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I'm amazed at the stupidity permeating this thread ( and wiling to burn karma to defend against it). A random guy wakes up at 1am with a cramped muscle. Goes t

I'm amazed at the stupidity permeating this thread ( and wiling to burn karma to defend against it). A random guy wakes up at 1am with a cramped muscle. Goes to facility that is equipped to deal with anything. On the spot surgeries, ability to break teeth safely to intubate and keep alive, drugs, cabinets with up to date equipment. Staffed with non-expired drugs that are regularly recycled. Staffed with people that can use all that round the clock, multiple backups. Staffed with people that keep the place reasonably sterile and safe. Staffed with all others to support an operation like that and expecting to get sued if it fails even a bit. And then complains, he had to pitch in for all that. An engineer, most likely earning above 8k usd, had to give a weekly salary for something that he considered worth dragging his butt out of bed at 1 am. The guy is delusional. The US health care is, on the expensive side, and can be better, but nobody can argue it without taking into account all that goes into maintaining that, just so one can randomly walk inside with a spasm, or after a huge carcrash with 40 broken bones, and liters of blood lost, and probably stay alive. I'm also amazed how most people here just ignore the reality of the scope of the overall operation, and claim that for a limited use case, it's too expensive. I'm not even going to insert a car analogy here. If you can't see why health care by nature is socialized and a utilitarian model, I'm not going to argue with people from USA thinking that everything should be proportional to the service and their pocket. Man up. You are not the center of the universe. This civilization was built for you, by people, and no matter if you like it or not, you will pay to maintain it for the people coming after you. Humanity, is a social concept worth defending.

