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I injured myself and needed to go to the ER. The injury wasn't life threatening, but I definitely needed to go to the hospital immediately. I called an Uber.

I injured myself and needed to go to the ER. The injury wasn't life threatening, but I definitely needed to go to the hospital immediately. I called an Uber. I don't have the time or expertise to do the months of legalese and calculus it would take me to understand my insurance policy, so I have no idea how much an ambulance ride would have cost me. $0? $400? $15000? None of those numbers would surprise me. As best I can tell, insurance companies throw a dart to decide whether you're covered or not, and then the healthcare provider makes up some insane number if you aren't. The Uber got me to the hospital faster than an ambulance would have, for less than $10, and I knew it would cost less than $10. The injury, though extremely gruesome and painful, only warranted an x-ray, some tylenol, and an ace bandage. I'm insured. They sent me a bill for over $900. For taking a picture, and giving me tylenol and an ace bandage. I view insurance as a tax my employers pay to the American healthcare system to be compliant. When I have my end-of-life event, whatever that is, I fully expect a choice between death, and living a little longer in bankruptcy. I'll probably get treated outside the US or choose death. The system works if your net worth is somewhere above $5 million. For everyone else it's just the mechanism that sends everything you earned back to rich people right before you die. Or maybe I'm wrong! I hope I'm wrong. The stack of papers is 4 inches high so I'll never know, but I sure hope so.

