals or doctors shouldn't be compensated for services rendered? Should they work for free and go out of business?
What other business exists where it's ok for people to get something and refuse to pay the bill? Auto repair? Groceries? Legal advice? Housing construction? Land purchase? Auto fuel? Electricity?
>On what planet would the special interest groups responsible for setting reimbursements make it less than the cost of delivery?
Take a guess what Medicaid pays for a labor epidural for a pregnant mother, which involves putting a very large needle next to a woman's spinal cord, with possible complications of paralysis, death, headache, back pain, infection, failure of epidural, etc?
If you run a hospital where 100% of patients are on Medicaid, the hospital will shut down immediately.
Medicaid simply pays less than the cost of delivery, and it does so because government knows it can get away with it. The government can impose its will with regulation and certification.
You have no idea how ridiculously underpaying Medicaid is. Can you imagine what would happen if government mandated that Facebook employees could only be paid a maximum of 10/hour?
> Take a guess what Medicaid pays for a labor epidural for a pregnant mother, which involves putting a very large needle next to a woman's spinal cord, with possible complications of paralysis, death, headache, back pain, infection, failure of epidural, etc?
I've looked up the price and for one hospital in Belgium [0]. The rates, including the room you stay in, are:
Uninsured: €140~€420
Insured: €17~€200
Insured with low income: €10~€190
The large variation is due to shared common room vs single personal room.
An epidural really shouldn't be insanely expensive. Of course, exposure to litigation and risk for the doctor is much lower here.
I think price transparency is a bit of a red herring. That's not to say I don't support the idea of requiring hospitals to be upfront about costs, but it isn't going to fix issues with ER visits referenced in the Vox article. Emergency medical treatment is not really a consumer good, where if you don't like the price your can shop around or just decline to spend money. What's more, there is massive information asymmetry. If a physician diagnoses you with X and recommends treatment Y, you're not in a position to evaluate whether there's some cheaper option Z instead. Price transparency is great for elective care, but most medical treatment is not elective in nature.
I recently had a spot appear in my vision. Went to my GP same day, the receptionist called around to get me into a local optometrist who determined it was a detached retina, she called and got me into the local hospital as an emergency case. It was busy but I got my first treatment that evening.
The entire journey, my green OHIP card was all I needed, no insurance forms, no pre-approvals, no extra charges. 5 hospital visits with 3 treatments so far.
I'm flabbergasted when I talk to American friends and family and they all seem to think two things:
1. Canadian health care "is terrible, people die waiting in emergency rooms"
2. The US system is by far the best and that's why it's so expensive
I know a Canadian who had a retina detach while in the States.
She went to a Dr. in the states. They determined she needed surgery immediately.
Unfortunately, the local hospital would not let her have the surgery. Why? The billing department was closed for the weekend. She offered to pay cash. Still, the answer was no. The surgery was delayed for 3 days. In that time, she her situation severely worsened, causing permanent damage that would have been prevented by surgery.
She immediately made an emergency trip the Vancouver -- and was treated the same day, surgery and everything. No cost.
In the UK, the entitlement is even more ubiquitous and fluid. I was diagnosed by my GP, referred to hospital and undergoing surgery under general anaesthetic, in half a day, without showing any form of ID.
This freaked me out, especailly when the admitting nurse couldn't match us to our GP's practice: "don't worry, we'll sort it out eventually, enjoy the rest of your night!"
Only if you don't look like you belong. Classic hidden privilege.
As a tall middle-aged white guy, I go wherever I want, nobody asks to see any ID, nobody checks why I'm there. If they need to interact with me they start by apologising "I'm sorry sir".
Hospitals, government departments, everywhere I go I look like I'm supposed to be there.
But behave the exact same way as a 5'6" black teenager and you'll get stopped and questioned constantly.
Former 5 foot 7 black teenager here, never got stopped. Never got questioned. Never had a single incidence of racism placed on me. Can't say that I know anyone who has had issues in my area either.
Looking like you belong has a lot more to do with your attitude than your race.
Dying while waiting is just a stupid argument based on a distant truth. You do wait considerably longer for non-life threatening procedures in Canada than you do in the US. That's the big sell of a medical system that cost 2 to 3 times yours. Hair transplants require less waiting.
The United States is the only country in the Western/European first-world where rationing of healthcare does not happen as a result of direct government mandate. There is still rationing in the United States, but it's covert.
Cognitive dissonance associated with politics in some cases, and probably just ignorance and an assumption that there's some amount of fairness and reasonability behind pricing in other cases?
Of course, over ten times as much is spent on the military. How can a country with no enemies nearby justify spending 60% of their budget on the military? Especially given how the only ones hostile to them are the ones they pissed off.
Whoa there. My family has a good friend whose child was born with a severe genetic disease in Canada. They are paying a ton out of pocket for care for their child since the gov't doesn't pay (night nurse, some physiotherapy). Both parents are having to work full time just to pay the medical bills.
For your average Canadian everything gets paid for, but if you have special needs, you're sometimes on the hook big time.
I think you're using an outlier to compare to an entire population, the argument doesn't really hold up.
(indeed, it's unfortunate for your friend and I'm sorry that they're in that situation)
For the average person though (which, when we talk about American healthcare, is largely who we are discussing), and a for the majority of the population, things work out very differently. Myself and the members of my family have had countless hospital stays, ER visits, surgeries, checkups, ambulance rides (approx $300 flat fee), assessments, scans and x-rays. All without any of us carrying any debt or dealing with any related financial hardship (lower tax bracket, so no special benefit plans or anything).
Friend's kid's appendix needed removal, multiple night stay at the hospital. No cost. What does that look like in America?
I had a deviated septum and didn't breath great. I breath just fine now after my totally covered septoplasty. What does that look like in America?
Kids recently got strep throat and needed a doctors appointment to get a prescription for antibiotics ($42 to cover the prescription) What does that look like in America? (honestly I'm curious about this one, would it be more than a couple hundred dollars for that?)
> Kids recently got strep throat and needed a doctors appointment to get a prescription for antibiotics ($42 to cover the prescription) What does that look like in America? (honestly I'm curious about this one, would it be more than a couple hundred dollars for that?)
It will depend upon your insurance plan, but this situation is pretty comparable. You'd likely pay a $20ish copay at the doctor's office and $20ish at the pharmacy.
And Americans pay more per-capita for federal-funded healthcare than Canadians do… just the Canadians get universal coverage for it. The US manages to spend as much public money on healthcare as most other western countries do, and gets much less for it.
Interestingly, America could fund a Canadian style healthcare system, covering everyone, using _just_ the existing federal healthcare spending (around 2 trillion), completely eliminating the need for private sector spending on healthcare (around 1 trillion). No need to raise taxes. Employers and individuals save a ton of money. The economy strengthens and everyone in the country gets coverage.
As always, that we don't have healthcare for everyone is a political problem, not a spending problem.
Hospital corporations and insurance corporations are not your friend.