peterwwillis 9y ago
Did you know that in the rest of the developed world, what you described is considered absolutely insane, and never happens? Not the people going to hospital thing - that happens all the time. It's just that nobody is ever charged thousands of dollars for it.
- deleted 9y ago
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- jfnixon 9y ago
  Sure they pay for it. It is called taxes, and it does come to thousands of dollars.
  - r00fus 9y ago
    Yeah, instead US residents pay taxes so corporations can avoid them.
  - thebokehwokeh2 9y ago
    In America, instead of paying taxes for socialized healthcare, people pay 2 - 3 times more to corporations because it's the American way. As a Canadian, I gladly fork over a few thousand a year to avoid tens to hundreds of thousands in one sitting should something horrible happen to mine/my family's health.
- derekp7 9y ago
  Do the other countries have a lower cost method of maintaining service, or is the patient charged the same, just not all at once (i.e., spread out over a lifetime of higher taxes)? If there are cheaper ways of providing healthcare, what would have to change in the US to implement it? For example, if there are three hospitals in a region, and they worked out an agreement among each other to not have overlap in specialized equipment (where hospital A sends all MRI patients to Hospital B just down the road), this is currently illegal (anti-collusion laws). Another example -- a patient comes in with a headache. Well there could be a number of potentially fatal conditions that could be the cause, and due to liability reasons, they have to run tests to rule these out before giving the patient an aspirin (yes, this is an issue, in lower-income areas people go in for non-emergency issues that most likely doesn't need a doctor).
  - maxerickson 9y ago
    Limitations on specialized equipment are enforced by many states: http://www.ncsl.org/research/health/con-certificate-of-need-state-laws.aspx#4 http://www.ncsl.org/research/health/con-certificate-of-need-...
  - dv_dt 9y ago
    US healthcare costs are completely out of control compared to other modern nations. We pay 2-3x the cost of other nations for our care per capita. Primarily I would attribute that to other nations applying a universal healthcare principle, and in some form or other placing government controls on the prices of medical procedures and drugs. We pay more, and our life expectancy is shorter. https://ourworldindata.org/the-link-between-life-expectancy-and-health-spending-us-focus https://ourworldindata.org/the-link-between-life-expectancy-... https://www.kff.org/health-costs/issue-brief/snapshots-health-care-spending-in-the-united-states-selected-oecd-countries/ https://www.kff.org/health-costs/issue-brief/snapshots-healt... https://www.pbs.org/newshour/health/health-costs-how-the-us-compares-with-other-countries https://www.pbs.org/newshour/health/health-costs-how-the-us-...
  - peterwwillis 9y ago
    Other countries develop custom funding models based on a universal healthcare initiative. Basically, they find a way to pay for it, and they just do it. This will never happen in the US, however, because the US is obsessed with concentrating power in private enterprise and refusing to fund social services. We have more than enough money to ensure the health and welfare of all of our citizens. We just don't actually care to do that, and would rather have rich companies and uneducated, sickly, indebted people.
Afforess 9y ago
False dichotomy. Yes, emergency rooms are a marvel of modern planning and materials. But just because they are impressive does not mean they need be expensive, or that such efficiency must be difficult to implement. The initial costs for the mediine is all front-loaded, in the R&D. The actual manufacturing of previously discovered medicine is cheap and trivial. The same is the case for many of the efforts of nurses and doctors (not to belittle their jobs), but they aren't doing R&D. They are following memorized checklists of knowledge, triaging based on information that was discovered elsewhere, then imported to their classrooms. All of this cost is also front-loaded. Grifters, middlemen, and oligopolies are why healthcare is expensive in America. There is no reason we can't fund expensive R&D and also get cheap medicine.
- UMadBreaux 9y ago
  I think you are underestimating the amount of experience and intuition it takes to be an effective medical professional.
  - munk-a 9y ago
    I think you are overestimating the portion of the cost that comes from the experience and intuition of doctors and underestimating the portion of the cost that comes from bureaucracy and simple exploitation. There have been some immensely interesting articles about price variations in chargemaster documents between hospitals. https://www.pbs.org/newshour/health/new-report-shows-staggering-differences-in-the-cost-of-medical-treatments https://www.pbs.org/newshour/health/new-report-shows-stagger...
    - chimeracoder 9y ago
      > There have been some immensely interesting articles about price variations in chargemaster documents between hospitals. In isolation, those prices are meaningless and can't be compared between two different hospital - even two different hospitals in the same network. Hospitals make a marginal loss on patients who are on Medicare and Medicaid. They mark up the list prices of everything else to private insurers in order to make up the difference. The way that those markups are distributed doesn't really reveal anything, and even the aggregate size of the markup doesn't reveal anything other than a vague correlation with the proportion of their patient population that is on public insurance. (That's even assuming that the private insurers pay the prices they are charged, which is never true - they negotiate for lower prices, although they are still required to pay more than Medicare does).
Jemmeh 9y ago
Plenty of countries provide emergency and late night/weekend care without putting people into massive debt for it. Of course there are places where people are worse off than us, but there are places better off than us too. I'm not going to eat the exact same Tostino's pizza every night and say "That's good enough" just because in some countries people are dying of thirst and starvation. You don't stop improving things just because it's worse off elsewhere. It is so great that we have an ER available to most people here at all times. But we can still do better with it. If you get in a car crash and they have to rush you to the nearest ER you don't get to shop around or choose, which is why it's a monopoly. They can charge you whatever price they want very specifically because your life literally depends on it. There's no market freedom in that. That's why healthcare shouldn't be left to just the free market. That's why so many countries have social healthcare. Sure the engineer you mentioned could handle it, an engineer can handle most financial burdens but not everyone is an engineer. One ER trip can make fixing your credit nearly impossible, and then you can't get a car(required in many areas of the USA due to how cities are planned) or a house, certain jobs, emergency loans, etc. It's not "a little on the expensive side", it's "How much can we milk you for with your life on the line?"