nvahalik 9y ago
The system works fairly well if you are poor too. I know several people who have walked into and out of the hospital without paying a dime. It really seems like the middle class gets the raw end of the deal.
- taxicabjesus 9y ago
  > It really seems like the middle class gets the raw end of the deal. My hairdresser figured she has to spend $5,000 before she can get any benefit from "health insurance". She & her husband decided it'd be better to pay the penalties, spend that first $5000 on herself, and "hope" that she won't need more. She's from Cuba, originally - left in 1987, iirc.
- deleted 9y ago
  [deleted]
- caresource_ta 9y ago
  Can confirm it works fairly well for the poor. I have been registered for Medicaid the past three years of school and have not had to used it until this year. Every single time I use my insurance (CareSource) I am absolutely blown away by how painless it is. Other than presenting proof of coverage twice in a series of multiple hospital and doctor's visits I have not had to worry about insurance for a single moment. At one point my physician was ordering lab work and kept asking if I wanted any additional lab work of my choosing and this just seemed absurd because on private insurance I would never consider lab work to be discretionary.
  - aidenn0 9y ago
    Medical is a horrible situation when I've had to use it. The places that take it you pay nothing, but many places won't take it, and many GPs at places that do take it won't take new patients on it. The dental care was also terrible: 2 places only in my city that accept it. Neither would give an appointment for a cleaning and a checkup at the same time, and I never was admitted less than 20 minutes after my appointment time.
  - KyeRussell 9y ago
    > At one point my physician was ordering lab work and kept asking if I wanted any additional lab work of my choosing and this just seemed absurd because on private insurance I would never consider lab work to be discretionary. From your perspective that's great, but it's still another sign of the system being broken. As soon as you involve cash flowing between multiple entities, it just becomes a massive cash grab. The physician seemingly knew they could take advantage of your cover in that instance. That in itself seems problematic. Note: I'm not from the US, so there's probably an aspect of Medicaid that I don't understand. We have a more sane healthcare system :)
- djsumdog 9y ago
  Well, not if you need treatment. If you're poor, yes you won't pay anything because the hospital won't bother to bill anyone. But if you need surgery and have no insurance or medicade, there are cases of doctors sending you home, waiting for sepsis and then amputating, because it's cheaper and takes less resources. Extremely poor people may not pay for care, but be assured that in America, they get no where near the same level of care. And if you're poor and have cancer? Most other western countries will give you a chance. There is a much deeper problem relating directly to this topic. Transportation. Access to real transpiration is THE BIGGEST FACTOR in escaping poverty. Uber isn't public transportation. A train is about $2 ~ $3 in most cities. In an Uber that would be a $10 ~ $20 ride. Multiply that by 7 days a week to and from work, and there simply is no comparison. Many cities have discounted fare cards for the poor as well. The structure of American cities hurts the poor.
  - chimeracoder 9y ago
    > And if you're poor and have cancer? Most other western countries will give you a chance Cancer is probably the worst example you could pick to prove your point. It turns out that the US system is highly-optimized for specialized care (which happens to include cancer), as opposed to routine care. That's one of the reasons it ends up being more expensive. In fact, even when including poor and uninsured people in the mix, the US has dramatically better outcomes when it comes to cancer treatment than the UK, Canada, Denmark, France, the Netherlands, etc.
    - notfromhere 9y ago
      Assuming you get treatment. In the US, cancer treatment is pre-paid, and if you don't have insurance you are SOL
      - chimeracoder 9y ago
        > Assuming you get treatment. In the US, cancer treatment is pre-paid, and if you don't have insurance you are SOL No, even factoring that in, the US has dramatically better outcomes for cancer than the other countries listed.
- lazulicurio 9y ago
  This to me is the biggest issue with health insurance in the US right now---it's effectively trying to cover two issues at once: 1) non-payment to health care providers 2) unexpected ailments to health care consumers. We have insurance companies as the middlemen, trying to make money from both ends. It's like having the same lawyer as prosecutor and defense attorney; no matter how much you trust any individual to do a good job, you're asking for trouble in the long run. I feel like the best solution would be to change the arrangement from consumer<-->insurance<-->provider to insurance<-->consumer<-->provider<-->insurance. Have providers charge consumers directly (so prices are more transparent), consumers buy actual "health insurance", and providers buy non-payment insurance. If the government needs to subsidize non-payment insurance rates for certain providers, it can do so without as much risk for inflating prices and screwing over people who can pay the bills.
eugeniub 9y ago
"taking a picture" is not the same thing as "an x-ray"
- aisofteng 9y ago
  It's called dramatic effect.
- oakridge 9y ago
  It is, but with wavelengths that aren't in the visible range.
- gonyea 9y ago
  It’s incredibly old tech and costs you maybe $5 in most countries.
  - bubblethink 9y ago
    I'm constantly surprised by costs for x-rays in the US too. It probably has more to do with the cost of labour, but even so, it's quite outrageous.
    - deepsun 9y ago
      Also, they actually email the x-rays to a different hospital where the cost of radiologist labor is highest. Happened to me.
    - tfha 9y ago
      Healthcare in the US is so bogged down by regulation, standards, certification, etc, that there's really no room for competition. You have to buy the X-ray machine that's 40x overpriced. You have to use the software that's 200x overpriced. You have to hire the guy with 8 years of schooling. American healthcare could be a lot better if we just allowed more breathing room for competition
    - knz 9y ago
      It's not just x-rays. I'm currently on holiday in New Zealand and had to take my infant daughter to the urgent care. The total cost was $21 USD (including the prescription). Back in the US it's $330 for a 15 minute appointment with her GP. There is no way it costs $1,300/hour to run a GP clinic. Between my employer and I, the cost of family insurance is > $20,000/year and we pay the first $6,000 in expenses. That's similar to the TOTAL income tax of a median household in New Zealand - how are they providing all of the functions of government plus universal health care for the cost of just health insurance?!? It really makes me wonder about the ROI on taxes in America.
api_or_ipa 9y ago
Crazy. Very recently I saw a guy get knocked out cold on his rollerblades and we called an ambulance. The question of cost never crossed my mind and I'm not sure I would ever want to make the utilitarian calculus: Am I helping this man or am I bankrupting him? IIRC it's $82 or something like that in Vancouver BC Canada.
- deepsun 9y ago
  Could he just said "I didn't call for ambulance, charge the guy who did"?
  - asdfaoeu 9y ago
    I don't know about Canada but in Australia the person who the ambulance is called for gets charged.
    - djsumdog 9y ago
