I accidentally stabbed myself in the finger while cutting open a package using a knife. Stupid, I know.
The would was small, maybe 1 centimeter, but deep enough that it wouldn't stop bleeding on its own. My girlfriend insisted we go to the ER (urgent cares around here are closed on Sundays), so we did.
I was the only one there that day. I was ushered in to see a doctor. The doctor looked at the wound, and said, "this is way too small for stiches, let's just use glue." So the ER nurse handed him a skin glue, and he used it to close the wound. After a few minutes, the wound was closed. I was prescribed antibiotics (kitchen knife, in case it had salmonella etc.) and sent my way.
Three months later, the bill arrived: $2,600.
That isn't a typo. Two thousand six hundred god damn dollars for skin glue on a small cut on the finger.
My insurance successfully negotiated it down, but still, the audacity of charging four figures for five minutes of medical care is just absolutely insane.
We desperately need single-payer healthcare in this country.
I sliced a banana peel of skin off my finger on glass by accident. 3 hours of various stages of waiting rooms after triage and I had been x-rayed and sewn up and sent home.
Cost me $8 in parking a $2 in Tim Hortons coffee.
I felt an immense level of pride in the taxes I pay (43% income tax before deductions) when it clicked that anyone who walked in would have gotten this same service.
I'll be honest, it was actually a hot chocolate and I love their hot chocolate when it's scalding hot. I sip it really slowly in a weird "aeration" move that mixes with air.
It reminds me warmly of 6am hockey practices when I was a kid.
You weren't paying for the glue and the five minutes. You were paying for the overhead of maintaining all the other stuff that was there that you might have needed under different circumstances but happened not to need that day.
While that's true, that's also true for all other countries where hospitals don't bill you $2,600 for glue and five minutes. So now the question merely shifts to why America needs that much money for stocking supplies and keeping doctors sitting at hospital.
Good point. There are three additional items that U.S. hospitals have to pay for that non-US hospitals don't (or that they have to pay a lot more for):
1. Malpractice insurance
2. The overhead incurred by insurance companies and
3. The cost of serving uninsured patients who can't pay out of pocket.
The third one is huge. US emergency rooms by law must treat serious conditions -- but only serious conditions -- whether the patient can pay or not (for some value of "serious" -- I'm not sure of the details, but that don't really matter here). So there's a substantial population that can't get preventive treatment and so have no choice but to let minor conditions go untreated until they become serious (and, of course, much more expensive to deal with).
So currently if you get sick, you "win" the sick lottery and get to pay for other people's illness as a result.
What's a fair rate for a cut that just needs skin glue and some antibiotics? $500? or is it more like $2600? Because it sounds like he's paying somewhere around a 5x multiplier just because 1) he got a cut and 2) he can pay it.
At some point that won't be sustainable, and emergency rooms will shut down from the cost. People will just stop going to emergency rooms if it means getting a bill for 5x for what it should cost.
It's more that they paid to cover the costs of all of the other emergency room patients that never paid their bills.
No one actually pays the sticker price anyway, that's an artifact of the strange ways that medical billing works. People that pay in cash (rather than insurance) are given large discounts.
Please go back and re-read what I wrote, paying particular attention to "might have needed under different circumstances but happened not to need that day".
Oh, I didn't notice that my bad. So like the hospital is prepared to do open heart surgery on me, I should pay for that just in case I need it when I go to the hospital for a common cold. Makes 100% sense.
You need single payer because you can overcharge anyone who can't negotiate lower rates (i.e. individuals who's personal business with the healthcare system doesn't have much if any effect on it).
Compare that to a state bargaining on behalf of 10+ million customers.
I'm not sure the government can do a good job negotiating on behalf of its citizens. It doesn't work well for student loans (blind checks that increases tuition) [1], California's power cost (rate set with gov cooperation) [2], or even Medicare [3].
I think we need to fix several more issues before single payer would be a suitable option.
How is this, from your link, the government bargaining on medical costs?
> but the plan bypasses an obvious remedy - one that President Donald Trump embraced as a candidate: allowing Medicare to negotiate drug prices directly with pharmaceutical companies.
To me (non-english native speaker) it reads as if though they are literally not allowed to negotiate.
When it comes to schools, here (Sweden) the government negotiates how much money the schools get per student, not just the interest rates of loans. Lowering interest rates means students can afford a higher loan. None of this is comparable to negotiating costs.
The points I posted are a few examples of the government doing a poor job at dealing with the public's money. With medicare they past laws preventing their ability to negotiate. For schools in the US, the federal government has no limit on the amount of loans they can give it. I think these are relevant to the government's negotiation ability as in both cases they're allowing the counter party to abuse them to the detriment of the public. I don't trust that if the government is the single payer for healthcare that they won't let the pharmaceutical companies and hospitals take advantage of them.