You shouldn't have to do this in a first world country, but:
* Go to the ER without ID
* (optional) Ask how much it will cost
* (optional) They do not give prices, as a matter of policy
* They must treat you by law
* Afterwards, offer a cash payment you deem reasonable
* They will accept or decline it
Transaction complete.
For non-emergency care and prescriptions, get cash quotes up front, pay in cash, and order discount online prescriptions from canada, a first world country.
For chronic medical conditions, leave the US and immigrate to a first world country.
The job of the ER is to prevent you from dying, not fix you. If you are injured in a way that requires an expensive surgery and therapy to fix but won't actually kill you if left untreated, even if it cripples you, they are not obligated to fix you under the law.
And of course this is bad for everyone involved. We don't pay for someone to get preventative or proactive treatments for a chronic condition, instead choosing to divert very expensive ER resources to treat as a series of emergency interventions. Worse for the patient, worse for the hospital, worse for anyone else paying into the system.
It goes back to WWII when we had a strange price controls on labor. Health insurance was a way for employers to provide employ compensation circumventing that. Originally it was quite manageable, but as with any system where neither the consumer nor the producer of the good/service has any incentive to keep down costs, it spiraled out of control.
Also, president Richard Nixon effectively linked national health care with socialism as part of Cold War propaganda. (That said, he did offer comprehensive health reform too that in a number of ways was more dramatic than we achieved under president Obama, but the congress killed it.)
Interesting question. I can't find anything online about a hospital invoking Shopkeeper's Privilege, but chances are they might try to, and even if the police would eventually release you, your identity would surely be discoverable by the hospital. I don't think the OP is giving safe advice.
I don't forget. They must treat you doesn't mean that you must not pay. They can just send you the bill home after the police get your details. If you have or not money to pay, that's a secondary issue, just like when you get a loan.
Just to be clear what the alternative to coercion (and I agree with that characterization): rejecting ER patients at the door means some of them will literally be dying in the streets.
Plenty of anecdotes in this thread, predictably. Let's talk about why things are so messed up.
The thing to realize here is that total government provision of healthcare is probably cheaper than the way the US does it, but that doesn't mean the market has failed. Healthcare in the United States is anything but a free market. It's the worst of all worlds: special interests extract rents through government regulations (drug patents, occupational licensing, handouts to insurance companies in legislation); the government effectively controls prices through its own payment programs; the whole system is over-regulated to an absurd degree. There is no price mechanism to help consumers or producers make proper choices.
So when someone says something like, "the free market can't effectively provide healthcare," I would kindly ask where they see a free market healthcare system. This sounds like a No True Scotsman argument, but it's not. You can't label something so ridiculous as US healthcare as "free market" without either total ignorance or intent to deceive.
In an ideal hospital, you should only have doctors, nurses, nurse assistants, nurse manager, accounting, pharmacy.
Think of all the unnecessary healthcare MBAs that siphon off enormous amounts of resources to generate as much profit as possible to be shared with other healthcare MBAs.
Think of all the suppliers of healthcare goods that try to patent and profit off of unnecessary medical "inventions" which do not make a difference compared to what was done previously.
Think of all the government bureaucrats paid to ration healthcare resources by underpaying for services which burden hospitals and doctors to raise charges for private insured.
Think of all the patients who don't give a crap about their health and refuse to correct their chronic conditions and rather go to the ER when things get really bad.
Think of all the lawyers who profit off of bad outcomes (not malpractice necessarily) which forces hospitals and doctors to practice defensive medicine.
Making everything single payor won't work, because guess what, there will still be a private insurance system for the people who can afford it vs the system for the rest. It doesn't fix anything.
You do need some administrators, like the receptionist, someone to manage the janitorial staff, etc. There's now something like 18 administrators for every doctor in a hospital. I think it was barely 5-6 years ago I was complaining because the ratio was 10 to 1. Their salaries are also pretty high, typically in the $250k range.
I think the boom has been in pay and employment of hospital CEO, CFO, CTO, nurse directors, nurse compliance officers, legal, billing departments and supervisors of supervisors.
The people who actually deliver care, ie doctors and nurses, are being perpetually marginalized.
Yep, the closest thing I've seen to a free market is the pet healthcare market in the US. I've met businessmen who got out of the human healthcare market into vet care because it was so much more profitable even though the prices are way, way lower.
Your statement makes no sense. You can decline to participate in the current system. And there are so many ways healthcare could be better in non-life-threatening situations.
How can people read and hear about stories like this, and even possibly think it's OK or even normal?
How do lawmakers in the USA convince people that this is acceptable? I have never directly paid a single cent for healthcare, and neither has anyone I know. When I had to get 6 stitches in my forehead at 2 AM on a Sunday morning, it cost me nothing. When my friend needed to get the tip of his finger reattached, it cost us $5 for parking. When my brother spend almost a week in hospital after coming off his motorbike, requiring surgery on both his knees, it cost him a grand total of $0 out of pocket.
Are people just so blind to how extortionate healthcare is in the USA?
The argument that I pay for my healthcare in my taxes doesn't hold water either. I pay less tax in Australia than I would in California, and I get free hospital care as part of that. I don't have health insurance and see no reason why I would purchase it either.
It's because most people in the US are brainwashed (note: I live in the US) into thinking paying ~$450 / month per adult for basic health insurance with high deductibles is a bargain because it "saves" them from $100,000+ hospital bills in an emergency scenario. Meanwhile they are still losing ~40% of their income to taxes if they own a small business with no insurance applied.
The messed up thing is, the US also offers "catastrophic" insurance for about $150 / month but they only allow people under the age of 30 to apply for it. But at the same time I'm pretty sure hospitals are forced by law to perform emergency surgery on you regardless of whether or not you have insurance (don't quote me on this).
In 2017 I had to spend thousands of dollars in tax penalties for not having insurance. Welcome to the US!
That may be the case in an "emergency" that threatens your life. But if you come to the ER with something that doesn't fall into that category? Something life changing like a detached tendon in your hand that will* render your hand permanently useless for life if not fixed within a few days? No insurance? Fork over 50% of the cost of the surgery, upfront, before they'll do anything about it. (this happened to somebody I know)
> into thinking paying ~$450 / month per adult for basic health insurance with high deductibles is a bargain because it "saves" them from $100,000+ hospital bills in an emergency scenario
It is, though. Insurance is expensive, but it's not a scam. That money tends to go mostly for care, overall. Someone has to pay it.
It's true that on the whole, the US tends to overpay for care and that other systems tend to get similar results for less cost. But that's a constant factor on the insurance payment.
Obviously many of us think making this an individual burden is a bad idea: obviously it's regressive and burdensome for the bottom of the income distribution, and more subtly it's a moral hazard for the healthy, who are tempted to forego insurance figuring that they don't need it and thus pushing the cost of providing care disproportionately onto the sick and the elderly.
But again, someone has to pay it. There's no magic wand here that makes health care cheap or free. Health care is expensive, someone's got to write that check.
> In 2017 I had to spend thousands of dollars in tax penalties for not having insurance. Welcome to the US!
> It is, though. Insurance is expensive, but it's not a scam. That money tends to go mostly for care, overall. Someone has to pay it.