xgbi 9y ago
Please, US is spending more percentage of GDP than France on health. https://data.worldbank.org/indicator/SH.XPD.TOTL.ZS?end=2014&locations=US-FR&start=2009 https://data.worldbank.org/indicator/SH.XPD.TOTL.ZS?end=2014... Come here in France and appreciate that you can go to the ER for ANYTHING (went 4 times last year for my kids because of bad cough and head injury), and not pay a dime. And they have the same kind of infrastructure to maintain here too, CT scanners, emergency rooms, surgeons and all. You cannot tell people that the guy is hallucinating hidden costs. It is the health system that is hallucinating these costs. It is a race to the top of who is going to charge the most.
- jblow 9y ago
  Okay, but France is not known for its stellar economy or the prosperity of its people. Over here, at least, France is known for its stifling amount of government control when it comes to anything economic. It’s possible these things are related. (Just sayin’!)
  - astrodust 9y ago
    Stellar compared to what? Anomalies like the US? Petrostates like Norway or Saudi Arabia? By world standards France is doing fine.
    - jblow 9y ago
      The comment was a criticism of the US as compared to France. So you can’t write off the US as an anomaly because that comparison was the whole point!
      - astrodust 9y ago
        The US is a large political entity and comparing it to France isn't fair. A better comparison is to the entire EU, both in terms of population and ecomomy. Where there's France there's states like Georgia which are neither the best nor the worst.
- 9y ago
tedunangst 9y ago
The hospital gets to choose whether the ER visit complexity is from 1 to 5. How is dispensing a muscle relaxant a 4? What would be an example of a 1?
- Balgair 9y ago
  Ahh, you misunderstand. The 'scale' is meaningless and only there to present a perception of judgement. They only have one to make you think that there is some decision to be made at all. It's like Uber ratings, anything less than a 5 star is a 0 star, or like TickeMaster pricing where there really was never a ticket on sale for 30$.
gruez 9y ago
so what you're saying is, as long as there's consumer surplus in healthcare, we should suck it up and deal with the high costs?
supercanuck 9y ago
I'm not entirely sure you read the article. The article discusses that there are 5 categories of care and that step throat is billed equally as a gun shot wound due to market failure and lack of competition. I'm not sure anyone is arguing that he should be paying the unit cost without anything going to overhead, but it seems reasonable that strep throat could be treated with antibiotics and be labelled a Category 1. I had this same situation play out with my daughter where we were concerned with appendicitis and it turned out to be gas. Still was considered a Level 5 even though I protested. Nothing you can do about it. What are you going to do negotiate with the staff at 9pm while your daughter is hurting? What leverage does anyone have in that situation?! You going to risk being a social parriah and risk your family relationships to save money?
- epmaybe 9y ago
  Isn't level 5 billing just noting that the diagnostic decision making was complex and complete enough to warrant billing that much? It requires that one perform a complete history, a complete physical exam, and warrant "high complexity medical decision making". To use another example: You have a lump on your breast. It's either cancer or a benign cyst. Would you bill these differently for the diagnosis work on the doctor's part? Maybe I'm misunderstanding what happened in your situation, but if the same exact steps are taken in diagnosing appencitis vs gas, wouldn't you bill the same? Edit: Oh I forgot to mention the main reason I commented. I have also heard that billing less (like level 4) even if you completed all the steps for level 5 but do not want to get flagged by the system for overbilling can in turn actually get you flagged for underbilling, and can be cause for an investigation/audit.
  - deleted 9y ago
    [deleted]
  - supercanuck 9y ago
    There is no way of knowing. No standards exist between 1-5. You walk into the ER and hope it doesnt result in bankruptcy.
    - 9y ago
vec 9y ago
Yeah, you're totally right. Running an ER has huge fixed costs. Running an ER will inevitably have huge fixed costs because emergencies are, by definition, unexpected so they have to be ready for anything. In most of the developed world those fixed costs are amortized over everyone, in the form of government subsidies of one sort or another. It's like the police or the fire department; everyone chips in some, via taxes, to keep the service running whether they currently need it or not. In America, however, we amortize them over everyone who comes into the ER. That's good for the guy who never needs medical attention: he gets all the peace of mind of having state of the art care a phone call away for free. It's good for the lady who rolls in at 3am with a gunshot wound: she gets her very elaborate lifesaving care for only a few percent over the marginal costs. It really sucks, though, for the guy with a dislocated thumb: he's forced to either massively cross-subsidize both the other patients or to forgo necessary but relatively simple care because of the huge expense. That guy doesn't need to believe the system should be free to have a valid complaint that he, personally, is getting screwed over by it.
gricardo99 9y ago
The problem is that at 1am, with whatever horrible pain prompts you to drag yourself, or your child, to seek out medical care, your ONLY option is often an ER. It's not about how amazing ERs are and therefore expensive. It's about horrible allocation of resources across the entire system. If you don't have insurance, guess what, the ER becomes your clinic. If your child is screaming in pain at 2am with an ear ache, guess what, urgent care is closed, you have to go to the ER. From personal experience, people will go to an ER knowing full well it's not life threatening and don't need the full services, knowing full well it's going to cost them a small fortune. But they just can't reasonably wait 6-12 hours to get treatment. Would you let your 3 year-old scream in agony until the next day because that's what time the Urgent care re-opens, so an MD cay say "Yup, that's an ear infection, here's your script, off you go"? It's a silly system that doesn't provide reasonable options to such common occurrences. People should dam well complain about it until there are better options.
- chimeracoder 9y ago
