4 ms·

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,

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).
sjezewski 9y ago
I can't upvote this enough. > Yes, emergency rooms are a marvel of modern planning and materials. Additionally, they're not good enough. I've helped a friend go through a traumatic ER experience where she suffered 3 strokes and they released her from ER 3 times saying she was fine before she called me for help. We got her psych-eval'd so that they couldn't release her for 72 hours, so they had to run tests, and lo and behold, they did the CT that showed she had 3 strokes. This was at a world famous hospital. Sadly, this isn't an exceptional story. Most folks don't believe it until they've experienced something like this personally. While I hope most people never have to experience this, we need more people to understand that this is a real problem. Anytime you're in a hospital, make sure you or someone close to you (ideally w legal authority to make decisions on your behalf) can fight for your care. Point is, yes they are amazing compared to an alternative of nothing. We have come far. But we can do better. They are by no means a paragon. Pick any part of healthcare, and there's room for improvement.

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).

sjezewski 9y ago

I can't upvote this enough. > Yes, emergency rooms are a marvel of modern planning and materials. Additionally, they're not good enough. I've helped a friend go through a traumatic ER experience where she suffered 3 strokes and they released her from ER 3 times saying she was fine before she called me for help. We got her psych-eval'd so that they couldn't release her for 72 hours, so they had to run tests, and lo and behold, they did the CT that showed she had 3 strokes. This was at a world famous hospital. Sadly, this isn't an exceptional story. Most folks don't believe it until they've experienced something like this personally. While I hope most people never have to experience this, we need more people to understand that this is a real problem. Anytime you're in a hospital, make sure you or someone close to you (ideally w legal authority to make decisions on your behalf) can fight for your care. Point is, yes they are amazing compared to an alternative of nothing. We have come far. But we can do better. They are by no means a paragon. Pick any part of healthcare, and there's room for improvement.