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I moved from the EU to the US... Toddler had a seizure (first and last ever). Called 911. $1300 for a 1.5 mile (per Google Maps) ambulance ride to the hospital

I moved from the EU to the US... Toddler had a seizure (first and last ever). Called 911. $1300 for a 1.5 mile (per Google Maps) ambulance ride to the hospital plus a $300 bill just towards "medical care" for the ride (none actually given). Then $800 for the ER, and a seperate $400 bill for the doctor (who sent us home after telling us to come back if more occurred but otherwise give child's tylenol and go see the child's pediatrician on Monday). Did I mention that both the ambulance company and the hospital have a local monopoly? There's no price competition, no choice to be made, nor could there be in a medical emergency. The problem with all of these is: If it happened again, I'm genuinely going to think "is this an emergency enough to justify a $2K medical bill?" That shouldn't be how medical treatment is decided. The whole "capitalism will solve it" thing just isn't working. I cannot shop around for medical care, I cannot see prices, and insurance is $1300/month for essentially no benefit (except to turn prices from bonkers to incredibly high).

elamje 7y ago
I agree that is outrageous. The problem is that people think it is capitalism. When there is no price transparency, there is no capitalism, period. Hopefully the US is on the way to government healthcare, but for now it would be great to just achieve price transparency so people can shop around. Without price there is no competition. Without competition there is no capitalism.
- metalchianti 7y ago
  Our current system is completely fueled by legalized price gouging. It's insane how much the medical industry is allowed to exploit these regulations.
- qwsxyh 7y ago
  No true capitalism.
  - orwin 7y ago
    is this a reference to : https://en.wikipedia.org/wiki/No_true_Scotsman https://en.wikipedia.org/wiki/No_true_Scotsman ?
- Ididntdothis 7y ago
  "When there is no price transparency, there is no capitalism, period." Capitalists are perfectly fine with lack of price transparency or other tricks as long as it makes them money. They don't like competition. What you are talking about is functioning markets.
  - jerf 7y ago
    There's a lot of equivocation in the term "capitalists". Using the term to mean "people who want to take the capitalist system and turn it into a non-capitalist system that permanently writes their own benefit into it" is, well, I'll go with "not the path to clear thinking about the problem". I'm not comfortable calling it wrong, I mean, such people exist and in quantity, but it's definitely asking for muddled thinking on the topic to call someone deliberately tearing a system apart a name that implies them to be an advocate of that system.
    - Ididntdothis 7y ago
      Look at the health system. There are a lot of capitalists who make a lot of money on their capital and don't seem very interested in change because most changes will cost profits. But from a market point of view the system is inefficient and lacks transparency .
    - astazangasta 7y ago
      Capitalists can mean ideological believers in capitalism, or it can mean those who own capital. The former may be interested in efficient markets; the latter generally only want to maximize returns.
      - Ididntdothis 7y ago
        that's why I want a clear distinction between the two. A lot of the second type of capitalist disguise themselves as the first type.
        orwin 7y ago
- makotech222 7y ago
  Capitalism is what leads to the place where we are now, with no competition, monopolies, and price gouging. How can you say that this isn't capitalism, when this is the obvious goal of every capitalist? 'Shopping around' is a terrible goal for healthcare. The goal should be complete democratic ownership, and free care for all human beings.
- hangonhn 7y ago
  Kenneth Arrow did a great analysis on efficient markets and the US healthcare industry. Basically it doesn't work the way it works in most free markets because of information asymmetry (he got the Nobel for it). Even if you had price transparency, you aren't in a position to decide what treatment to buy because you're not the doctor and don't have the necessary knowledge to make that decision. The whole process is misaligned because the recipient is not knowledgable enough to make the decision, the decision maker (doctor) is not the payor, and the actual payor (insurance) is often neither of those. Efficient markets require certain preconditions to be met to work. It's true in many situations but there are some well known edge cases.
  - conanbatt 7y ago
    I would welcome a link to the analysis you point if you wish, but this is very reductive. There are a million markets with information asymmetry and work just fine, and there are plenty of examples of cash-pay systems that work reasonably well for healthcare. I disagree with OP that the problem is price transparency, but the healthcare market in the us is intervened in ways that prevent the classic workings of a market.
  - Ididntdothis 7y ago
    I think you are right but I still think two steps would make the system much saner: - Price transparency - One price for the same service. The practice of charging $500 to the insurance but $10000 to the uninsured needs to stop. Maybe it's fine to vary by a few percent but there is no other market where the same product costs 20x more depending on who pays. If the excuse is that this is to compensate for non payers then let's pay for this from a separate pot.
    - SolaceQuantum 7y ago
      None of this addresses the point- even if you have price transparency and one price for the same service, you are not educated enough to select services you need. Doubly so if an emergency happens.
      - 7y ago
8ytecoder 7y ago