  > The problem is that at 1am, with whatever horrible pain prompts you to drag yourself, or your child, to seek out medical care, your ONLY option is often an ER. It's not your only option. Chances are, it's not even your best option. Urgent care clinics are much more appropriate for the bulk of things people are discussing in this thread. Not only are they cheaper for the patient, but they'll get treated faster, and they'll receive better care, because most of these things aren't what emergency physicians are actually trained to deal with.
  - chuckkir 9y ago
    It's likely the only option unless you live in a large metropolitan area or can drive a couple hours. I guess there aren't enough clients to support both so we get the one that can do everything.
  - gricardo99 9y ago
    I mentioned urgent cares. There are none open 24/7 near me, and that seems to be pretty common. I don't live in some remote area.
rbcgerard 9y ago
Not addressed in the article is the collections part of the equation - as ERs can’t turn people away, they often end up treating many people that are uninsured and/or can’t pay for their care - causing ER’s to try make up the difference on patients that can pay...
lewis500 9y ago
This is absurd. Look at the cost escalations over time. Were ER’s not well equipped ten years ago? No they have just ratcheted up the cost because they can. Consider that, given their bargaining position, wouldn’t it be a surprise if they didn’t take advantage of it? What’s holding them back from shaking everybody down for as much as they can? Morals? Lol. Just because the hospital has a bunch of equipment and training doesn’t mean it’s efficient to charge everyone that goes in there for all of it. There is such a thing as marginal cost. The marginal cost of this guys visit was next to nothing, but they shook him down for all kinds of other crap, much of which has dubious health value. I went to the hospital for a slipped disk. From cursory inspection the doctor could tell I had a slipped disk, but they gave me an x Ray. I said “does the x Ray show my slipped disk?” the doctor said “it doesn’t show that. I just gave you the x Ray to be on the safe side.” Then I had to get an MRI and they gave me a ton of opiates that I threw in the trash, after reading about them online. In the end, the physical therapy that got me back to health cost less than the ER visit. On top of everything, what really gets me is the gall of the medical shake down industry to bring up “costs.” They use the government to make everything as expensive as possible: the absurd licensing and education requirements, the restrictions on foreign practitioners and nurses, the “certificate of need” BS, the lax anti trust treatment as hospitals consolidate into regional monopolies under the laughable excuse of “efficiency,” the use of regulation to restrict suppliers of even generic drugs, the abominable statistical malpractice and pharm rep industry and stupid commercials used to push useless and harmful drugs on everyone—many of them paid for by government in both research and point of sale. At every level the whole system is by design a shamanistic and monopolistic ritual that achieves very little. Look at the failure to replicate of all these stupid studies, the way doctors respond to reimbursements in their use of quack drugs and surgeries, the flatlining of real quality of life stats even as expenditures explode, the power of the various professional associations.
guelo 9y ago
Also man up, woman making minimum wage with no savings and children to support?
mherdeg 9y ago
Yeah so: 1. The US healthcare system is pretty good for some people in some places. I broke a shoulder this week in a bad fall. All local urgent care had JUST closed so I went to a local ER, the only kind of place available with imaging, to confirm the nature on the injury. ER trip was a little slow (I was triaged appropriately behind people with emergent issues) but within a few hours I got a sling, confirmation from X ray images that no immediate surgery was needed, and followup instructions. When I left the ER I got a referral to the hospital's orthopedic group, and was able to get an appointment the next day with a PA & MD who specialize in sports medicine and broken shoulders. My GP confirms that this is a trustworthy referral. So within 18 hrs of injury I got an expert to review the injury and they decided there was enough info from existing diagnostics to avoid additional tests (no more X ray views, no CT) and understand the pros/cons of further intervention. I also scheduled a follow-up at T+36 from injury with my GP to make sure nothing ELSE was broken (mindful that shoulder experts will only look at the shoulder), and was reassured that nothing else is wrong and conservative management is ok. So that's 3 healthcare visits within 36 hours of an injury, with almost immediate post-ER triage to (I am reliably told) a high-quality local expert. This all felt really good and probably slightly faster than I would have been treated when I lived in the UK (with NHS London-area A&E as well as employer private insurance). No complaints about the US system if you have employer provided insurance. I'm fully expecting to see a $4000 bill for these 3 trips and to pay significantly less than that because I carry a traditional high-premium low-coinsurance health plan. Overall it seemed pretty good, but only because I was fairly confident that paying for care wouldn't permanently ruin my finances. Would have felt pretty painful to be uninsured. EMTALA keeps people alive but the medium term financial impact of the US's high quality of ER care is not to be taken lightly. Also would have felt pretty painful if I had been in SF and been taken to SF General Hospital post injury as they are notorious for being extremely convenient to access but out-of-network to all insurance providers: https://www.quora.com/Why-does-San-Francisco-General-Hospital-not-contract-with-health-insurance-providers?share=1 https://www.quora.com/Why-does-San-Francisco-General-Hospita... I do note that although US care is pretty great it can seem a little over the top sometimes: 2. This article gives an example of a patient with strep throat visiting an ER and being diagnosed using a CT scan … why? That seems like an odd choice. I once visited an NHS urgent care clinic with a bad sore throat and I was told "you Americans come in for every sore throat, this is just a virus, go away." They didn't even run a strep test, just ruled it out from symptoms. No antibiotics or other treatment etc. Felt kinda harsh but was dirt cheap for the NHS and I think the outcome was the same as a similar US urgent-care visit. (Actually, I visited an NHS urgent care clinic twice for that sore throat. The first time they told me that because I had an American passport they would charge me £60 to be seen. I was incredulous -- are you sure about that? I'm a UK taxpayer here on a work visa -- and got an apology from a service manager a week later.)
deleted 9y ago
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peterwwillis 9y ago