      How much is an ambulance in Australia? Last time I was there, I saw a protest against the Abbot government (yea it was that long ago) because he wanted to put in a co-pay (yes, Australians don't have co-pays). In the US, with insurance, they're typically like $300.
      - philliphaydon 9y ago
        I don’t know if it’s the same for everyone, but about 8 years ago I got gastro and thought I was dying because I was in so much pain. I was a Kiwi living in Australia l, called myself an ambulance and I don’t have Medicare so figured I had to pay the bill. After being discharged I gave them my passport and the hospital bill was $0 while the ambulance bill was around $950 Aud. When I moved to singapore to live I got appendicitis. I called a taxi and paid $9 to go to the hospital. Too scared to get ambulance now even if it’s covered by insurance.
        djsumdog 9y ago
FussyZeus 9y ago
This is all coming from a hardcore capitalist, so know that going in: Health Insurance, as a concept, is disgusting. You "Insure" property. You "Insure" specifically against loss of that property, and the cost of insurance is determined (forgetting an awful lot of math, but the basics are) by: The value of the property in question, the amount of payout required to replace said property in the case of full loss, put up against the security of said property and the odds of loss occurring. For cars, this presents as the value of the car, factoring in where you live and work (the two places the car is most likely to be), the costs to repair or replace the car, the security devices the cars have, and obviously your driving record. To insure a life, you need to first establish the value of a human life, specifically your life. Your life (probably) is infinitely valuable to you. The cost to repair you in our current system could also be infinite, given the numerous and terrible things that can happen to a person with literally no fault of their own. By the same token, the odds of you needing that payout are also damn near incalculable; every place you go, every activity you engage in from skydiving to eating turtle soup in Mexico all have a probability of killing you. By the same token you can trip and crack your skull open in Harlem, NY or in the center of the Pentagon, it makes no difference. Therefore, you have an asset with incalculable worth, incalculable cost to repair or replace, that is exposed to hundreds of things per day that could result in a full-policy payout, with barely a hint of predictability. Even if the industry behind it weren't legendarily corrupt and full of fraud and nonsense from every player in it, this would be completely insane to attempt. The solution (the first part anyway) is to outlaw health insurance, completely, full stop. Then hospitals must be instructed to destroy their chargemasters and go back to charging for services at reasonable rates. After that, everything else should more or less be solved.
- throwaway0255 9y ago
  I completely agree, but I don't think it's a winnable fight. I think it's so big and so entangled with everything that the only thing that could ever pry it loose is some kind of fundamentally transformative event that results in the complete dissolution of our entire economy and/or nation. Trying to make any progress through typical political avenues is hopeless. You're casting your vote into an ocean of voters that don't even see health insurance as a financial product, they see it as healthcare itself.
blhack 9y ago
There is pretty much nothing that infuriates me more than the health insurance system. Here is just one example (other than your ambulance example, which is like some trolley-car problem come real): We use "insurance" for routine medical examinations which are supposedly to be done regardless of health. We use "insurance" for YEARLY checkups. The absurdity of this is on par with insuring yourself against getting hungry, or buying gasoline insurance to fill up your car. Gas in $8000/gallon. But pay $900/month and we will cover the cost! It is absolutely embarrassing that this is the system we have allowed to exist. I consider myself a pretty staunch capitalist in most regards. Health insurance is definitely not one of them.
- domenzain 9y ago
  It makes good financial sense for insurers to push the insured to take preventative measures. An insurer should provide incentive to bring a building up to code to avoid a costly fire. The option to simply raise prices accounting for the fire leaves out the business of those who cannot afford it: the people leaving in a building that's not up to code.
  - elgenie 9y ago
    > "It makes good financial sense for insurers to push the insured to take preventative measures." This is only true in a well-designed system. In a system in which insurance policies are for a one-year term and can be declined or premium-hiked as necessary after that term is up, encouraging preventive checkups can be counterproductive if the risk of being on the hook for problems discovered in the checkups is higher than the preventive benefit during the duration of the policy.
  - uoaei 9y ago
    The point seems to be more that "insurance" as a word betrays the original intention of the service while the current state of affairs demonstrates how much the concept has been bastardized. Insurance is for those events where you don't expect a gruesome injury and need to insure, or hedge, against those one-offs. Preventative care isn't the same idea because you expect to get older and things to fail slowly. But barring any conditions or disorders, this isn't insurance against external sources of damage but just an action taken against inevitable consequences of having an organic body that tries to keep itself in a delicate and easily-broken balance for 50+ years.
rectangletangle 9y ago
Similar story; dislocated my shoulder, and needed to visit the ER. Came to the same conclusion at the time, that Uber would be the cheaper/easier option. The driver got me safely to the ER, likely faster than an ambulance would have. The driver was even courteous enough to help me with the door. I don't remember the exact price, but it was reasonable, I'm sure it probably saved me hundreds relative to an ambulance ride. It was probably the more socially responsible option all things considered. I didn't require urgent medical care, so taking Uber helped ensure those resources where free to those whom might have (though this thought didn't cross my mind at the time).
- lostlogin 9y ago
  If it’s anything like the taxi drivers here in Auckland, you have a fair chance of getting a driver with some sort of medical qualification too.
thewhitetulip 9y ago
If you have something life threatening and you know it in advance, please have a look at Indian healthcare system. It will not be that costly and there are a few mind blowing hospitals who are really very damn good.
make3 9y ago
the American system is so fucked up. I don't know how you can read things like that and think it's not. downvote me all you want.
vostok 9y ago
> The system works if your net worth is somewhere above $5 million. For everyone else it's just the mechanism that sends everything you earned back to rich people right before you die. Must be above my net worth! Sure I can afford to pay out of pocket for everyday medical expenses, but cancer or a heart attack would probably destroy my finances.
rconti 9y ago