You just need more competition and regulations to make prices public and stated before the procedure.
I live in a country with single payer healthcare. It sucks tremendously. Instead of paying there is waiting, sometimes for long months for absolutely crucial procedures.
Fortunately I also live in a country with reasonable regulations and sizeable private healthcare facilities. I pay reasonable prices (which means often 5x-20x less than in US) if I need treatment and I can get it in timely manner.
It's not single payer that makes our system better. It's competition and reasonable regulation that makes it possible to have cheap services available.
The single payer solution assumes the status quo is the only possible way healthcare can be priced. However prices for the same procedure can vary wildly depending on the provider in the same area in US. In all other areas of commerce, prices tend to be comparable among competitors especially within the same geographic area. So why is healthcare the only industry that doesn't act like that?
I honestly don't know, but I think part of the problem is a lack of price transparency. People cannot shop for the best prices for non-urgent procedures, etc. I bet price transparency would at least help stabilize the prices across providers. Is that enough to solve the problem completely? Doubtful, but it would be a start.
There's a difference between single payer and universal coverage.There are many other systems. For example, France and Germany do not have single payer. Single payer is just well known in the US due to the proximity with Canada.
Well. A for profit entity can hardly be regarded as bargaining on your behalf. They are bargaining on behalf of their revenue. The difference between what they negotiate and what they charge you is their entire business.
That's if you have insurance, which - surprise - is only reasonably priced if you are part of a group (e.g. employer) which can negotiate on your behalf.
Ah, so then that's what this boils down to? The high cost of health care is a symptom of capitalism run a muck? We're being charged these exorbitant rates simply because they can get away with it? If only we had a single payer that was able to negotiate, these costs would evaporate over night? Not sure it's that simple...
Although, in a way it does kind of make sense. Unlike consumer goods (television, cars, etc.), one's health is something they're likely willing to break-the-bank for. So without any kind of restraint, I could see costs getting out of control. The hospital is focused on making as much money as they can, and the consumer is focused on preserving their health. If one doesn't have their health after all, what do they have?
Add an ever increasing demand (baby boomers are aging rapidly) and suddenly, things begin to look much worse for the demand side of the equation.
Consider:
- The US is much fatter, on average
- Medicare's standards for reimbursement are often not based on cost effectivenes
- The US government will pay around $150K/QALY vs. e.g. the UK's c. $40K/QALY.
More expensive healthcare per capita is what I'd expect given those attributes and "single payer is the only solution" does not seem to be logically linked to the problem and facts.
Please note that the data you link does not address obesity and health costs simultaneously! Obesity is indeed a contributing factor, around 5% of total.[ξ] And from your references, the US has substantially more obeses and overweights per capita than the countries against which it is compared for health costs
Thanks! That seems high, although I suspect the pricing has something to do with opportunity cost for the hospital. ER docs are limited, and he wasn't available to assist with [serious life-threatening trauma] while he was gluing your finger up.
I had something similar (knife slip, a few stitches) come out to like $350 at urgent care. I paid with (literal) cash.
Any other system is going to be written by lobbyist relying on complexity for cover.
If consumers had as much political strength on capitol hill as the medical industry, another system could be worked out. But they don't. The window was closed on that option with Citizens United.
The pricing for medical bills is always insane but hospitals routinely take much less. I don't know the purpose of these "shock bills" that are never actually the real price. But I've seen the actual price paid be as low as 5-10% of these insane bills.
Well for a minor cut you went to a facility that has staff and equipment available 24x7 to deal with multiple concurrent heart attacks, strokes, major injury and trauma.
Next time wash it out, bandage it up and wait for cheaper treatment if you still need it.
The would was small, maybe 1 centimeter, but deep enough that it wouldn't stop bleeding on its own. My girlfriend insisted we go to the ER (urgent cares around here are closed on Sundays), so we did.
I was the only one there that day. I was ushered in to see a doctor. The doctor looked at the wound, and said, "this is way too small for stiches, let's just use glue." So the ER nurse handed him a skin glue, and he used it to close the wound. After a few minutes, the wound was closed. I was prescribed antibiotics (kitchen knife, in case it had salmonella etc.) and sent my way.
Three months later, the bill arrived: $2,600.
That isn't a typo. Two thousand six hundred god damn dollars for skin glue on a small cut on the finger.
My insurance successfully negotiated it down, but still, the audacity of charging four figures for five minutes of medical care is just absolutely insane.
We desperately need single-payer healthcare in this country.