Did you know that in the rest of the developed world, what you described is considered absolutely insane, and never happens? Not the people going to hospital thing - that happens all the time. It's just that nobody is ever charged thousands of dollars for it.

deleted 9y ago
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jfnixon 9y ago
Sure they pay for it. It is called taxes, and it does come to thousands of dollars.
- r00fus 9y ago
  Yeah, instead US residents pay taxes so corporations can avoid them.
- thebokehwokeh2 9y ago
  In America, instead of paying taxes for socialized healthcare, people pay 2 - 3 times more to corporations because it's the American way. As a Canadian, I gladly fork over a few thousand a year to avoid tens to hundreds of thousands in one sitting should something horrible happen to mine/my family's health.
derekp7 9y ago
Do the other countries have a lower cost method of maintaining service, or is the patient charged the same, just not all at once (i.e., spread out over a lifetime of higher taxes)? If there are cheaper ways of providing healthcare, what would have to change in the US to implement it? For example, if there are three hospitals in a region, and they worked out an agreement among each other to not have overlap in specialized equipment (where hospital A sends all MRI patients to Hospital B just down the road), this is currently illegal (anti-collusion laws). Another example -- a patient comes in with a headache. Well there could be a number of potentially fatal conditions that could be the cause, and due to liability reasons, they have to run tests to rule these out before giving the patient an aspirin (yes, this is an issue, in lower-income areas people go in for non-emergency issues that most likely doesn't need a doctor).
- maxerickson 9y ago
  Limitations on specialized equipment are enforced by many states: http://www.ncsl.org/research/health/con-certificate-of-need-state-laws.aspx#4 http://www.ncsl.org/research/health/con-certificate-of-need-...
- dv_dt 9y ago
  US healthcare costs are completely out of control compared to other modern nations. We pay 2-3x the cost of other nations for our care per capita. Primarily I would attribute that to other nations applying a universal healthcare principle, and in some form or other placing government controls on the prices of medical procedures and drugs. We pay more, and our life expectancy is shorter. https://ourworldindata.org/the-link-between-life-expectancy-and-health-spending-us-focus https://ourworldindata.org/the-link-between-life-expectancy-... https://www.kff.org/health-costs/issue-brief/snapshots-health-care-spending-in-the-united-states-selected-oecd-countries/ https://www.kff.org/health-costs/issue-brief/snapshots-healt... https://www.pbs.org/newshour/health/health-costs-how-the-us-compares-with-other-countries https://www.pbs.org/newshour/health/health-costs-how-the-us-...
- peterwwillis 9y ago
  Other countries develop custom funding models based on a universal healthcare initiative. Basically, they find a way to pay for it, and they just do it. This will never happen in the US, however, because the US is obsessed with concentrating power in private enterprise and refusing to fund social services. We have more than enough money to ensure the health and welfare of all of our citizens. We just don't actually care to do that, and would rather have rich companies and uneducated, sickly, indebted people.