Nowhere near as close - I had what I thought was food poisoning and went to the ER. Deeply aware of US ER fees and was already questioning my choice. I go there and was made to wait 30 minutes in excruciating pain. But it got better and I felt good enough that I decided to leave - specifically because I’m scared of the costs. I informed them and left. Did not see the doctor or anyone. Except the nurse who took my weight and height. Got a bill for $1000. Literally for stepping into the ER. It’a no coincidence that US has such high opioid addiction and homelessness. Even in third world countries these people would have gotten treatment that didn’t bankrupt them.
- dekhn 7y ago
  one reason ERs are so expensive is they are required to provide medical services for people who can't pay. so you are paying a subsidized price. also those fees are negotiable if you are patient and can spend a bunch of time on the phone.
  - Udik 7y ago
    How can a private business be required to perform a public service at its own cost? If the service is public, the public should pay for it; if it's not, each pays his own. Consider this: a public service is financed by taxes that are proportional to one's income. The way it works now, both a minimum wage worker and Jeff Bezos are asked to pay $1k to walk into a ER, to "subsidize" what is effectively a public service.
    - tapland 7y ago
      In the US you pay just as much as us in the EU from your taxes towards healthcare as well. You are being double dipped for the privilege of having portions of the population not able to afford actual care.
      - yitosda 7y ago
        Possibly, on average. Some pay (vastly) more, some less. I don't see the double-dipping in the math though. EU has populations of people who aren't contributing in taxes much or at all.
vonmoltke 7y ago
> The whole "capitalism will solve it" thing just isn't working. I cannot shop around for medical care, I cannot see prices, and insurance is $1300/month for essentially no benefit (except to turn prices from bonkers to incredibly high). Considering that, for the services you mentioned, in the US it is often a government itself sending the rhetorical you those bills, I think it is a bit more complicated than merely blaming capitalism. Edit: does someone mind telling me why I am wrong?
- creddit 7y ago
  > Edit: does someone mind telling me why I am wrong? You went against the hive mind. There's no need for explanation.
- Reedx 7y ago
  You're certainly correct it's more complicated than that, so the downvotes aren't due to being wrong. shrug Healthcare in the US is neither free market nor socialized. It's an absurd mess of both worlds combined into a singular nightmare.
  - vonmoltke 7y ago
    It's essentially the worst of both worlds. Just enough socialism for a selected class of businesses to capture the profits of necessary services. Made worse by the fact that sometimes those "businesses" include local governments.
- mladenkovacevic 7y ago
  I didn't downvote you since legitimate opinions shouldn't be downvoted but the reason I think you're wrong is that US is a particularly chronic case of the government serving the needs of capitalism above and beyond the population at large. It's like saying don't blame Catholicism, blame the Vatican. One is a direct expression of the other.
  - vonmoltke 7y ago
    > I didn't downvote you since legitimate opinions shouldn't be downvoted but the reason I think you're wrong is that US is a particularly chronic case of the government serving the needs of capitalism above and beyond the population at large. I think it's more a problem of local governments often acting as quasi-capitalist entities themselves. If charging people $1000 for a ride in a fire department ambulance reduces property taxes, why not? > It's like saying don't blame Catholicism, blame the Vatican. One is a direct expression of the other. Eh, I don't think that is accurate because the Vatican is Catholicism, not merely an expression of it. Also, my point was that you can't blame one idea or entity for the state of health care in the US. There are a number of sociological factors that need to be addressed, including but not limited to extreme capitalist beliefs, belief in "rugged individualism", moralism, and xenophobia.
umvi 7y ago
Well my family moved to Germany and this was our experience with German healthcare: 1. Mom goes to doctor because of shoulder pain 2. Doctor prescribes "health spa" (wtf?) to see if the pain will go away. Apparently "spa time" is a common default prescription because the healthcare system is overrun with people that come in with sniffles and aches that go away in a few days? 3. Spa Time does nothing (as predicted); doctor orders xrays 4. Process/analysis/??? is taking forever; in the meantime we have moved back to USA 5. US doctor correctly diagnoses problem same day as initial visit and orders specialized PT that actually helps
- baud147258 7y ago
  > because the healthcare system is overrun with people that come in with sniffles and aches that go away in a few days I have a family member who's working in ER in a public hospital in France, she told us that there's a lot of people who come in for nothing, often abusing the free ambulance service. And apparently whenever it's raining there's less people coming in, all things being equal.
- y4mi 7y ago
  I'd wager that you just went to an 'allgemeinarzt'... they're doctors for general illnesses, which usually go away within a few days. practically just to get an AU so you can get a few days of paid leave[1]. If you're having an actual issue, you'd have to go to a specialized doctor or a hospital which has the equipment to actually diagnose your issue... such as an xray machine in your case. diagnosis is done right after taking the image, so you'd have had a similar experience if you went to an actual clinic [1] according to the Finanzamt (german IRS) the average worker takes an additional 12 days of paid leave like that... additional to the normal 20-30 days.
rdtsc 7y ago