Yes but the govt already takes a bit over 40% of my income (I run my own business). I'm certainly paying my share. It's not my fault that the govt would rather use those funds on non-healthcare related things.
I'm all for a true universal health care for everyone, but if you're already taxing me so hard, I shouldn't have even more taken away from me. That's unreasonable.
> Because someone has to pay it, and you didn't!
I would bet anything the amount I paid in penalties is more than what most people pay to be insured just going by the average income in the US compared to the "assisted pay" discount you get for having a certain bracket of income.
I don't even make that much either. I'm in the "typical software developer income" bracket, but I'm self employed so I have no help or matching from an employer. I'm essentially paying both halves with no benefits (health or retirement).
And to top it off, if I get into medical trouble I'm left hanging.
That seems very hard to determine, especially as a business owner. What's the value to you of safe shipping lanes to get raw materials to you? What's the value of employees not worrying about being executed by warlords? What's the value of having US customers who can afford your products?
I don't think you can say what your "fair share" is as some limit for what you pay. Rather, the amount the businesses are taxed has to be a matter of pragmatism.
> I would bet anything the amount I paid in penalties is more than what most people pay to be insured
One would hope so. That is the point of penalties, after all.
> That seems very hard to determine, especially as a business owner. What's the value to you of safe shipping lanes to get raw materials to you? What's the value of employees not worrying about being executed by warlords? What's the value of having US customers who can afford your products?
I am a freelance web developer and online teacher. I have no employees or physical goods.
About half of my customers are from the US and I am in a hyper competitive world wide market.
FYI, there's a loophole out of the penalty. Don't know anyone who's tried it, but if you get a disconnect notice from the utility you get three months I think, so just time your payments accordingly.
I wonder if everyone wanting to sue in America and high malpractice insurance costs might be a reason we pay more with less quality of care in America? I mean sure if you get hurt, you want some sort of recourse but I wonder if that's why American medicine is so high.
A lot of the full time RV community parks and walks over to Los Algodones, Mexico for eye care/glasses, dental and some medicines that aren't a certain schedule they can get and are allowed to take back a certain amount. They pay cash directly, no insurance is needed.
I guess they don't drive because of needing a separate auto insurance policy for Mexico. I believe most US policies cover only Canada, but not Mexico for trips across the border. Plus it might be quicker to just walk back and forth for a day trip. There's a official border crossing back and forth on foot for pedestrians, compared to cars which has a lot longer line.
However I'm not too sure what kind of recourse you have if a dentist or some other doctor messes up. Haven't researched it too much personally. There's some YouTube videos about it though, they have like a entire block of just dental offices back to back. Kinda amazing, but it's a popular area for medical tourism. A lot of them even speak English in that town, accepts US dollars and everything. Some people just visit for lunch and check out the town.
When an OB doc pays 6 figures a year in malpractice insurance — that’s why.
The party on the left who complain the loudest about health cost are incidentally heavily supported by the plaintiffs lawyers. Look at who opposed tort reform in Texas — it wasn’t Republicans, they are the ones that proposed it; it was plaintiff lawyers and the candidates they purchase.
Literally billions a year is paid in malpractice claims and punitive damages in the 7 figures is common. Who pays those awards? We do. Try suing the NHS. Or in the case of Alfie, try even having someone else willing to pay to leave the hospital — not happening.
There is also cross-subsidation as well. When an uninsured “undocumented” person visits the ER for a sore throat — that money is almost never collected, hence the $100 bed pan. When services are effectively shoplifted, everyone else covers the loss. For data on this, look at the finances of south Texas hospitals compared to a hospital in Wyoming. Or better yet, go work in a hospital billing department. Those that disagree with this have never worked in an ER.
Ironically, in Mexico, if you need an emergency surgery, you better have proof of funds or they will literally let you die in the waiting room.
But the US? Pregnant woman walks in to any US hospital, they’ll be treated regardless of ability to pay or citizenship — which is a good thing, but then we can’t be surprised when we get to pay for that when we visit the ER.
The hospital can’t turn you down if you walk in with a medical emergency but they will charge you for it and if you don’t pay they’ll only patch you up until you’re no longer an emergency.
People under 30 who have nothing (known) wrong with them. I was rejected for a condition which barely affects my life, at a time when I was a poorly-paid contractor with no insurance through work.
Exactly. In a country where regulations allow you to start your own insurance company or your own ISP, it works well as an alternative.
With heavy regulation (Obamacare, net neutrality), it is much harder for the small time players to start their own businesses to address shortcomings of the existing companies.
I grew up on the coasts and for a long time would have believed that. People might hate the system but they will comply and work within it.
Living in the midwest has changed my mind, here people need the system to be true because it is the basis for their entire way of seeing the world. They listen to Rush adn to Fox News...and they accept it at a philisophical level. They rely on being told it because otherwise they would have to confront a lot of realities all at once. I don't see brainwashed as a slight, I see it as said with compassion and sadness.
“It's because most people in the US are brainwashed (note: I live in the US) into thinking paying ~$450 / month per adult for basic health insurance with high deductibles is a bargain because it "saves" them from $100,000+ hospital bills in an emergency scenario.”
What are the other options? Most dont choose their health insurance based on belief in one system or another.
I agree there are plenty in the midwest, with conservative views, who believe in conservatism to unhealthy levels, no thanks to the crack pots they listen to on the radio.
The only person I’ve heard who felt the american healthcare system was the best in te world was in a speech by GW Bush. His speech was answered with silence because the audience was in such shock.
I hate it all, and would rather pay much more taxes if we had universal healthcare.
That aside, I had a few different people give me the following reason why this is acceptable to them. "Why should we pay any of our hard earned money to the government so some drug addict can get their fix?" "Why should I pay for single mothers who made bad decisions?" It is almost always other people making poor decisions or getting into poor situations that justify their choices on this type of stuff.
When you ask about parents who's kids can't get surgery, they reply in a similar fashion, "there's government programs for them, so I don't need to pay anymore taxes." They have never had to use one of these "wonderful" government programs. That's key to their thinking.
Try to tell them that it could be their kids that need a surgery they can't afford and it'll go something like, "well that's why we pay for insurance out of our pocket." They never stop to think about people who are in a bad situation.
There is NO getting through to some of these people until they need the help they refuse to pay for. I have seen one couple change their minds once their insurance refused to cover something for their kid. Immediately they were "raising awareness" for this type of stuff... but whatever at least they eventually came to.
So to answer your question, they aren't blind per se, as they see how stupid it is. They are however selfish as shit and don't care about anyone outside of their initial friends and family.
A simple retort to that would be "Why should we pay any of our hard earned money to the government so it can send our children off to some fucking desert to fight in an unwinnable war that was started before they were even born?"
60% of the US budget is spent on the military. Reduce that to just 50 or 40% and suddenly, hundreds of billions would become available to spend on health care, education, infrastructure, etc.
Raising taxes is probably also something to do though, the US is racking up trillions in debts at the moment.
In addition to being cruel, this kind of penny-pinching is often penny-wise and pound-foolish. It's easy to lose more money verifying that people are not shiftless than you save by denying them benefits.