My wife was in a car accident, and surprisingly, the ambulance bill (perhaps 5 miles, "night" surcharge (7pm), private ambulance in the bay area) was "only" ~$3400. I seem to recall an ambulance ride when I was a kid (20 years ago) costing something like $5k plus when I crashed my bicycle. Funny thing, though, the ambulance bill was the only thing NOT covered 100% initially. The hospital and surgeons bill your insurance, and we didn't pay a dime (other than a comical $200k+ explanation of benefits telling us our claim was denied when they initially submitted to the wrong insurance). The ambulance company billed us, and I spent ~6 months working it out, and I think it's finally sorted. The upshot is because it was a "car accident", the health insurance doesn't want to pay it; car insurance is primary. In theory the car insurance is the primary on her entire hospital stay, but because the medical payments on our car insurance is only $10k it's basically pointless to involve them. They don't even know there was a hospital visit. So I had to go back and forth a bunch of times to even (re-)open the car insurance claim, get it submitted, send more and more documents, fend off the ambulance company always threatening to send us to collections because I had better things to do than deal with their crap, and so on. Current status is I've paid maybe $600 on a payment plan, my insurance says they paid in full, the payment wasn't yet reflected on the ambulance co billing site, but in theory once that payment posts they issue me a refund on my payments to date. We're so incredibly lucky to have insurance; actually she was double-covered at the time of the accident (hence the billing confusion initially), we have money, we have family in the area to help with doctor visits, and there was really only one provider. I can only imagine what a nightmare sorting the bills would have been if we had to manually submit to insurance from multiple providers and stay on top of many many claims. It would be a full time job for sure.
- StreamBright 9y ago
  These sort of stories I usually use to explain to non-US people how is to live there.
  - Fiahil 9y ago
    If I’m a foreigner and I’m breaking my arm while being in San Francisco, do I have to pay for the 5k bill coming my way, too ?
pvinis 9y ago
Why did you need a throwaway for this comment?
- deleted 9y ago
  [deleted]
- pvinis 9y ago
  I'm honestly asking. It's a very good and valid comment and I didn't see any obvious reasons why they might decide to use a throwaway account.
skrause 9y ago
Here in Germany the copayment for an ambulance is 10 €, everything else is covered by the health-insurance. So the choice is easy: If it's urgent call an ambulance, if it's not urgent and/or there are other ways too get to the hospital quickly and easily use those instead.
nofilter 9y ago
Yeah, never moving to America. Never. I value my life more than that. In Estonia (and I'd imagine most of Europe), the ambulance ride is free (unless you prank call them, then you get a fine). The healthcare is free (paid by your employer), doesn't matter how badly you're injured. The only thing that's not free is dental care, but you can insure that, so you pay a monthly fee and they cover the actual cost if something happens. And no, it's not a made-up number.
- dbancajas 9y ago
  Is it a good place to live? What about racism etc?
  - endisukaj 9y ago
    You'll be hard-pressed to find the sort of systematic racism found in the US (especially by institutions) anywhere in Europe. Sure, you might get the occasional glance if you are black especially in Eastern Europe and it's mostly because out of curiosity since there are not many African immigrants in ex-Communist countries as there are in, say, France. But other than that you'll be fine. I should say though that Eastern European countries do have issues with Islamophobia in general, so if you are muslim I would not recommend those countries.
    - bmmayer1 9y ago
      Have you ever been in a Parisian suburb?
    - chimeracoder 9y ago
      > You'll be hard-pressed to find the sort of systematic racism found in the US (especially by institutions) anywhere in Europe This ia really common misconception perpetuated by (white) Europeans. It couldn't be more wrong. Systemic racism is pervasive throughout Europe, and in many ways, it's even more institutionalized in Europe than it is in the US. Please stop spreading the myth that Europe is free of institutionalized racism, or even that it's somehow better in this regard than the US.
vijayr 9y ago
They sent me a bill for over $900. For taking a picture, and giving me tylenol and an ace bandage. That is awful :( Imagine someone making minimum wage. 900$ is huge for most people. Honest question - outside of politics, is there anything a person on the road do to help make this situation better (other than not falling sick)? Any company/org working on solutions?
- logfromblammo 9y ago
  Generally speaking, most of the people "working on the problem" are actually working out ways to profit enough from the existing mess that it doesn't affect them personally. If you intend to visit the US, you absolutely need to buy traveler's insurance, with medical coverage, before you enter. If you can't afford the premium, cancel your trip, and go spend money in a country with a better paradigm for emergency medicine.
Dove 9y ago
If it's not life-threatening, don't go to the ER. Go to urgent care. They'll charge you $100-$200 for the visit, plus cost of materials. $27 X-Ray kind of cost of materials in my experience. https://www.howmuchisit.org/how-much-does-urgent-care-cost/ https://www.howmuchisit.org/how-much-does-urgent-care-cost/ Better yet, get direct primary care. It's ideal for tylenol and ace bandage situations. I am completely convinced that even if you have insurance, you are much better off acting as a self-pay patient. Your options are better, and you have a much better idea of how much things cost. People say you can't shop for a hospital in an emergency, and that's true -- but I already know how much the hospitals around here cost and how good they are because I have to for routine medical care.
- zappo2938 9y ago
  Between the hours of 10 to 10.
  - Dove 9y ago
    Depends on the place. Some are 24 hour. Some are just long business hours. See what's available near you before you get hurt.
- bastawhiz 9y ago
  Many places don't have urgent care facilities. And you'd still need to use an ambulance (or Uber) to get there otherwise if you aren't well enough to drive.
  - Dove 9y ago
    Many places don't have them, but many people who do have access to them are unaware and don't understand the advantage. OP sounded like someone who thought the only option available was going to a hospital and rolling the dice on insurance. I'm trying to encourage people to learn about urgent care. It can handle a lot of common problems and the price is super predictable. Usually it's listed on the web site. (Come see us with a UTI? $125). It's worth learning about as an option. Google urgent care near you! It doesn't solve everyone's problem, but it solves a lot of people's -- and I want the industry to thrive and expand and hence bring down the cost of urgent medical care for everyone. Absolutely you still need to get there. Absolutely Uber is a good option when you shouldn't be driving. Don't take an ambulence unless getting medical care on the way could be lifesaving. Don't go to an ER unless getting medical care in the next couple hours could be lifesaving.
chapium 9y ago
“I'm insured. They sent me a bill for over $900. For taking a picture, and giving me tylenol and an ace bandage.” What also happened: You received care at an ER. The time of professionals was used on you and not other patients at that time. You also received a diagnosis and verification that the injury was easily treatable and didnt require much else. What if they came to a different conclusion? $900 is expensive but you are grossly mischaracterizinf the services you received.