Similar story. Came from Europe to US to go to college. Got a terrible strep throat. Went to the nearest emergency room. Waited for almost an hour. Saw some intern for 10 minutes who prescribed me a codeine pill and later charged me $400. That was in early 2000s money. The funny thing is I already had insurance through the university, but this doctor wasn't "in-network" apparently. Even if there wasn't a monopoly I can only imagine the insurance company advising clients to use specific hand signals to indicate which network they belong to so the ambulance driver knows where to drive if you're incapacitated and can't speak. "Raise and wiggle three fingers for Blue Cross Blue Shield, and two for Anthem". Or maybe have everyone get tattoos on their arms with their insurance network details.
- LinuxBender 7y ago
  How did an intern prescribe something to you? That should not be possible. Also, codeine isn't a treatment for strep. They should have given you antibiotics after diagnosing a throat swab.
  - rdtsc 7y ago
    I was in pain and I guess after checking that my throat wasn't going to close completely he gave me something for the "pain". > How did an intern prescribe something to you? He seemed young enough to be intern. I didn't specifically check his age or credentials.
    - LinuxBender 7y ago
      Perhaps a young doctor. :-) They should have advised against you leaving until they did a throat culture. It's rare, but strep can develop into a life threatening condition.
- masonic 7y ago
  This does not make sense on several levels: 1) strep throat is not an appropriate use of the ER. 2) codeine is not a course of treatment for strep or any other communicable disease. A course of antibiotics is mandatory. 3) strep infection cannot be diagnosed at first sight. Culturing is required.
mrlala 7y ago
Same here.. $1300/mo for family of 4. 10k deductible. Another $2k/year for dental. And then it barely seems to cover any normal stuff.. physical therapy for son, still get $1k bill. Dental work for kids, another $1k. And you are totally right all it does is make you think "is my kid really doing that bad that I should take him in?". Fuck having to get down to that mentality... I hate it, but it's the reality of the situation I'm in. If someone is lurking outside our house, we don't think to ourselves.. "Hmm, should I call the police? I don't see a gun, he probably isn't too dangerous.. I'll just wait it out". No, you freakin call the police when you need it and don't have to worry about going bankrupt because of it. Really sick of this backwards ass country we live in with regards to healthcare. I can afford it.. sort of.. but I have no idea how people below my income deal with day to day medical stuff. It's horrifying.
- vasilipupkin 7y ago
  it's very naive to think that Europeans don't pay for their healthcare. Germans make monthly payments for insurance, etc. Are they that much lower than 1300 a month? according to posters here, basic insurance is 800 dollars a month. Average net disposable income in Germany is 34K.3 a year http://www.oecdbetterlifeindex.org/countries/germany/ http://www.oecdbetterlifeindex.org/countries/germany/ In the US, it's roughly 45K. So, Germans pay less for insurance, but not that much less, considering it as a % of disposable income. And this is for the basic public option. Many Germans pay for private insurance.
  - oneplane 7y ago
    They are much lower, think in the 100 to 150 range. And that's without company discounts if you have a job. On top of that, there is a fixed limited amount you have to pay yourself per year if you actually use it, and everything else is covered.
  - RaptorJ 7y ago
    naive calculation from an estimated 8% effective rate[0] says a german family making 60,000 would pay 400/month. Additionally however, no deductibles. [0] https://www.npr.org/templates/story/story.php?storyId=91971406 https://www.npr.org/templates/story/story.php?storyId=919714...
acolumb 7y ago
Yet people blame Obamacare for the prices you just mentioned :).
- morsmodr 7y ago
  That . after the smiley is making me go bonkers, lol.
lettergram 7y ago
I’m of the opinion that is how we should assess medical treatment, by cost. People get a ton of unnecessary treatment. Depending where you live $2k for a hospital trip via an ambulance may also be fair. Think about how many people saw your son, drove you, the bed he took. In SF a bed in a hotel is $400 - $500. That’s just a bed, not anything else. Your take home salary in the U.S. is typically 80% after tax (effective tax rate). In the EU it’s closer to 50% (or less). It’s much more expensive in the EU just not all at one time. That’s perception. I do think we should have competition though and open pricing. Can’t decide to do something or not unless pricing is clear. Also if you are upset about medicinal costs be upset at the medical schools. They limit the number of doctors intentionally to inflate salaries.
- andbberger 7y ago
  You're wrong.
  - dang 7y ago
    Can you please stop posting unsubstantive comments to Hacker News? If someone is wrong, it's great to provide correct information in a factual way. If you can't or don't want to do that, it's fine to post nothing. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
- mrtksn 7y ago
  >In the EU it’s closer to 50% (or less) It’s much more expensive in the EU just not all at one time Not really, procedures and the drugs themselves are much cheaper as they are usually negotiated on a national level. Personnel salaries are also not that high. If everything is cheaper you cannot argue that the total cost is higher.
  - lettergram 7y ago
    The personal salaries is really messed up because of they are barely graduating more doctors now than the 90’s that’s an intentional inflation of salaries.
thorwasdfasdf 7y ago
The problem is, there's no price caps on anything, so these profit seeking monopolistic predatory hospitals can charge whatever they want. Medical emergencies are the number 1 cause of bankrupcy in the US. The US spends 19% of GDP on medical with worse service and outcomes. this is more than twice the Euro average. In the US, you need to be very careful with medical care. You should never ever go to a hospital unless you're absolutely sure that your life is in danger, and even then, you should research your condition first. Also, don't have kids. The medical insurance premiums in the US are extremely high, if your employer isn't paying for it.