> Because the Florida law requires that applicants who pass the test be reimbursed for the cost, an average of $30, the cost to the state was $118,140. This is more than would have been paid out in benefits to the people who failed the test, Mr. Newton said. As a result, the testing cost the government an extra $45,780, he said.
"Why should we pay any of our hard earned money to the government so some drug addict can get their fix?" "Why should I pay for single mothers who made bad decisions?"
furthermore, taxpayers already foot the bill for these cases anyway since the government reimburses the hospitals, at least partially, for treating the uninsured. What the govt doesn't reimburse, the hospitals pass on to the insured customers (at this point it is hard to call them patients) in the form of higher costs.
> They are however selfish as shit and don't care about anyone outside of their initial friends and family.
evidently people in Canada, the UK, Japan, Sweden, Singapore and other places where there is a comprehensive, well-managed health care system are not "selfish as shit."
so, we should probably ask: "why? why are people selfish as shit in America?"
> There is NO getting through to some of these people until they need the help they refuse to pay for. I have seen one couple change their minds once their insurance refused to cover something for their kid. Immediately they were "raising awareness" for this type of stuff... but whatever at least they eventually came to.
There's a risk associated to the type of thinking that takes root before a breakthrough experience like this: it's the idea that if something bad like were to happen to them, it's because they are exception to the rule, where the rule is plugging your ears and repeating personal responsibility over and over again.
That's to say such a situation gets internalized as, "It's unfair that my treatment isn't covered because I pay for insurance coverage, so of course I expect to be covered when I'm sick. If you don't pay for insurance, you shouldn't expect anything."
Which is a close relative to, "It's okay that I'm benefiting from public assistance, because I'm actually suffering and I'm not cheating the system like everyone else."
We do it for the illusion of freedom which is used to trick unfortunately ignorant people out of services that would cost the wealthy a bigger percentage of their income.
"Choose what X is right for you and your family"
This allows the wealthy the chance to choose a better level of healthcare, schools, and basically everything else leaving the rest of the nation to choose only what they can afford (guess what, its not much). By patronizing the nation by saying "You're so smart, you know better what you need than a stupid Washington bureaucrat like me!", they stroke our ego's just enough to convince people that they are able to get a better deal (ie, beat the system).
It infuriates me that the people who ran for office and chose to "represent" us in a lot of cases completely abdicate their responsibility to do anything. Not to be partisan, but one party is a lot worse about this than another, to me if you go through all the trouble to put yourself in government and enrich yourself handsomely while you are there, at least fucking pretend you are going to try and solve something rather than this self-deprecation that comes out of the Republican party.
I've never met anyone (of either party) who thinks that stories like this are acceptable. The issue, as always, is how do we fix it? Pointing to European democracies merely shows that it can be done, it doesn't necessarily offer a blueprint for how to make it happen in a country with very different size and culture.
Bernie Sanders' "medicare for all" is the plan I've seen get the most support. If we got single payer healthcare, it would probably happen that way. It would cost $1.4 trillion per year[1], which is more than everything the government currently spends outside of entitlement programs. Adding this much spending without raising revenue would more than double the annual deficit.
"Tax the rich to pay for it," Bernie says! Okay, sounds good. His supporters will point to how the top marginal tax rate in the 1950s was 91%[2], and everything was great during that post-war boom. Here's the problem: regardless of the tax laws or rates, the US federal tax revenue has always been 15-20% of GDP[3] (we are currently at 17.3% of GDP). This figure has not changed since 1945, even as the tax law has been wildly changed many times over. That's not to say that nothing can ever change this figure -- it is different in other countries after all. But numerous attempts to change it by manipulating marginal tax rates have failed, and there's no reason to think that Bernie's tax-the-rich plan will do any better.
We are on pace to run a $1 trillion deficit this year thanks to the Republican tax cuts. Simply rescinding the cuts and putting things back they way they were in 2017 gets us about 2/3 of the way to paying the cost of Medicare for all.
It can be done, we the people need to stand up and demand it while voting in leaders who will make it happen.
In 2017, before the Republican tax cuts kick in, the treasury took in $3.3 trillion, or 17.3% of GDP. Projections are that, with tax cuts in full force in 2020, we will take in $3.6 trillion or 16.4% of GDP. You're right that annual deficits will reach $1 trillion by that point, up from $660 billion in 2017.
So let's say we want to add Bernie's $1.4 trillion Medicare-for-all to 2020's projected budget of $4.6 trillion -- we're now spending about $6 trillion total in 2020. To maintain the same annual deficit we have in 2017, we'd need tax receipts of $5.3 trillion, or 24% of the projected GDP. If we wanted to balance the budget, we'd need tax receipts of $6 trillion, or 27% of GDP. That is massively higher than the US has ever been able to get. Undoing the Republican tax cuts would barely put a dent in it.
Since raising revenue to 27% of GDP through aggressive taxation is unrealistic, let's say we could do 20% of GDP -- Bill Clinton and Jimmy Carter era policies were able to reach that level. That means we need to raise $6 trillion in 2020, and we need that to be 20% of GDP. So our GDP in 2020 would have to be $30 trillion. We would need to sustain 16% annual economic growth during a period of record taxation to get there. The growth has never been that high, not even during record booms, and we would need to reach it and sustain it for three years straight.
Bottom line, if you want Medicare-for-all, you're going to have to accept much higher annual deficits than this country has ever seen -- and that's after a major tax increase on the rich.
We all know it's bad. We pay hundreds a month to insurance companies because it's a law that we have to, and our employers pay even more. The health care industry is massively profitable. There's simply nothing we can do about it, or many of the issues plaguing this country. Before anyone says so, the illusion that we can change it by voting is not helpful. We can all elect a representative who will say they are going to change it, and they don't have to do a damn thing we want them to. Our system of government is broken, not just our health care system.
With the explicit goal of causing the individual marketplaces to implode. In the meantime it's increased the cost to taxpayers of subsidizing marketplace plans!
That doesn't really excuse the political cowardice of undermining the system while leaving most of it in place.
I guess we are pretty screwed though, there's no willingness to prop up the buy side of the market and no willingness to make regulatory changes that would negatively impact incumbents on the sell side.
(the fair, "market based" approach to decreasing medical costs in the US is to dramatically increase the number of doctors and mid-level providers).
> That report instead finds that the Obamacare market has continued "stabilizing," and that insurers are "regaining profitability" despite continued political uncertainty over the health-care law.
For a bit of anecdotal data, my premiums went up 2% last year, after 17% the previous year. I also got a $500 refund as they'd exceeded the 20% non-medical costs cap.
That was the talking point, and may have been true in a couple of places (especially those states that refused to expand Medicaid or only did the minimum to comply with the law), but I'm aware of no evidence that was true overall.
>How do lawmakers in the USA convince people that this is acceptable?
One side of government is intent on breaking government and then using that dysfunction as a justification to create more dysfunction. The American political environment relies entirely on fear and creating fear using misinformation.