nvahalik 9y ago

The system works fairly well if you are poor too. I know several people who have walked into and out of the hospital without paying a dime. It really seems like the middle class gets the raw end of the deal.

taxicabjesus 9y ago
> It really seems like the middle class gets the raw end of the deal. My hairdresser figured she has to spend $5,000 before she can get any benefit from "health insurance". She & her husband decided it'd be better to pay the penalties, spend that first $5000 on herself, and "hope" that she won't need more. She's from Cuba, originally - left in 1987, iirc.
deleted 9y ago
[deleted]
caresource_ta 9y ago
Can confirm it works fairly well for the poor. I have been registered for Medicaid the past three years of school and have not had to used it until this year. Every single time I use my insurance (CareSource) I am absolutely blown away by how painless it is. Other than presenting proof of coverage twice in a series of multiple hospital and doctor's visits I have not had to worry about insurance for a single moment. At one point my physician was ordering lab work and kept asking if I wanted any additional lab work of my choosing and this just seemed absurd because on private insurance I would never consider lab work to be discretionary.
- aidenn0 9y ago
  Medical is a horrible situation when I've had to use it. The places that take it you pay nothing, but many places won't take it, and many GPs at places that do take it won't take new patients on it. The dental care was also terrible: 2 places only in my city that accept it. Neither would give an appointment for a cleaning and a checkup at the same time, and I never was admitted less than 20 minutes after my appointment time.
- KyeRussell 9y ago
  > At one point my physician was ordering lab work and kept asking if I wanted any additional lab work of my choosing and this just seemed absurd because on private insurance I would never consider lab work to be discretionary. From your perspective that's great, but it's still another sign of the system being broken. As soon as you involve cash flowing between multiple entities, it just becomes a massive cash grab. The physician seemingly knew they could take advantage of your cover in that instance. That in itself seems problematic. Note: I'm not from the US, so there's probably an aspect of Medicaid that I don't understand. We have a more sane healthcare system :)
djsumdog 9y ago
Well, not if you need treatment. If you're poor, yes you won't pay anything because the hospital won't bother to bill anyone. But if you need surgery and have no insurance or medicade, there are cases of doctors sending you home, waiting for sepsis and then amputating, because it's cheaper and takes less resources. Extremely poor people may not pay for care, but be assured that in America, they get no where near the same level of care. And if you're poor and have cancer? Most other western countries will give you a chance. There is a much deeper problem relating directly to this topic. Transportation. Access to real transpiration is THE BIGGEST FACTOR in escaping poverty. Uber isn't public transportation. A train is about $2 ~ $3 in most cities. In an Uber that would be a $10 ~ $20 ride. Multiply that by 7 days a week to and from work, and there simply is no comparison. Many cities have discounted fare cards for the poor as well. The structure of American cities hurts the poor.
- chimeracoder 9y ago
  > And if you're poor and have cancer? Most other western countries will give you a chance Cancer is probably the worst example you could pick to prove your point. It turns out that the US system is highly-optimized for specialized care (which happens to include cancer), as opposed to routine care. That's one of the reasons it ends up being more expensive. In fact, even when including poor and uninsured people in the mix, the US has dramatically better outcomes when it comes to cancer treatment than the UK, Canada, Denmark, France, the Netherlands, etc.
  - notfromhere 9y ago
    Assuming you get treatment. In the US, cancer treatment is pre-paid, and if you don't have insurance you are SOL
    - chimeracoder 9y ago
      > Assuming you get treatment. In the US, cancer treatment is pre-paid, and if you don't have insurance you are SOL No, even factoring that in, the US has dramatically better outcomes for cancer than the other countries listed.
lazulicurio 9y ago
This to me is the biggest issue with health insurance in the US right now---it's effectively trying to cover two issues at once: 1) non-payment to health care providers 2) unexpected ailments to health care consumers. We have insurance companies as the middlemen, trying to make money from both ends. It's like having the same lawyer as prosecutor and defense attorney; no matter how much you trust any individual to do a good job, you're asking for trouble in the long run. I feel like the best solution would be to change the arrangement from consumer<-->insurance<-->provider to insurance<-->consumer<-->provider<-->insurance. Have providers charge consumers directly (so prices are more transparent), consumers buy actual "health insurance", and providers buy non-payment insurance. If the government needs to subsidize non-payment insurance rates for certain providers, it can do so without as much risk for inflating prices and screwing over people who can pay the bills.