- vonmoltke 7y ago
  > Medical emergencies are the number 1 cause of bankrupcy in the US. Nit: Medical expenses are the top cause, not medical emergencies. Not that this is much better.
api 7y ago
The US system is worse than "capitalism will solve it." It combines everything that is bad about socialized medicine (regulatory red tape, bureaucratic overhead, slowed advancement, state-enforced moribund monopolies) with everything that is bad about privatized medicine (predatory pricing behavior, regressive cost burden, non-universal coverage). It's a remarkably bad system, a kind of "pessimum" solution that benefits only insurance companies as far as I can tell. I've also heard that it's run as a kind of jobs program that's designed to employ massive numbers of middle-tier management, clerical, and bureaucratic types. The US has a lot of these worst possible outcome systems. We seem to like to take all the worst ideas from the left and combine them with all the worst ideas from the right. Another example of the worst ideas of both sides is zoning and urban planning in California.
ajmurmann 7y ago
I think what we've got in the US cannot be described as capitalism either. The market is way too regulated to be a well functioning market. I think we've just got the right mix of capitalism, regulation and complexity for the average consumer to be confused to get the perfect crony capitalism. The US health Care system is a Rube Goldberg machine made out of grifters. Edit: of course there are great people working in health care, but they get ground to pieces by the grifting machine.
merpnderp 7y ago
State granted monopolies aren't capitalism. What the US has is literally the worst of capitalism and socialism mixed together in some sort of corrupt, inept, admin heavy hybrid system. It's like pick a team already, but you can't do both; create healthy markets through regulations, or get rid of the markets, but right now the regulations just create incredibly unhealthy markets.
blockchainman 7y ago
“Capitalism will solve it” is not at fault here. What you’re describing is crony capitalism. It sounds as if your local politicians are not doing a great job at creating TRUE competition along with a TRUE free market. In other words your local monopoly should not even exist it should be broken up.
avocado4 7y ago
> The whole "capitalism will solve it" thing just isn't working. There's no capitalism in US health care system - you alluded to it yourself with lack of price transparency example. The key issue is medical cartel with AMA at the core who lobby hard to restrict supply of physicians as well as narrow scope of practice for everybody else. As a result you have people having to go through a gatekeeping 500k-a-year dermatologist to get a prescription for $250 creams which you can buy over the counter in the UK for 10 pounds. Nobody really talks about medical cartel in politics because doctors are popular with average Joe - unlike insurance and drug companies.
- chimeracoder 7y ago
  > There's no capitalism in US health care system - you alluded to it yourself with lack of price transparency example. This is true. > The key issue is medical cartel with AMA at the core, The AMA has basically zero power over any of the issues you describe. > AMA lobbies hard to restrict supply of physicians as well as narrow scope of practice for everybody else. No, the number of physicians is limited by the number of residency programs, which is determined by how much funding there is. Residency programs are not self-sustaining, so they're funded by Medicare. > As a result you have people having to go through a gatekeeping 500k-a-year dermatologist Most physicians take home a lot less than you'd think. The gross salary is misleading, because physicians also have high licensing, insurance, equipment, and continuing education costs. The gross pay does not take these expenses into account, and furthermore, these expenses are typically not tax-deductible for most physicians. It varies heavily by region and specialty, but the average (not top - average) physician in a city like New York or San Francisco actually has a lower take-home pay than a mid-level FAANG engineer[0] in either city. [0] e.g. an L4 engineer at Google.
  - Ididntdothis 7y ago
    "It varies heavily by region and specialty, but the average (not top - average) physician in a city like New York or San Francisco actually has a lower take-home pay than a mid-level FAANG engineer in either city. " That's a pretty high bar though.
toasterlovin 7y ago
FWIW, according to this list[0], U.S. median household income is about $10k/year higher than Germany. [0]: https://en.wikipedia.org/wiki/Median_income#Gross_median_household_income_by_country https://en.wikipedia.org/wiki/Median_income#Gross_median_hou...
OrgNet 7y ago
not being able to see prices ahead of time is probably the biggest problem... but it also stinks that with or without insurance, you appear to pay about the same total cost.
rayiner 7y ago
What about the 60% of Americans who have health insurance through their employers? The median American spends about $3,000 a year on premiums + out of pocket expenses: https://www.commonwealthfund.org/publications/issue-briefs/2019/may/how-much-us-households-employer-insurance-spend-premiums-out-of-pocket https://www.commonwealthfund.org/publications/issue-briefs/2.... That's less than what most would pay in mandatory social insurance taxes in Europe.
- tapland 7y ago
  > That's less than what most would pay in mandatory social insurance taxes in Europe. Yeah, it might be. But you also pay that in the US, to the same degree. Why is it so common to think that US citizens don't pay taxes towards healthcare? They do, and just as much as western europeans. The europeans just don't have to pay those extra $3k. US healthcare costs twice as much per person as healthcare in other western nations.
AnIdiotOnTheNet 7y ago
> "is this an emergency enough to justify a $2K medical bill?" Yep, that's how you think about medical problems as an American. Get used to it.