It is a defined political strategy that one side is committed to[0]. There is a difference between a group of people doing things that you think will break government and a group of people doing things with the intent of breaking government.
This type of 'counter argument' is a symptom of exactly what I'm talking about.
I've literally had someone on reddit tell me that (and I quote) "the only reason why you have free healthcare is that we[USA] subsidize it by protecting your country so that you are free to spend your budget on healthcare".
And I mean....maybe there is a little bit of truth to that, but what sort of attitude is this? It was almost pride as in "yeah we're paying through the nose so you don't have to"?
It's funny that guy would say that because, because of the wars the USA and its greatest ally begin, we have to deal with millions of economic immigrants now, which are seriously hamstringing our system. So I'd say it's kinda the opposite
Trump had made it pretty clear he was against the Iraq war, and plans on closing military bases overseas to reduce military costs.
Keeping our military in European bases certainly does cost the United States significant resources to counter the Russian threat to Europe. While NATO countries don't pay their fair share of costs of maintaining their security, the United States has to pay the balance.
If European countries actually spent what they ought to, they absolutely would have less money to spend on their welfare systems.
>>While NATO countries don't pay their fair share of costs of maintaining their security, the United States has to pay the balance.
The counterpoint here is that US keeps American bases in Europe because US wants to keep their bases here and it serves their interests first and foremost, any defensive goals are secondary, if not tertiary. All Nato nations could contribute exactly ZERO to the budget and US would still be getting the best deal out of everyone here.
I mean, if US wants to tell itself that it's protecting Europe from Russia, then sure, whatever they need to sleep well at night. I, as a European citizen, don't believe that for one second.
>>How is paying for someone else's defense a good deal for America?
Just get rid of the notion that America is "paying for someone else's defense" and it should become clearer - US currently has a complete military hegemony worldwide, and you can't maintain it without having forward bases all over the globe - countries inr Europe provide space for these bases, sometimes willingly, mostly over promises of things that have never materialized. In a lot of cases I think it's clear that the presence and actions of American forces around those bases are antagonizing Russia - at which point I'm not asking myself "why is Russia upset" but "wtf are the Americans doing". I have zero faith that in case of any conflict with Russia, US would come to our help or even prioritise us on the list of locations to defend - I'd much rather rely on our neighbours for help than a country literally on the other side of the planet whose interests don't necessarily align with ours.
Why should stitches be free? Of course they arent, its being paid for under your country’s healthcare model. The cost is harder to see to the individual but its there. I’m all for universal healthcare but comparisons like this are deceiving.
The advantage of the single-payer model is this: if some clinic decides to mark-up one patient's treatment by 4,453%, the single payer can not only refuse to pay for that treatment, but also refuse to pay all other treatments performed at that clinic. This keeps the cost for treatment in a much more reasonable range, since the health care budget is debated and scrutinised as part of government spending.
The Australian model is that health care providers can charge what they like, but Medicare only pays a predetermined amount for every kind of treatment. Providers are free to charge more, but have to capture the difference as a 'copay' or by billing the patient's private health insurance.
I disagree. It’s a universal form of insurance that everyone contributes too. It’s free in the same way a public library or road is free to use. It just becomes another societal cost which frankly, no one notices. It’s not perfect either, if you want something unusual or not common, it’s possible you’ll have to pay for it if it can’t be arranged at the right price. Certain vaccines for example. So there’s still a need for health benefits but without a system charging high prices by default, even those costs tend to be more reasonable.
I understand where you're coming from, I too live in a country where healthcare is free at the point of use, but your claim is ludicrous. If you've ever payed any taxes then you have payed for the services you've received.
In America you pay for health insurance and Medicaid and Medicare taxes. So we are already paying for universal healthcare we just don’t get it until we are 65 or poor or disabled.
Nobody thinks this is good, but half of our voters think government is the problem, and these problems would disappear if the government would stop messing everything up and let businesses provide health care how they want.
I'm pretty sure "how they want" looks exactly like it does right now, with the only change being the option to refuse treating uninsured emergency cases.
You don’t have to convince me! I think socialized medicine is the way to go. But I see enough from the other side to have an idea of the thinking there.
Part of the reasoning is that prices are high because of excessive regulation, like that requirement to treat all emergency cases. Get rid of those and prices will become affordable, the theory goes. I don’t think that would help nearly enough to make it work, but others clearly disagree.
> The argument that I pay for my healthcare in my taxes doesn't hold water either
Indeed. Americans spend more per capita on healthcare than any country in the world, and needless to say, for all that spending we don't even cover everyone.
To put it another way, we _already_ spend enough on healthcare to cover everyone. That we don't cover everyone is a political problem (allowing for the existence of a for profit system with no public alternative), not a spending problem.
> How do lawmakers in the USA convince people that this is acceptable?
When comparing different health care systems there are dozens, probably even hundreds, of points they can be compared on.
If a US politician or party advocating universal, affordable, effective healthcare uses Australia, or Canada, or the UK, or Germany, or any other specific system as a model, or even just as an example to compare to, their opponents can find for that specific system something that it does not handle as well as the US currently does. They use those to convince their constituents that the current US system is better than the proposed replacement.
If the politician advocating change does not reference specific other systems, then their opponents say they are pushing for a government takeover of healthcare using an untried, untested system based just on theory and speculation.
Another thing they like to do is label every other system as "socialized medicine", and paint a picture of adopting such a system meaning we will have to go to government assigned doctors who work in government owned hospitals and deal with a giant, intrusive, inefficient bureaucracy for every medical thing we do no matter how minor.
its not about laws or health. it's the american dream.
hospitals and doctors are in it for the money. so anything that forces you to pay, they will make you pay, because they will get money and that's the American dream.
the incentives are all wrong. remember the news about a bank telling drug companies to straight out quit researching cures and only go for treatments because those generate more money? its all the same problem
Yes, prices in the USA seem totally out of control.
I pay a significant amount in the UK in tax towards the NHS ( I think about £7500 a year of my tax goes towards it) but that's nothing like what I'd pay in the USA.
It's not just the system there that is poor, it's how expensive it is in addition.
> Are people just so blind to how extortionate healthcare is in the USA?
Yes, Americans are utterly blind to this. It's amazing. But it has taken no small amount of effort on the part of specially interested parties to create and maintain that blindness.
A plastic surgeon can do cosmetic surgery, but they aren't cosmetic surgeons: their specialty covers many less-well-known but far more important treatments.
A plastic surgeon specialises in repairing or reconstructing damaged body parts: in this case, the treatment is clearly reconstructive surgery on the patient's ear in the hospital. The patient was weighing the cost of that surgery against living with a damaged ear…
Plastic surgeons also do cosmetic alterations of body parts, such as removing moles, etc. Some platic surgeons work privately to only do these kinds of procedures for celebrities etc., so you may be more familiar with this minority & their work rather than their primary specialty.
The thing that is often hard to understand about the United States is that many Americans hate each other, and many hate the non-Americans that live here even more. We aren't so much a melting-pot, where a single culture emerges from disparate ones living together, as we are an arena with enclaves of very separate, very antagonistic cultures that happen to live in the same country.