eugeniub 9y ago

"taking a picture" is not the same thing as "an x-ray"

aisofteng 9y ago
It's called dramatic effect.
oakridge 9y ago
It is, but with wavelengths that aren't in the visible range.
gonyea 9y ago
It’s incredibly old tech and costs you maybe $5 in most countries.
- bubblethink 9y ago
  I'm constantly surprised by costs for x-rays in the US too. It probably has more to do with the cost of labour, but even so, it's quite outrageous.
  - deepsun 9y ago
    Also, they actually email the x-rays to a different hospital where the cost of radiologist labor is highest. Happened to me.
  - tfha 9y ago
    Healthcare in the US is so bogged down by regulation, standards, certification, etc, that there's really no room for competition. You have to buy the X-ray machine that's 40x overpriced. You have to use the software that's 200x overpriced. You have to hire the guy with 8 years of schooling. American healthcare could be a lot better if we just allowed more breathing room for competition
  - knz 9y ago
    It's not just x-rays. I'm currently on holiday in New Zealand and had to take my infant daughter to the urgent care. The total cost was $21 USD (including the prescription). Back in the US it's $330 for a 15 minute appointment with her GP. There is no way it costs $1,300/hour to run a GP clinic. Between my employer and I, the cost of family insurance is > $20,000/year and we pay the first $6,000 in expenses. That's similar to the TOTAL income tax of a median household in New Zealand - how are they providing all of the functions of government plus universal health care for the cost of just health insurance?!? It really makes me wonder about the ROI on taxes in America.

api_or_ipa 9y ago

Crazy. Very recently I saw a guy get knocked out cold on his rollerblades and we called an ambulance. The question of cost never crossed my mind and I'm not sure I would ever want to make the utilitarian calculus: Am I helping this man or am I bankrupting him? IIRC it's $82 or something like that in Vancouver BC Canada.

deepsun 9y ago
Could he just said "I didn't call for ambulance, charge the guy who did"?
- asdfaoeu 9y ago
  I don't know about Canada but in Australia the person who the ambulance is called for gets charged.
  - djsumdog 9y ago
    How much is an ambulance in Australia? Last time I was there, I saw a protest against the Abbot government (yea it was that long ago) because he wanted to put in a co-pay (yes, Australians don't have co-pays). In the US, with insurance, they're typically like $300.
    - philliphaydon 9y ago
      I don’t know if it’s the same for everyone, but about 8 years ago I got gastro and thought I was dying because I was in so much pain. I was a Kiwi living in Australia l, called myself an ambulance and I don’t have Medicare so figured I had to pay the bill. After being discharged I gave them my passport and the hospital bill was $0 while the ambulance bill was around $950 Aud. When I moved to singapore to live I got appendicitis. I called a taxi and paid $9 to go to the hospital. Too scared to get ambulance now even if it’s covered by insurance.
      - djsumdog 9y ago

FussyZeus 9y ago

This is all coming from a hardcore capitalist, so know that going in: Health Insurance, as a concept, is disgusting. You "Insure" property. You "Insure" specifically against loss of that property, and the cost of insurance is determined (forgetting an awful lot of math, but the basics are) by: The value of the property in question, the amount of payout required to replace said property in the case of full loss, put up against the security of said property and the odds of loss occurring. For cars, this presents as the value of the car, factoring in where you live and work (the two places the car is most likely to be), the costs to repair or replace the car, the security devices the cars have, and obviously your driving record. To insure a life, you need to first establish the value of a human life, specifically your life. Your life (probably) is infinitely valuable to you. The cost to repair you in our current system could also be infinite, given the numerous and terrible things that can happen to a person with literally no fault of their own. By the same token, the odds of you needing that payout are also damn near incalculable; every place you go, every activity you engage in from skydiving to eating turtle soup in Mexico all have a probability of killing you. By the same token you can trip and crack your skull open in Harlem, NY or in the center of the Pentagon, it makes no difference. Therefore, you have an asset with incalculable worth, incalculable cost to repair or replace, that is exposed to hundreds of things per day that could result in a full-policy payout, with barely a hint of predictability. Even if the industry behind it weren't legendarily corrupt and full of fraud and nonsense from every player in it, this would be completely insane to attempt. The solution (the first part anyway) is to outlaw health insurance, completely, full stop. Then hospitals must be instructed to destroy their chargemasters and go back to charging for services at reasonable rates. After that, everything else should more or less be solved.

throwaway0255 9y ago
I completely agree, but I don't think it's a winnable fight. I think it's so big and so entangled with everything that the only thing that could ever pry it loose is some kind of fundamentally transformative event that results in the complete dissolution of our entire economy and/or nation. Trying to make any progress through typical political avenues is hopeless. You're casting your vote into an ocean of voters that don't even see health insurance as a financial product, they see it as healthcare itself.