Afforess 9y ago

False dichotomy. Yes, emergency rooms are a marvel of modern planning and materials. But just because they are impressive does not mean they need be expensive, or that such efficiency must be difficult to implement. The initial costs for the mediine is all front-loaded, in the R&D. The actual manufacturing of previously discovered medicine is cheap and trivial. The same is the case for many of the efforts of nurses and doctors (not to belittle their jobs), but they aren't doing R&D. They are following memorized checklists of knowledge, triaging based on information that was discovered elsewhere, then imported to their classrooms. All of this cost is also front-loaded. Grifters, middlemen, and oligopolies are why healthcare is expensive in America. There is no reason we can't fund expensive R&D and also get cheap medicine.

UMadBreaux 9y ago
I think you are underestimating the amount of experience and intuition it takes to be an effective medical professional.
- munk-a 9y ago
  I think you are overestimating the portion of the cost that comes from the experience and intuition of doctors and underestimating the portion of the cost that comes from bureaucracy and simple exploitation. There have been some immensely interesting articles about price variations in chargemaster documents between hospitals. https://www.pbs.org/newshour/health/new-report-shows-staggering-differences-in-the-cost-of-medical-treatments https://www.pbs.org/newshour/health/new-report-shows-stagger...
  - chimeracoder 9y ago
    > There have been some immensely interesting articles about price variations in chargemaster documents between hospitals. In isolation, those prices are meaningless and can't be compared between two different hospital - even two different hospitals in the same network. Hospitals make a marginal loss on patients who are on Medicare and Medicaid. They mark up the list prices of everything else to private insurers in order to make up the difference. The way that those markups are distributed doesn't really reveal anything, and even the aggregate size of the markup doesn't reveal anything other than a vague correlation with the proportion of their patient population that is on public insurance. (That's even assuming that the private insurers pay the prices they are charged, which is never true - they negotiate for lower prices, although they are still required to pay more than Medicare does).

Jemmeh 9y ago

Plenty of countries provide emergency and late night/weekend care without putting people into massive debt for it. Of course there are places where people are worse off than us, but there are places better off than us too. I'm not going to eat the exact same Tostino's pizza every night and say "That's good enough" just because in some countries people are dying of thirst and starvation. You don't stop improving things just because it's worse off elsewhere. It is so great that we have an ER available to most people here at all times. But we can still do better with it. If you get in a car crash and they have to rush you to the nearest ER you don't get to shop around or choose, which is why it's a monopoly. They can charge you whatever price they want very specifically because your life literally depends on it. There's no market freedom in that. That's why healthcare shouldn't be left to just the free market. That's why so many countries have social healthcare. Sure the engineer you mentioned could handle it, an engineer can handle most financial burdens but not everyone is an engineer. One ER trip can make fixing your credit nearly impossible, and then you can't get a car(required in many areas of the USA due to how cities are planned) or a house, certain jobs, emergency loans, etc. It's not "a little on the expensive side", it's "How much can we milk you for with your life on the line?"

xgbi 9y ago

Please, US is spending more percentage of GDP than France on health. https://data.worldbank.org/indicator/SH.XPD.TOTL.ZS?end=2014&locations=US-FR&start=2009 https://data.worldbank.org/indicator/SH.XPD.TOTL.ZS?end=2014... Come here in France and appreciate that you can go to the ER for ANYTHING (went 4 times last year for my kids because of bad cough and head injury), and not pay a dime. And they have the same kind of infrastructure to maintain here too, CT scanners, emergency rooms, surgeons and all. You cannot tell people that the guy is hallucinating hidden costs. It is the health system that is hallucinating these costs. It is a race to the top of who is going to charge the most.

jblow 9y ago
Okay, but France is not known for its stellar economy or the prosperity of its people. Over here, at least, France is known for its stifling amount of government control when it comes to anything economic. It’s possible these things are related. (Just sayin’!)
- astrodust 9y ago
  Stellar compared to what? Anomalies like the US? Petrostates like Norway or Saudi Arabia? By world standards France is doing fine.
  - jblow 9y ago
    The comment was a criticism of the US as compared to France. So you can’t write off the US as an anomaly because that comparison was the whole point!
    - astrodust 9y ago
      The US is a large political entity and comparing it to France isn't fair. A better comparison is to the entire EU, both in terms of population and ecomomy. Where there's France there's states like Georgia which are neither the best nor the worst.
9y ago

tedunangst 9y ago

The hospital gets to choose whether the ER visit complexity is from 1 to 5. How is dispensing a muscle relaxant a 4? What would be an example of a 1?