It is often very difficult to convince these groups, especially the economically prosperous ones, to contribute to a system that helps the others, even to their own detriment. The rich don't want to pay for healthcare for the poor, the conservatives don't want to pay for healthcare for illegal immigrants, the mid-westerners don't want to capitulate to the coastal-elite agenda, progressives have zero respect for the values of conservatives and on and on. There are cultural lines drawn, and crossing those lines is nearly unthinkable to many Americans, even if it costs them their health.
American culture is broken and divided, most people can see that but they think that the other groups are the problem, and I'm not sure we will make much progress on our massive problems unless something changes with it.
Tens of millions of Americans thought it was smart to elect Donald Fucking Trump president. We're paying the price for decades of underfunding and ignoring our educational system with an astoundingly ignorant electorate.
I will bring up one point. The wages medical practitioners make are generally higher in the US. So the cost of medical care is higher.
I live in Belgium, mostly good and free healthcare (barring payment of a few euros here and there). I have 3 cousins who are (or are studying to become) doctors and while specialised doctors can make decent money (€75 -> 450k), they don't come anywhere close to what a US based doctor might be making.
Someone making between $1 to 2m in the US (e.g. certain surgeons) might "only" be making $300 - 400k here. And the quality level is exactly the same.
This is not the reason US healthcare is costly. Canadian doctors do very well - there isn't much incentive to work south of the border. The reason US healthcare is expensive is because you have multiple payors and a ridiculously complex web of rules for everyone to navigate.
Wages certainly are a contributing factor to the cost of US healthcare. Canadian physician salaries are high by any normal standard, but still much lower than US salaries, especially when you get into specialties.
it has little to do with the pay of doctors and everything to do with health care administration costs, and insurance companies extracting as much profit as possible.
That's a good point, but not the only reason. The insurance industry extracts a big profit margin by just moving money from one risk pool to another, and that profit has to come from somewhere, so, costs go up. It's inevitable.
If you were to break down the charges from a surgery, the portion that goes to the surgeons salary is rather small, and particularly the portion that might be the difference between EU and US salaries. I think differences in charges for things like prescription drugs make a much higher impact.
There was no treatment for his condition beyond palliative care. He was on life support for the rest of his life, no matter what anyone did.
His doctors, whose duty is to the patient, determined that it was more harmful to artificially keep him "alive" (he was in a semi-vegetative state due to serious brain damage) than to disconnect his life support and allow him to die.
The offer of "care" in another country (the Vatican) was simply palliative care: they intended to simply keep him alive on life support indefinitely. There was no treatment for his condition.
His doctors, quite rightly, concluded that transport to another country would do him no good and would instead cause more harm.
The court case was between his doctors and his parents. The UK government had absolutely nothing to do with it.
From what I can tell, Americans seem to define "government" to include the courts as one of its branches, whereas Brits define it to only mean the legislative branch and maybe part of the executive in US terms. Which makes it interesting when British people accuse Americans of lying for claiming the government was responsible for this, especially since I'm sure some of those people know Americans mean something different by that word.
Aren't judges appointed by the president in the US? Reports of Supreme Court candidates every time the US elects a president appears to indicate a lack of judicial independence.
I'm not hugely well informed on US law so could be misunderstanding this process.
Edit: Wikipedia tells me Article 3 of the Constitution makes the federal courts part of federal government
> Aren't judges appointed by the president in the US?
Appointed by, but not accountable to once appointed, and the appointments are permanent. The President can't direct judges or fire them because he doesn't like how they do their job (Congress can “fire” them by impeachment, but that requires a supermajority in the Senate after charges by a majority of the House, which means it doesn't happen on a whim of the political majority.)
UK courts have had judicial independence since the Act of Settlement. Governments don't appoint judges - now via an independent panel since the Blair govt abolished the Lord Chancellor, but even then govts didn't have influence or appointing powers.
The courts quite often upset UK governments (of whichever party) when they strike down bad laws via judicial review, or by finding some aspect of government policy illegal.
An independent judiciary is a foundation of all true democracies. The government may make the laws, but the judiciary are fully independent when making judgements about a case.
IANAL but I believe in this case, the point of law it came down to was largely about deciding what was best for the patient, not the parents.
In parliamentary systems, “the government” is often most frequently understood in a sense somewhst similar to the way “the administration” is used in the US, referring to basically the cabinet and their political subordinates who direct policy.
This is probably a bit confusing for Americans because in the UK big cabinet posts in that executive will be filled by people from the legislature. So all the senior jobs go to elected representatives - but the citizens who elected them don't get to pick who gets which job.
Imagine if Mitch McConnell runs the executive, he gets to pick Senators for important stuff like the Secretary of State, and lesser things like the top of the FCC go to Republicans in the House. They're still in Congress, they just are now also running an executive. Just as now all the real work is done by career civil servants, the politicians are there to set political direction.
The Palace where the UK's elected legislators meet is divided down the middle so that members of the political parties that aren't in Government are quite literally "the opposition" - they're facing the members from the governing party.
Because power might shift suddenly a serious opposition political party has to have "shadows" of every major executive role. A Shadow Environment Minister for example doesn't have a huge Department actually governing the environment like the "real" Environment Minister but they need to know what's going on in that department and be able to explain how their party would do it differently, because tomorrow they could be in power.
"Hoboken University Medical Center, where Pell was seen, declined to comment on the bill. The hospital did, according to Pell, reverse the entire balance after Vox began inquiring about the fees."
I'll bet the hospital sees that as 'fixing the situation' and all I am left wondering is how many other people don't have Vox reporters sending emails for the same type of treatment. I'm hoping the CMS plan [0] to require published prices might help this type of nonsense just a little.
Hidden price-gouging is a real problem here. CarePoint Health, the company that operates this facility and a couple others nearby in Jersey City and Bayonne, has a reputation of consistently exorbitant ER bills, in addition to only accepting a limited set of insurance providers.
On the other hand, Hoboken University Medical Center would have closed a decade ago if not purchased by CarePoint at the time. Prior to that acquisition, it was a non-profit community hospital for over 140 years -- it's the oldest hospital in the state, but it eventually hit severe financial difficulties. Today it has a good reputation in some areas, especially obstetrics. But as someone who lives a few blocks away, the poor reputation of its ER's billing practices is definitely worrisome.
Disclosure: I worked at the same company as Jess Pell and vaguely recall hearing about this overbilling situation a while back, but that's far from the only time I've heard about this particular ER overbilling someone.
I doubt it, hospitals were already required to make those prices available, the change is that they have to make them available on the internet.
While hospitals are already required under guidelines developed by CMS to either make publicly available a list of their standard charges, or their policies for allowing the public to view a list of those charges upon request, CMS is updating its guidelines to specifically require that hospitals post this information. The agency is also seeking comment on what price transparency information stakeholders would find most useful and how best to help hospitals create patient-friendly interfaces to make it easier for consumers to access relevant health care data so they can more readily compare providers.
One reason to doubt it is that an awful lot of people live within reasonable distance of 1 hospital, and almost everyone else lives near busy hospitals.