blhack 9y ago

There is pretty much nothing that infuriates me more than the health insurance system. Here is just one example (other than your ambulance example, which is like some trolley-car problem come real): We use "insurance" for routine medical examinations which are supposedly to be done regardless of health. We use "insurance" for YEARLY checkups. The absurdity of this is on par with insuring yourself against getting hungry, or buying gasoline insurance to fill up your car. Gas in $8000/gallon. But pay $900/month and we will cover the cost! It is absolutely embarrassing that this is the system we have allowed to exist. I consider myself a pretty staunch capitalist in most regards. Health insurance is definitely not one of them.

domenzain 9y ago
It makes good financial sense for insurers to push the insured to take preventative measures. An insurer should provide incentive to bring a building up to code to avoid a costly fire. The option to simply raise prices accounting for the fire leaves out the business of those who cannot afford it: the people leaving in a building that's not up to code.
- elgenie 9y ago
  > "It makes good financial sense for insurers to push the insured to take preventative measures." This is only true in a well-designed system. In a system in which insurance policies are for a one-year term and can be declined or premium-hiked as necessary after that term is up, encouraging preventive checkups can be counterproductive if the risk of being on the hook for problems discovered in the checkups is higher than the preventive benefit during the duration of the policy.
- uoaei 9y ago
  The point seems to be more that "insurance" as a word betrays the original intention of the service while the current state of affairs demonstrates how much the concept has been bastardized. Insurance is for those events where you don't expect a gruesome injury and need to insure, or hedge, against those one-offs. Preventative care isn't the same idea because you expect to get older and things to fail slowly. But barring any conditions or disorders, this isn't insurance against external sources of damage but just an action taken against inevitable consequences of having an organic body that tries to keep itself in a delicate and easily-broken balance for 50+ years.

rectangletangle 9y ago

Similar story; dislocated my shoulder, and needed to visit the ER. Came to the same conclusion at the time, that Uber would be the cheaper/easier option. The driver got me safely to the ER, likely faster than an ambulance would have. The driver was even courteous enough to help me with the door. I don't remember the exact price, but it was reasonable, I'm sure it probably saved me hundreds relative to an ambulance ride. It was probably the more socially responsible option all things considered. I didn't require urgent medical care, so taking Uber helped ensure those resources where free to those whom might have (though this thought didn't cross my mind at the time).

lostlogin 9y ago
If it’s anything like the taxi drivers here in Auckland, you have a fair chance of getting a driver with some sort of medical qualification too.

thewhitetulip 9y ago

If you have something life threatening and you know it in advance, please have a look at Indian healthcare system. It will not be that costly and there are a few mind blowing hospitals who are really very damn good.

make3 9y ago

the American system is so fucked up. I don't know how you can read things like that and think it's not. downvote me all you want.

vostok 9y ago

> The system works if your net worth is somewhere above $5 million. For everyone else it's just the mechanism that sends everything you earned back to rich people right before you die. Must be above my net worth! Sure I can afford to pay out of pocket for everyday medical expenses, but cancer or a heart attack would probably destroy my finances.

rconti 9y ago

My wife was in a car accident, and surprisingly, the ambulance bill (perhaps 5 miles, "night" surcharge (7pm), private ambulance in the bay area) was "only" ~$3400. I seem to recall an ambulance ride when I was a kid (20 years ago) costing something like $5k plus when I crashed my bicycle. Funny thing, though, the ambulance bill was the only thing NOT covered 100% initially. The hospital and surgeons bill your insurance, and we didn't pay a dime (other than a comical $200k+ explanation of benefits telling us our claim was denied when they initially submitted to the wrong insurance). The ambulance company billed us, and I spent ~6 months working it out, and I think it's finally sorted. The upshot is because it was a "car accident", the health insurance doesn't want to pay it; car insurance is primary. In theory the car insurance is the primary on her entire hospital stay, but because the medical payments on our car insurance is only $10k it's basically pointless to involve them. They don't even know there was a hospital visit. So I had to go back and forth a bunch of times to even (re-)open the car insurance claim, get it submitted, send more and more documents, fend off the ambulance company always threatening to send us to collections because I had better things to do than deal with their crap, and so on. Current status is I've paid maybe $600 on a payment plan, my insurance says they paid in full, the payment wasn't yet reflected on the ambulance co billing site, but in theory once that payment posts they issue me a refund on my payments to date. We're so incredibly lucky to have insurance; actually she was double-covered at the time of the accident (hence the billing confusion initially), we have money, we have family in the area to help with doctor visits, and there was really only one provider. I can only imagine what a nightmare sorting the bills would have been if we had to manually submit to insurance from multiple providers and stay on top of many many claims. It would be a full time job for sure.