elamje 7y ago

I agree that is outrageous. The problem is that people think it is capitalism. When there is no price transparency, there is no capitalism, period. Hopefully the US is on the way to government healthcare, but for now it would be great to just achieve price transparency so people can shop around. Without price there is no competition. Without competition there is no capitalism.

metalchianti 7y ago
Our current system is completely fueled by legalized price gouging. It's insane how much the medical industry is allowed to exploit these regulations.
qwsxyh 7y ago
No true capitalism.
- orwin 7y ago
  is this a reference to : https://en.wikipedia.org/wiki/No_true_Scotsman https://en.wikipedia.org/wiki/No_true_Scotsman ?
Ididntdothis 7y ago
"When there is no price transparency, there is no capitalism, period." Capitalists are perfectly fine with lack of price transparency or other tricks as long as it makes them money. They don't like competition. What you are talking about is functioning markets.
- jerf 7y ago
  There's a lot of equivocation in the term "capitalists". Using the term to mean "people who want to take the capitalist system and turn it into a non-capitalist system that permanently writes their own benefit into it" is, well, I'll go with "not the path to clear thinking about the problem". I'm not comfortable calling it wrong, I mean, such people exist and in quantity, but it's definitely asking for muddled thinking on the topic to call someone deliberately tearing a system apart a name that implies them to be an advocate of that system.
  - Ididntdothis 7y ago
    Look at the health system. There are a lot of capitalists who make a lot of money on their capital and don't seem very interested in change because most changes will cost profits. But from a market point of view the system is inefficient and lacks transparency .
  - astazangasta 7y ago
    Capitalists can mean ideological believers in capitalism, or it can mean those who own capital. The former may be interested in efficient markets; the latter generally only want to maximize returns.
    - Ididntdothis 7y ago
      that's why I want a clear distinction between the two. A lot of the second type of capitalist disguise themselves as the first type.
      - orwin 7y ago
makotech222 7y ago
Capitalism is what leads to the place where we are now, with no competition, monopolies, and price gouging. How can you say that this isn't capitalism, when this is the obvious goal of every capitalist? 'Shopping around' is a terrible goal for healthcare. The goal should be complete democratic ownership, and free care for all human beings.
hangonhn 7y ago
Kenneth Arrow did a great analysis on efficient markets and the US healthcare industry. Basically it doesn't work the way it works in most free markets because of information asymmetry (he got the Nobel for it). Even if you had price transparency, you aren't in a position to decide what treatment to buy because you're not the doctor and don't have the necessary knowledge to make that decision. The whole process is misaligned because the recipient is not knowledgable enough to make the decision, the decision maker (doctor) is not the payor, and the actual payor (insurance) is often neither of those. Efficient markets require certain preconditions to be met to work. It's true in many situations but there are some well known edge cases.
- conanbatt 7y ago
  I would welcome a link to the analysis you point if you wish, but this is very reductive. There are a million markets with information asymmetry and work just fine, and there are plenty of examples of cash-pay systems that work reasonably well for healthcare. I disagree with OP that the problem is price transparency, but the healthcare market in the us is intervened in ways that prevent the classic workings of a market.
- Ididntdothis 7y ago
  I think you are right but I still think two steps would make the system much saner: - Price transparency - One price for the same service. The practice of charging $500 to the insurance but $10000 to the uninsured needs to stop. Maybe it's fine to vary by a few percent but there is no other market where the same product costs 20x more depending on who pays. If the excuse is that this is to compensate for non payers then let's pay for this from a separate pot.
  - SolaceQuantum 7y ago
    None of this addresses the point- even if you have price transparency and one price for the same service, you are not educated enough to select services you need. Doubly so if an emergency happens.
    - 7y ago

8ytecoder 7y ago

Nowhere near as close - I had what I thought was food poisoning and went to the ER. Deeply aware of US ER fees and was already questioning my choice. I go there and was made to wait 30 minutes in excruciating pain. But it got better and I felt good enough that I decided to leave - specifically because I’m scared of the costs. I informed them and left. Did not see the doctor or anyone. Except the nurse who took my weight and height. Got a bill for $1000. Literally for stepping into the ER. It’a no coincidence that US has such high opioid addiction and homelessness. Even in third world countries these people would have gotten treatment that didn’t bankrupt them.