> While hospitals are already required under guidelines developed by CMS to either make publicly available a list of their standard charges...
This requirement is useless, though. The "standard charges" don't reflect reality. My wife receives regular infusions in an infusion center. They bill $3k to insurance each time. Insurance pays about $400, which the hospital happily accepts. That $3k number is what an uninsured patient would be asked to pay, and it's the number they'll list as the standard charge, but it's complete, invented bullshit.
Will publishing prices just cause more price inflation though? Similar to what happened with CEO compensation when companies became more transparent about their compensation?
No other industry entirely hides the end price you'll pay, or even an estimate, until after you have gone through the service. It's a sad state of affairs but not something we have to be stuck with; most of the time we could get these numbers ahead of time.
ER visits are difficult in their own ways; you can be brought in unconscious and go through treatment you can't agree to, you can be close to death and the time it takes to check costs could impact if you live or not. This means you'd want to do something like fixed costs for these services but with good medical coverage for everyone those fixed costs could be what people do in place of insurance.
I don't have an answer other than universal healthcare. There are reasons that this can't happen at the moment and it's still difficult to implement in a way that works across the board. This is a hard problem and will take a lot of effort to get right
That said, mandatory transparency (from both the hospitals as the insurance/healthcare plans on what exactly happens in what scenario (say x-ray for possibly broken elbow), and the current rate/probability of scenarios) should be requisite, but that is only a necessary condition. The behaviours of the medical industry should also be binding.
I paid $5500 last year for an unnecessary emergency room visit (doctor sent me down to get a scan).
They wired me up to machines and made me wait 5 hours for the scan, then 3 hours to get discharged. They wouldn’t let me leave until the doctor on duty wrote up her treatment recommendation. Even though I was just there for a scan.
No insurance last year so after my “35% cash payer discount” it came out to $5500 after the many parties in the ER sent me separate bills. Scan was $2000 of that, but I could have paid $600 across town.
Don’t go to the ER unless you’re unconscious. It’s that rare case where you are paying AND you are the product.
I recently had an appendectomy. The doctors said that if you are having abdomen problems, you absolutely should go to the ER as there's too high a chance it's life threatening. They said that limbs and such weren't as ER-necessary and urgent care might suffice, depending on severity. But for the stomach, just go to the ER.
I initially stopped at an urgent care facility, but they told me to sit and wait before even asking my symptoms. I'm not afraid of many medical things, but my appendix has always made me extra nervous. So we left and went to the ER, where they asked a few questions and rushed me into a room, and then a scan shortly after. We had caught it very early.
I cannot get over how odd "in network" is for everyone outside the united states. For emergencies we all just go to the nearest hospital. They see us. They treat us. Or they stabilize us and discuss whether we should transfer to another hospital for better/faster treatment. There is no discussion of in or out of networks.
Stories like this make me very happy that I no longer live in the US. The constant fear of a surprise medical bill is a stress I don't need.
Insurers offer guaranteed patients to hospitals and doctors in exchange for reduced payment rates. In other words, they hospitals make their money off of volume. This is why there are networks of providers.
If you prefer, you can visit any hospital you want in the United States, as long as you pay for the medical care. Why should hospitals accept low insurance payment from insurers who do not give them a benefit of increased patient volume?
Typically, the rates negotiated with the various insurance companies are basically secret. No one wants to share the data and there is great incentive not to.
If you are in the insurer side, you think you have a competitive advantage compared to company Y. Sharing what you are paying per procedure is bad business
If you are on the Hospital side, you want to make sure the insurers keep paying more, and publishing means a quick race to the bottom.
This means that in most cases in america, you cant know what something is going to cost until after you get billed. Its great for literally everyone except the consumer.
My personal opinion is that this should be illegal. Prices for the same treatment should be equal regardless of patient or insurer. The insurance repayment policies could differ, but at least the base pay won't seem completely made up.
The base rate is the same (in theory), but insurance policy A is only going to pay 18% of procedure Z and policy B will pay 27%; uninsured patients will be offered a 50% discount if they pay promptly, otherwise the bill will eventually be sold to collections for 1% if it's not paid)
My 3 year old son hurt his arm. It was after 7pm so we had to go to the ER. We see a nurse, she didn't check anything. X-Rays and then they gave us a hospital room. Immediately I realized we were getting into a spending black whole. After 30 seconds I told the nurse we wanted to leave. My son wasn't crying and he was climbing a chair using his "hurt" arm. They wouldn't let us leave. After hustling with them we left. we got a $1,500 USD bill that we had to pay because we didn't know what to do.
Most credit scores are ignoring medical collections or deemphasizing it.
I went to the ER a while back, my insurance paid roughly 1600 for the 8k+ they billed. I have a HSA that pays out as well, yet they have tried to bill me on top of that. They'll never see another cent.
Credit is overrated anyway. Causes more troubles than it's worth.
The insurer only pays part of the bill because you entered into a contract with the insurer that specified that as such.
No insurer pays 100% of every medical bill, no matter what, with no expectation of copay or deductible. Even if you had that sweet deal, you would be paying premiums that nobody could afford.
Do you have a right to receive services from another human without appropriate payment?
They're not talking about the copay or deductible. They're talking about "Hospital believes that the services provided should cost $X, insurance company believes that a reasonable price is $Y, you now owe the hospital $X - $Y".
That's the problem! Hospital overcharges because government pays less than the cost of delivering care, so costs have to be recouped from other sources: privately insured, and uninsured.
The one caught in the middle is the individual who gets screwed by both the hospital and insurer/government.
So you think I should pay made up bullshit costs, while below saying the individual gets screwed by the hospital and insurance.
Maybe you should make up your mind.
I just play the game. They make the rules. Don't like it, tough shit, I've paid in hundreds of thousands to insurance over my lifetime. So cry me a river that they've created this shit system we've got with their lobbying and private/public monopolies.
For all the people railing against hospital corporations, please note:
1. Los Angeles County, of 10.1 million people, runs its own hospital system.
2. New York City, of 8.6 million people, runs its own hospital system.
3. Colorado, of 5.6 million people, runs its own hospital system.
Etc etc. (All of them quickly add up to the population of Canada.) They still do these horrible things we're talking about here, even though they're ultimately accountable to the people and must do what our laws says they must do.
And we think we're gonna suddenly be like Canada, like magic? If so, get the five people running the LA County hospitals to do so. (Yes, five people represent 10.1 million people, lol.) And the same goes for NYC and CO and the rest.
Balance billing is complete bullshit. My long-term plan to deal with it is to move to Texas for their superior creditor protection laws, retire off of retirement accounts + annuities + owning primary residence, have zero assets that creditors can go after, and tell the hospital and insurance company to figure it out because they are legally unable to force me to pay.
Ok, mine is way less than her, but at one of the ER in Wisconsin, they sent me a bill of $400 for literally telling me that I have no disease and sending me back. Out of that, the insurance paid $300, and I paid 100 out of my pocket.
I had gone to ER only because it was at an odd time and no other hospital was open.