Balgair 9y ago
Ahh, you misunderstand. The 'scale' is meaningless and only there to present a perception of judgement. They only have one to make you think that there is some decision to be made at all. It's like Uber ratings, anything less than a 5 star is a 0 star, or like TickeMaster pricing where there really was never a ticket on sale for 30$.

gruez 9y ago

so what you're saying is, as long as there's consumer surplus in healthcare, we should suck it up and deal with the high costs?

supercanuck 9y ago

I'm not entirely sure you read the article. The article discusses that there are 5 categories of care and that step throat is billed equally as a gun shot wound due to market failure and lack of competition. I'm not sure anyone is arguing that he should be paying the unit cost without anything going to overhead, but it seems reasonable that strep throat could be treated with antibiotics and be labelled a Category 1. I had this same situation play out with my daughter where we were concerned with appendicitis and it turned out to be gas. Still was considered a Level 5 even though I protested. Nothing you can do about it. What are you going to do negotiate with the staff at 9pm while your daughter is hurting? What leverage does anyone have in that situation?! You going to risk being a social parriah and risk your family relationships to save money?

epmaybe 9y ago
Isn't level 5 billing just noting that the diagnostic decision making was complex and complete enough to warrant billing that much? It requires that one perform a complete history, a complete physical exam, and warrant "high complexity medical decision making". To use another example: You have a lump on your breast. It's either cancer or a benign cyst. Would you bill these differently for the diagnosis work on the doctor's part? Maybe I'm misunderstanding what happened in your situation, but if the same exact steps are taken in diagnosing appencitis vs gas, wouldn't you bill the same? Edit: Oh I forgot to mention the main reason I commented. I have also heard that billing less (like level 4) even if you completed all the steps for level 5 but do not want to get flagged by the system for overbilling can in turn actually get you flagged for underbilling, and can be cause for an investigation/audit.
- deleted 9y ago
  [deleted]
- supercanuck 9y ago
  There is no way of knowing. No standards exist between 1-5. You walk into the ER and hope it doesnt result in bankruptcy.
  - 9y ago

vec 9y ago

Yeah, you're totally right. Running an ER has huge fixed costs. Running an ER will inevitably have huge fixed costs because emergencies are, by definition, unexpected so they have to be ready for anything. In most of the developed world those fixed costs are amortized over everyone, in the form of government subsidies of one sort or another. It's like the police or the fire department; everyone chips in some, via taxes, to keep the service running whether they currently need it or not. In America, however, we amortize them over everyone who comes into the ER. That's good for the guy who never needs medical attention: he gets all the peace of mind of having state of the art care a phone call away for free. It's good for the lady who rolls in at 3am with a gunshot wound: she gets her very elaborate lifesaving care for only a few percent over the marginal costs. It really sucks, though, for the guy with a dislocated thumb: he's forced to either massively cross-subsidize both the other patients or to forgo necessary but relatively simple care because of the huge expense. That guy doesn't need to believe the system should be free to have a valid complaint that he, personally, is getting screwed over by it.

gricardo99 9y ago

The problem is that at 1am, with whatever horrible pain prompts you to drag yourself, or your child, to seek out medical care, your ONLY option is often an ER. It's not about how amazing ERs are and therefore expensive. It's about horrible allocation of resources across the entire system. If you don't have insurance, guess what, the ER becomes your clinic. If your child is screaming in pain at 2am with an ear ache, guess what, urgent care is closed, you have to go to the ER. From personal experience, people will go to an ER knowing full well it's not life threatening and don't need the full services, knowing full well it's going to cost them a small fortune. But they just can't reasonably wait 6-12 hours to get treatment. Would you let your 3 year-old scream in agony until the next day because that's what time the Urgent care re-opens, so an MD cay say "Yup, that's an ear infection, here's your script, off you go"? It's a silly system that doesn't provide reasonable options to such common occurrences. People should dam well complain about it until there are better options.

chimeracoder 9y ago
> The problem is that at 1am, with whatever horrible pain prompts you to drag yourself, or your child, to seek out medical care, your ONLY option is often an ER. It's not your only option. Chances are, it's not even your best option. Urgent care clinics are much more appropriate for the bulk of things people are discussing in this thread. Not only are they cheaper for the patient, but they'll get treated faster, and they'll receive better care, because most of these things aren't what emergency physicians are actually trained to deal with.
- chuckkir 9y ago
  It's likely the only option unless you live in a large metropolitan area or can drive a couple hours. I guess there aren't enough clients to support both so we get the one that can do everything.
- gricardo99 9y ago
  I mentioned urgent cares. There are none open 24/7 near me, and that seems to be pretty common. I don't live in some remote area.

rbcgerard 9y ago

Not addressed in the article is the collections part of the equation - as ERs can’t turn people away, they often end up treating many people that are uninsured and/or can’t pay for their care - causing ER’s to try make up the difference on patients that can pay...