dekhn 7y ago
one reason ERs are so expensive is they are required to provide medical services for people who can't pay. so you are paying a subsidized price. also those fees are negotiable if you are patient and can spend a bunch of time on the phone.
- Udik 7y ago
  How can a private business be required to perform a public service at its own cost? If the service is public, the public should pay for it; if it's not, each pays his own. Consider this: a public service is financed by taxes that are proportional to one's income. The way it works now, both a minimum wage worker and Jeff Bezos are asked to pay $1k to walk into a ER, to "subsidize" what is effectively a public service.
  - tapland 7y ago
    In the US you pay just as much as us in the EU from your taxes towards healthcare as well. You are being double dipped for the privilege of having portions of the population not able to afford actual care.
    - yitosda 7y ago
      Possibly, on average. Some pay (vastly) more, some less. I don't see the double-dipping in the math though. EU has populations of people who aren't contributing in taxes much or at all.

vonmoltke 7y ago

> The whole "capitalism will solve it" thing just isn't working. I cannot shop around for medical care, I cannot see prices, and insurance is $1300/month for essentially no benefit (except to turn prices from bonkers to incredibly high). Considering that, for the services you mentioned, in the US it is often a government itself sending the rhetorical you those bills, I think it is a bit more complicated than merely blaming capitalism. Edit: does someone mind telling me why I am wrong?

creddit 7y ago
> Edit: does someone mind telling me why I am wrong? You went against the hive mind. There's no need for explanation.
Reedx 7y ago
You're certainly correct it's more complicated than that, so the downvotes aren't due to being wrong. shrug Healthcare in the US is neither free market nor socialized. It's an absurd mess of both worlds combined into a singular nightmare.
- vonmoltke 7y ago
  It's essentially the worst of both worlds. Just enough socialism for a selected class of businesses to capture the profits of necessary services. Made worse by the fact that sometimes those "businesses" include local governments.
mladenkovacevic 7y ago
I didn't downvote you since legitimate opinions shouldn't be downvoted but the reason I think you're wrong is that US is a particularly chronic case of the government serving the needs of capitalism above and beyond the population at large. It's like saying don't blame Catholicism, blame the Vatican. One is a direct expression of the other.
- vonmoltke 7y ago
  > I didn't downvote you since legitimate opinions shouldn't be downvoted but the reason I think you're wrong is that US is a particularly chronic case of the government serving the needs of capitalism above and beyond the population at large. I think it's more a problem of local governments often acting as quasi-capitalist entities themselves. If charging people $1000 for a ride in a fire department ambulance reduces property taxes, why not? > It's like saying don't blame Catholicism, blame the Vatican. One is a direct expression of the other. Eh, I don't think that is accurate because the Vatican is Catholicism, not merely an expression of it. Also, my point was that you can't blame one idea or entity for the state of health care in the US. There are a number of sociological factors that need to be addressed, including but not limited to extreme capitalist beliefs, belief in "rugged individualism", moralism, and xenophobia.

umvi 7y ago

Well my family moved to Germany and this was our experience with German healthcare: 1. Mom goes to doctor because of shoulder pain 2. Doctor prescribes "health spa" (wtf?) to see if the pain will go away. Apparently "spa time" is a common default prescription because the healthcare system is overrun with people that come in with sniffles and aches that go away in a few days? 3. Spa Time does nothing (as predicted); doctor orders xrays 4. Process/analysis/??? is taking forever; in the meantime we have moved back to USA 5. US doctor correctly diagnoses problem same day as initial visit and orders specialized PT that actually helps

baud147258 7y ago
> because the healthcare system is overrun with people that come in with sniffles and aches that go away in a few days I have a family member who's working in ER in a public hospital in France, she told us that there's a lot of people who come in for nothing, often abusing the free ambulance service. And apparently whenever it's raining there's less people coming in, all things being equal.
y4mi 7y ago
I'd wager that you just went to an 'allgemeinarzt'... they're doctors for general illnesses, which usually go away within a few days. practically just to get an AU so you can get a few days of paid leave[1]. If you're having an actual issue, you'd have to go to a specialized doctor or a hospital which has the equipment to actually diagnose your issue... such as an xray machine in your case. diagnosis is done right after taking the image, so you'd have had a similar experience if you went to an actual clinic [1] according to the Finanzamt (german IRS) the average worker takes an additional 12 days of paid leave like that... additional to the normal 20-30 days.

rdtsc 7y ago

Similar story. Came from Europe to US to go to college. Got a terrible strep throat. Went to the nearest emergency room. Waited for almost an hour. Saw some intern for 10 minutes who prescribed me a codeine pill and later charged me $400. That was in early 2000s money. The funny thing is I already had insurance through the university, but this doctor wasn't "in-network" apparently. Even if there wasn't a monopoly I can only imagine the insurance company advising clients to use specific hand signals to indicate which network they belong to so the ambulance driver knows where to drive if you're incapacitated and can't speak. "Raise and wiggle three fingers for Blue Cross Blue Shield, and two for Anthem". Or maybe have everyone get tattoos on their arms with their insurance network details.