StreamBright 9y ago
These sort of stories I usually use to explain to non-US people how is to live there.
- Fiahil 9y ago
  If I’m a foreigner and I’m breaking my arm while being in San Francisco, do I have to pay for the 5k bill coming my way, too ?

pvinis 9y ago

Why did you need a throwaway for this comment?

deleted 9y ago
[deleted]
pvinis 9y ago
I'm honestly asking. It's a very good and valid comment and I didn't see any obvious reasons why they might decide to use a throwaway account.

skrause 9y ago

Here in Germany the copayment for an ambulance is 10 €, everything else is covered by the health-insurance. So the choice is easy: If it's urgent call an ambulance, if it's not urgent and/or there are other ways too get to the hospital quickly and easily use those instead.

nofilter 9y ago

Yeah, never moving to America. Never. I value my life more than that. In Estonia (and I'd imagine most of Europe), the ambulance ride is free (unless you prank call them, then you get a fine). The healthcare is free (paid by your employer), doesn't matter how badly you're injured. The only thing that's not free is dental care, but you can insure that, so you pay a monthly fee and they cover the actual cost if something happens. And no, it's not a made-up number.

dbancajas 9y ago
Is it a good place to live? What about racism etc?
- endisukaj 9y ago
  You'll be hard-pressed to find the sort of systematic racism found in the US (especially by institutions) anywhere in Europe. Sure, you might get the occasional glance if you are black especially in Eastern Europe and it's mostly because out of curiosity since there are not many African immigrants in ex-Communist countries as there are in, say, France. But other than that you'll be fine. I should say though that Eastern European countries do have issues with Islamophobia in general, so if you are muslim I would not recommend those countries.
  - bmmayer1 9y ago
    Have you ever been in a Parisian suburb?
  - chimeracoder 9y ago
    > You'll be hard-pressed to find the sort of systematic racism found in the US (especially by institutions) anywhere in Europe This ia really common misconception perpetuated by (white) Europeans. It couldn't be more wrong. Systemic racism is pervasive throughout Europe, and in many ways, it's even more institutionalized in Europe than it is in the US. Please stop spreading the myth that Europe is free of institutionalized racism, or even that it's somehow better in this regard than the US.

vijayr 9y ago

They sent me a bill for over $900. For taking a picture, and giving me tylenol and an ace bandage. That is awful :( Imagine someone making minimum wage. 900$ is huge for most people. Honest question - outside of politics, is there anything a person on the road do to help make this situation better (other than not falling sick)? Any company/org working on solutions?

logfromblammo 9y ago
Generally speaking, most of the people "working on the problem" are actually working out ways to profit enough from the existing mess that it doesn't affect them personally. If you intend to visit the US, you absolutely need to buy traveler's insurance, with medical coverage, before you enter. If you can't afford the premium, cancel your trip, and go spend money in a country with a better paradigm for emergency medicine.

Dove 9y ago

If it's not life-threatening, don't go to the ER. Go to urgent care. They'll charge you $100-$200 for the visit, plus cost of materials. $27 X-Ray kind of cost of materials in my experience. https://www.howmuchisit.org/how-much-does-urgent-care-cost/ https://www.howmuchisit.org/how-much-does-urgent-care-cost/ Better yet, get direct primary care. It's ideal for tylenol and ace bandage situations. I am completely convinced that even if you have insurance, you are much better off acting as a self-pay patient. Your options are better, and you have a much better idea of how much things cost. People say you can't shop for a hospital in an emergency, and that's true -- but I already know how much the hospitals around here cost and how good they are because I have to for routine medical care.

zappo2938 9y ago
Between the hours of 10 to 10.
- Dove 9y ago
  Depends on the place. Some are 24 hour. Some are just long business hours. See what's available near you before you get hurt.
bastawhiz 9y ago
Many places don't have urgent care facilities. And you'd still need to use an ambulance (or Uber) to get there otherwise if you aren't well enough to drive.
- Dove 9y ago
  Many places don't have them, but many people who do have access to them are unaware and don't understand the advantage. OP sounded like someone who thought the only option available was going to a hospital and rolling the dice on insurance. I'm trying to encourage people to learn about urgent care. It can handle a lot of common problems and the price is super predictable. Usually it's listed on the web site. (Come see us with a UTI? $125). It's worth learning about as an option. Google urgent care near you! It doesn't solve everyone's problem, but it solves a lot of people's -- and I want the industry to thrive and expand and hence bring down the cost of urgent medical care for everyone. Absolutely you still need to get there. Absolutely Uber is a good option when you shouldn't be driving. Don't take an ambulence unless getting medical care on the way could be lifesaving. Don't go to an ER unless getting medical care in the next couple hours could be lifesaving.

chapium 9y ago

“I'm insured. They sent me a bill for over $900. For taking a picture, and giving me tylenol and an ace bandage.” What also happened: You received care at an ER. The time of professionals was used on you and not other patients at that time. You also received a diagnosis and verification that the injury was easily treatable and didnt require much else. What if they came to a different conclusion? $900 is expensive but you are grossly mischaracterizinf the services you received.