lewis500 9y ago

This is absurd. Look at the cost escalations over time. Were ER’s not well equipped ten years ago? No they have just ratcheted up the cost because they can. Consider that, given their bargaining position, wouldn’t it be a surprise if they didn’t take advantage of it? What’s holding them back from shaking everybody down for as much as they can? Morals? Lol. Just because the hospital has a bunch of equipment and training doesn’t mean it’s efficient to charge everyone that goes in there for all of it. There is such a thing as marginal cost. The marginal cost of this guys visit was next to nothing, but they shook him down for all kinds of other crap, much of which has dubious health value. I went to the hospital for a slipped disk. From cursory inspection the doctor could tell I had a slipped disk, but they gave me an x Ray. I said “does the x Ray show my slipped disk?” the doctor said “it doesn’t show that. I just gave you the x Ray to be on the safe side.” Then I had to get an MRI and they gave me a ton of opiates that I threw in the trash, after reading about them online. In the end, the physical therapy that got me back to health cost less than the ER visit. On top of everything, what really gets me is the gall of the medical shake down industry to bring up “costs.” They use the government to make everything as expensive as possible: the absurd licensing and education requirements, the restrictions on foreign practitioners and nurses, the “certificate of need” BS, the lax anti trust treatment as hospitals consolidate into regional monopolies under the laughable excuse of “efficiency,” the use of regulation to restrict suppliers of even generic drugs, the abominable statistical malpractice and pharm rep industry and stupid commercials used to push useless and harmful drugs on everyone—many of them paid for by government in both research and point of sale. At every level the whole system is by design a shamanistic and monopolistic ritual that achieves very little. Look at the failure to replicate of all these stupid studies, the way doctors respond to reimbursements in their use of quack drugs and surgeries, the flatlining of real quality of life stats even as expenditures explode, the power of the various professional associations.

guelo 9y ago

Also man up, woman making minimum wage with no savings and children to support?

mherdeg 9y ago

Yeah so: 1. The US healthcare system is pretty good for some people in some places. I broke a shoulder this week in a bad fall. All local urgent care had JUST closed so I went to a local ER, the only kind of place available with imaging, to confirm the nature on the injury. ER trip was a little slow (I was triaged appropriately behind people with emergent issues) but within a few hours I got a sling, confirmation from X ray images that no immediate surgery was needed, and followup instructions. When I left the ER I got a referral to the hospital's orthopedic group, and was able to get an appointment the next day with a PA & MD who specialize in sports medicine and broken shoulders. My GP confirms that this is a trustworthy referral. So within 18 hrs of injury I got an expert to review the injury and they decided there was enough info from existing diagnostics to avoid additional tests (no more X ray views, no CT) and understand the pros/cons of further intervention. I also scheduled a follow-up at T+36 from injury with my GP to make sure nothing ELSE was broken (mindful that shoulder experts will only look at the shoulder), and was reassured that nothing else is wrong and conservative management is ok. So that's 3 healthcare visits within 36 hours of an injury, with almost immediate post-ER triage to (I am reliably told) a high-quality local expert. This all felt really good and probably slightly faster than I would have been treated when I lived in the UK (with NHS London-area A&E as well as employer private insurance). No complaints about the US system if you have employer provided insurance. I'm fully expecting to see a $4000 bill for these 3 trips and to pay significantly less than that because I carry a traditional high-premium low-coinsurance health plan. Overall it seemed pretty good, but only because I was fairly confident that paying for care wouldn't permanently ruin my finances. Would have felt pretty painful to be uninsured. EMTALA keeps people alive but the medium term financial impact of the US's high quality of ER care is not to be taken lightly. Also would have felt pretty painful if I had been in SF and been taken to SF General Hospital post injury as they are notorious for being extremely convenient to access but out-of-network to all insurance providers: https://www.quora.com/Why-does-San-Francisco-General-Hospital-not-contract-with-health-insurance-providers?share=1 https://www.quora.com/Why-does-San-Francisco-General-Hospita... I do note that although US care is pretty great it can seem a little over the top sometimes: 2. This article gives an example of a patient with strep throat visiting an ER and being diagnosed using a CT scan … why? That seems like an odd choice. I once visited an NHS urgent care clinic with a bad sore throat and I was told "you Americans come in for every sore throat, this is just a virus, go away." They didn't even run a strep test, just ruled it out from symptoms. No antibiotics or other treatment etc. Felt kinda harsh but was dirt cheap for the NHS and I think the outcome was the same as a similar US urgent-care visit. (Actually, I visited an NHS urgent care clinic twice for that sore throat. The first time they told me that because I had an American passport they would charge me £60 to be seen. I was incredulous -- are you sure about that? I'm a UK taxpayer here on a work visa -- and got an apology from a service manager a week later.)

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