LinuxBender 7y ago
How did an intern prescribe something to you? That should not be possible. Also, codeine isn't a treatment for strep. They should have given you antibiotics after diagnosing a throat swab.
- rdtsc 7y ago
  I was in pain and I guess after checking that my throat wasn't going to close completely he gave me something for the "pain". > How did an intern prescribe something to you? He seemed young enough to be intern. I didn't specifically check his age or credentials.
  - LinuxBender 7y ago
    Perhaps a young doctor. :-) They should have advised against you leaving until they did a throat culture. It's rare, but strep can develop into a life threatening condition.
masonic 7y ago
This does not make sense on several levels: 1) strep throat is not an appropriate use of the ER. 2) codeine is not a course of treatment for strep or any other communicable disease. A course of antibiotics is mandatory. 3) strep infection cannot be diagnosed at first sight. Culturing is required.

mrlala 7y ago

Same here.. $1300/mo for family of 4. 10k deductible. Another $2k/year for dental. And then it barely seems to cover any normal stuff.. physical therapy for son, still get $1k bill. Dental work for kids, another $1k. And you are totally right all it does is make you think "is my kid really doing that bad that I should take him in?". Fuck having to get down to that mentality... I hate it, but it's the reality of the situation I'm in. If someone is lurking outside our house, we don't think to ourselves.. "Hmm, should I call the police? I don't see a gun, he probably isn't too dangerous.. I'll just wait it out". No, you freakin call the police when you need it and don't have to worry about going bankrupt because of it. Really sick of this backwards ass country we live in with regards to healthcare. I can afford it.. sort of.. but I have no idea how people below my income deal with day to day medical stuff. It's horrifying.

vasilipupkin 7y ago
it's very naive to think that Europeans don't pay for their healthcare. Germans make monthly payments for insurance, etc. Are they that much lower than 1300 a month? according to posters here, basic insurance is 800 dollars a month. Average net disposable income in Germany is 34K.3 a year http://www.oecdbetterlifeindex.org/countries/germany/ http://www.oecdbetterlifeindex.org/countries/germany/ In the US, it's roughly 45K. So, Germans pay less for insurance, but not that much less, considering it as a % of disposable income. And this is for the basic public option. Many Germans pay for private insurance.
- oneplane 7y ago
  They are much lower, think in the 100 to 150 range. And that's without company discounts if you have a job. On top of that, there is a fixed limited amount you have to pay yourself per year if you actually use it, and everything else is covered.
- RaptorJ 7y ago
  naive calculation from an estimated 8% effective rate[0] says a german family making 60,000 would pay 400/month. Additionally however, no deductibles. [0] https://www.npr.org/templates/story/story.php?storyId=91971406 https://www.npr.org/templates/story/story.php?storyId=919714...

acolumb 7y ago

Yet people blame Obamacare for the prices you just mentioned :).

morsmodr 7y ago
That . after the smiley is making me go bonkers, lol.

lettergram 7y ago

I’m of the opinion that is how we should assess medical treatment, by cost. People get a ton of unnecessary treatment. Depending where you live $2k for a hospital trip via an ambulance may also be fair. Think about how many people saw your son, drove you, the bed he took. In SF a bed in a hotel is $400 - $500. That’s just a bed, not anything else. Your take home salary in the U.S. is typically 80% after tax (effective tax rate). In the EU it’s closer to 50% (or less). It’s much more expensive in the EU just not all at one time. That’s perception. I do think we should have competition though and open pricing. Can’t decide to do something or not unless pricing is clear. Also if you are upset about medicinal costs be upset at the medical schools. They limit the number of doctors intentionally to inflate salaries.

andbberger 7y ago
You're wrong.
- dang 7y ago
  Can you please stop posting unsubstantive comments to Hacker News? If someone is wrong, it's great to provide correct information in a factual way. If you can't or don't want to do that, it's fine to post nothing. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
mrtksn 7y ago
>In the EU it’s closer to 50% (or less) It’s much more expensive in the EU just not all at one time Not really, procedures and the drugs themselves are much cheaper as they are usually negotiated on a national level. Personnel salaries are also not that high. If everything is cheaper you cannot argue that the total cost is higher.
- lettergram 7y ago
  The personal salaries is really messed up because of they are barely graduating more doctors now than the 90’s that’s an intentional inflation of salaries.

thorwasdfasdf 7y ago

The problem is, there's no price caps on anything, so these profit seeking monopolistic predatory hospitals can charge whatever they want. Medical emergencies are the number 1 cause of bankrupcy in the US. The US spends 19% of GDP on medical with worse service and outcomes. this is more than twice the Euro average. In the US, you need to be very careful with medical care. You should never ever go to a hospital unless you're absolutely sure that your life is in danger, and even then, you should research your condition first. Also, don't have kids. The medical insurance premiums in the US are extremely high, if your employer isn't paying for it.