Lay people don't have the training to determine if an ailment is life-threatening or not; that's why they pay for insurance, so they can see a medical professional who is qualified to say if you could die or not.
You mean one should wait until the signs show with certainty that they're about to die before going to the ER? That'd a bit of a stretch :). Of course, I went because I thought it was an emergency (though I can see your definition of 'emergency' is quite different from mine). It's not like I went because I had cold.
Yeah. Easy. When I went to an ER because I had fainted multiple times they wanted to send me away, because "that's nothing too serious" ... and I thought that sounds reasonable and wanted to go home, they are the experts after all, aren't they? A good friend told them to do their fucking job instead and they grudgingly agreed to check me, but "you will be out of here in no time, there's nothing" ... so ... they did a blood check and I waited. And waited. "Well .. we don't know, something is off, we will keep you here for the night. But it's only a precaution, there's probably nothing wrong with you!" ... next day they found Stage 3 cancer, which had spread through my whole body. I almost died, had to spend weeks in intensive care, get chemo and operations and the full program.
And all of that only happened because my friend didn't take multiple "no" from the ER doctor for an answer and insisted that I get at least a rudimentary checkup by them, otherwise I would be dead. So, respectfully, your comment is bullshit.
You could also go to a primary care doctor who would be capable of performing a detailed exam to address your chief complaint.
Your friend was right in that the emergency room doctor should do their job, but their job isn't to be the primary physician, they're there to diagnose and treat emergencies.
If you were tachycardic, tachypneic, apneic, hypotensive, hypertensive, febrile, hypothermic, bloody, pale, in severe localized pain, slurring speech, paretic, then the ER would investigate until answers are obtained, because all of the above are concerning.
A complaint of only fainting has many non emergency causes, and you would have to provide additional information that would warrant investigation. Ordering fishing expedition tests in the ER is extremely wasteful in a non emergency situation. Imagine how many people go to the ER for nonemergency care and expensive tests are ordered unnecessarily! Because of defensive medicine, this happens way too much, which is why healthcare costs so damn much in this country.
> “I decided to decline treatment because I can’t really afford any surprise bills right now,” she said. “The bill I’d probably incur would not be worth saving my ear, which was sad but a choice I had to make.”
She felt that losing her ear was a possible outcome of the accident, which certainly seems like an emergency.
More broadly, it can be difficult for a layman to determine what warrants emergency care vs what doesn't.
Hitting your head hard enough to cause injury is almost always a reason to seek immediate medical attention, especially if the head injury is the result of losing consciousness in the first place.
What is it that does cost $5k? Keeping a mostly-unused tomography machine and crew ready in case someone at the ER needs it? Insurance premiums charged per patient who walks in the door?
We get these complaints in Germany too (where I currently live) BTW. "A five-minute drive with an ambulance shouldn't cost €500!" someone complained to the newspaper here recently. It doesn't, what costs €500 is keeping enough ambulances ready that one can arrive within x minutes with y% probability, for IMO overcautious values of x and y.
€500 is still something many people can pay in Germany, 5k isn't something the average American can foot (with no treatment to boot). It's not at all a comparable complaint.
IIRC an ambulance ride in the US is 10-20k, that's indicative of just how much more medical care costs over there.
I have never heard of an ambulance ride costing anywhere _near_ $10K-$20K. The average, out-of-pocket price of an ambulance ride is much closer to $1000 - and often less. New York's 2012 fee schedule offers a good example: https://www1.nyc.gov/assets/fdny/downloads/pdf/about/fee-sch...
Sure, there's an extra digit. Much US healthcare seems to suffer from Extra Digit Syndrome.
What might be similar that the billable item is not the costly item. Of course I don't know the first thing about US health care costs (as opposed to billable items).
> a mostly-unused tomography machine and crew ready in case someone at the ER needs it
No hospital administration would allow this: they would refer you to a separate medical imaging clinic, or run one on hospital grounds that all departments would refer patients to.
eh in germany driving the ambulance is free - if you really need one. of course there are people who call the ambulance without too much reasons and even than as long as the amublance doctor will allow you to take the drive to the hospital you would still be on the safe side.
Some of the PKV companies offer cheapish plans that effectively do not, or that make you pay the first €x00/month yourself. Things like that. They're marketed as insurance against big problems for a small price.
As far as I know, point of the exorbitant fees is the weird process of collective bargaining between the care-providers and insurers.
I.e. you, as the hospital, inflate your price, by X00% margin over what you actually plan to charge the insurance. Then you let the insurance negotiators negotiate, and you negotiate down to the reasonable price.
This looks really good on the paper. Unfortunately, you as a patient, if you don't have good coverage, you end up paying the inflated price, that you didn't really have the chance of negotiating (and wouldn't really have the chance even if you hadn't been unconcious ;)
Like, if I compare it to Czech Republic, where I live (or even Germany), the prices seem much more reasonable (i.e. you would be able to get a complication-free birth in hospital for ~400$, more complicated, i.e. cesarean section ~1500$, including hospital stay, in US it seem to be 5-10x as much)
> that you didn't really have the chance of negotiating
Not American, but from what I've read in these types of news articles, you often CAN negotiate it down a lot, but when you get a huge bill in the mail, the first thing you think isn't "I'm going to try to haggle down my $5000 bill with this huge hospital" you think "I'm so screwed. Time to google 'personal bankruptcy', was it 7 years?". Pharmaceutical companies are also always saying that they will subsidize prescription medications for those who can't afford it, but I dunno how much that is BS or not.
Oh, good to know. From the horror stories you usually read in the news it seemed that "try to haggle down my $5000 bill with this huge hospital" is something you just don't get to do, if you are a patient, I will remember that if that ever comes up (even though I hope it doesn't :)
If you use insurance they are less willing to negotiate.
(but you are getting the negotiated price anyway; the paranoid part of my brain thinks they run a scam here by recoding bills that come after the deductible has been met, which is a different sort of negotiation than agreeing on prices for services)
I wonder what the result would be of the US government requiring all hospitals to have a public, fixed, non-negotiable price list the same for all insured and uninsured.
In my view "emergency room" is a red herring. I once went to an ER for something. My first interaction was at a window where a worker asked me what was up, then pointed me down the hall to a facility that looked like and was just a regular urgent care clinic.
Medical care is anything if not statistical. If an ER is receiving non-emergency patients, they know it, and can design their care processes to handle those patients efficiently.
If they're billing patients $5k for a bandage, it's solely a financial boondoggle. There is also a political aspect -- blaming poor people for "wasting" care by making unnecessary use of the ER.
And if you do have an emergency you're fucked because the health insurance you were already required by law to pay for has incentives that, like the healthcare provider, do not align with actual patient care?
I remember when I was still a school kid there was another kid that fell on his head when he did skate boarding. He said that everything was alright. In the afternoon he got headache but still claimed it was alright. Next day he was dead...
Imagine if you took your car into the shop - there is no price list, they won't give you an estimate, and for weeks after they send you random bills without indicating what it's for?
This affects everybody in the US, and I don't understand why it's allowed to continue, except the medical industry has bought off all the politicians