vonmoltke 7y ago
> Medical emergencies are the number 1 cause of bankrupcy in the US. Nit: Medical expenses are the top cause, not medical emergencies. Not that this is much better.

api 7y ago

The US system is worse than "capitalism will solve it." It combines everything that is bad about socialized medicine (regulatory red tape, bureaucratic overhead, slowed advancement, state-enforced moribund monopolies) with everything that is bad about privatized medicine (predatory pricing behavior, regressive cost burden, non-universal coverage). It's a remarkably bad system, a kind of "pessimum" solution that benefits only insurance companies as far as I can tell. I've also heard that it's run as a kind of jobs program that's designed to employ massive numbers of middle-tier management, clerical, and bureaucratic types. The US has a lot of these worst possible outcome systems. We seem to like to take all the worst ideas from the left and combine them with all the worst ideas from the right. Another example of the worst ideas of both sides is zoning and urban planning in California.

ajmurmann 7y ago

I think what we've got in the US cannot be described as capitalism either. The market is way too regulated to be a well functioning market. I think we've just got the right mix of capitalism, regulation and complexity for the average consumer to be confused to get the perfect crony capitalism. The US health Care system is a Rube Goldberg machine made out of grifters. Edit: of course there are great people working in health care, but they get ground to pieces by the grifting machine.

merpnderp 7y ago

State granted monopolies aren't capitalism. What the US has is literally the worst of capitalism and socialism mixed together in some sort of corrupt, inept, admin heavy hybrid system. It's like pick a team already, but you can't do both; create healthy markets through regulations, or get rid of the markets, but right now the regulations just create incredibly unhealthy markets.

blockchainman 7y ago

“Capitalism will solve it” is not at fault here. What you’re describing is crony capitalism. It sounds as if your local politicians are not doing a great job at creating TRUE competition along with a TRUE free market. In other words your local monopoly should not even exist it should be broken up.

avocado4 7y ago

> The whole "capitalism will solve it" thing just isn't working. There's no capitalism in US health care system - you alluded to it yourself with lack of price transparency example. The key issue is medical cartel with AMA at the core who lobby hard to restrict supply of physicians as well as narrow scope of practice for everybody else. As a result you have people having to go through a gatekeeping 500k-a-year dermatologist to get a prescription for $250 creams which you can buy over the counter in the UK for 10 pounds. Nobody really talks about medical cartel in politics because doctors are popular with average Joe - unlike insurance and drug companies.

chimeracoder 7y ago
> There's no capitalism in US health care system - you alluded to it yourself with lack of price transparency example. This is true. > The key issue is medical cartel with AMA at the core, The AMA has basically zero power over any of the issues you describe. > AMA lobbies hard to restrict supply of physicians as well as narrow scope of practice for everybody else. No, the number of physicians is limited by the number of residency programs, which is determined by how much funding there is. Residency programs are not self-sustaining, so they're funded by Medicare. > As a result you have people having to go through a gatekeeping 500k-a-year dermatologist Most physicians take home a lot less than you'd think. The gross salary is misleading, because physicians also have high licensing, insurance, equipment, and continuing education costs. The gross pay does not take these expenses into account, and furthermore, these expenses are typically not tax-deductible for most physicians. It varies heavily by region and specialty, but the average (not top - average) physician in a city like New York or San Francisco actually has a lower take-home pay than a mid-level FAANG engineer[0] in either city. [0] e.g. an L4 engineer at Google.
- Ididntdothis 7y ago
  "It varies heavily by region and specialty, but the average (not top - average) physician in a city like New York or San Francisco actually has a lower take-home pay than a mid-level FAANG engineer in either city. " That's a pretty high bar though.

toasterlovin 7y ago

FWIW, according to this list[0], U.S. median household income is about $10k/year higher than Germany. [0]: https://en.wikipedia.org/wiki/Median_income#Gross_median_household_income_by_country https://en.wikipedia.org/wiki/Median_income#Gross_median_hou...

OrgNet 7y ago

not being able to see prices ahead of time is probably the biggest problem... but it also stinks that with or without insurance, you appear to pay about the same total cost.

rayiner 7y ago

What about the 60% of Americans who have health insurance through their employers? The median American spends about $3,000 a year on premiums + out of pocket expenses: https://www.commonwealthfund.org/publications/issue-briefs/2019/may/how-much-us-households-employer-insurance-spend-premiums-out-of-pocket https://www.commonwealthfund.org/publications/issue-briefs/2.... That's less than what most would pay in mandatory social insurance taxes in Europe.

tapland 7y ago
> That's less than what most would pay in mandatory social insurance taxes in Europe. Yeah, it might be. But you also pay that in the US, to the same degree. Why is it so common to think that US citizens don't pay taxes towards healthcare? They do, and just as much as western europeans. The europeans just don't have to pay those extra $3k. US healthcare costs twice as much per person as healthcare in other western nations.

AnIdiotOnTheNet 7y ago

> "is this an emergency enough to justify a $2K medical bill?" Yep, that's how you think about medical problems as an American. Get used to it.