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The Cost of Not Getting Tested for Coronavirus: A $10K ER Bill
- lostgame 7y agoAs a Canadian who has also lived in America, I am consistently mortified by the costs of health care in the states. Are they intentionally designed to force the lower class into even more poverty (I’ve seen $50 being charged for a pill of Advil - first hand) - or is it just an unintended side effect? I find it harder to believe it’s accidental than intentional. EDIT: Due to jiveturkey’s pathetic and wholly inaccurate defense of this system, and my inability to post in this thread further, I need to specify I was changed $740 to see the doctor and identify the issue. The pill itself cost $50. Please don’t defend this pathetic slavery of the lower class, guys, unless you’re a part of it. I’ve actually got a photograph of this bill somewhere on my backup drive I’d love to share. EDIT 2: And before any of you say this isn’t intentional, please look up Martin Shkreli. The only difference between him and the other guys at the top of the industry is that he got caught. Get real, guys. Please. Most of the comments here are beyond sad - I’m glad this has so many upvotes from people who silently disagree.
- thorwasdfasdf 7y agoI think they're doing it just because they can. there are some long winded explanations about this being about the negotation process between the hospitals and insurance companies but that's no exucuse. at the end of the day, it's just unmitigated greed on the part of the hospitals.
- toomuchtodo 7y agoIt's politics as well. The Democratic candidate campaigning on maintaining the status quo is leading against the candidate who is campaigning on single payer. There's not much left to do when larger cohorts of voters prefer an inefficient, wasteful system (or a candidate who supports such a system). What we currently have is what people are voting for. I've tried to make everything stated above objective in keeping with forum guidelines. Personally, I find the situation incredibly demoralizing. Perhaps the outcome of COVID-19 is a demonstration as to why healthcare needs to be fixed.
- pstuart 7y agoThe Overton Window has slid so far to the right that such remedies are considered to be radical. Sigh.
- kortilla 7y agoSingle payer healthcare for all has always been radical in the US. The Overton Window shifting to the left over the last decade is what has allowed Bernie to have any relevance at all.
- toomuchtodo 7y agoHas it been? Those 65 and older (Medicare), those on assistance (Medicaid), and current/past military service members (Tricare) all appear to be very satisfied with their single payer healthcare. I genuinely don't understand why this is considered a radical idea when so many citizens are happy with this public benefit. This leads me to believe that the only cohort who believes it to be radical is that which is to be disrupted by such a policy. https://news.gallup.com/poll/186527/americans-government-health-plans-satisfied.aspx https://news.gallup.com/poll/186527/americans-government-hea... "Americans' satisfaction with the way the healthcare system works for them varies by the type of insurance they have. Satisfaction is highest among those with veterans or military health insurance, Medicare and Medicaid, and is lower among those with employer-paid and self-paid insurance. Americans with no health insurance are least satisfied of all."
- kortilla 7y agoYes, they are happy with it just like they are happy with social security income. The radical part (in the US) is suggesting that it should be available to everyone regardless of age (or veteran/military status) without any concrete plans to pay for it. > This leads me to believe that the only cohort who believes it to be radical is that which is to be disrupted by such a policy. Then you are being willfully myopic if you can’t possibly envision people who don’t have faith in the government to not cause a meaningful regression in care by destroying the private market. You can both be unhappy with the current opaque healthcare market and not support Medicare for all.
- deleted 7y ago[deleted]
- pengaru 7y agoI don't think it requires any more than an indifference towards the welfare of others from those who believe they can afford any kind of healthcare they would ever need while simultaneously pursuing a minimal tax bill.
- munk-a 7y agoThey are not - the effect these prices have on the poor is an unintended[1] consequence of the true aim. Extracting the most money possible from insurance payors - honestly, if hospitals could bill "You owe us 50$ or as much of that that your insurance would cover" then they would. Nobody actively wants to impoverish the poor (except for a small number of utterly terrible people) but payors force cost pass on to their subscribers as a way to keep the costs from getting too crazy and and the uninsured get hit by the full bill that providers want to extract out of payors simply because it's impossible for them to under bill without getting hit by lawsuits. That paragraph was an attempt to be really fairly voiced so just to follow up - this system is utterly rotten and terrible, the US has one of the worst health care systems in the world when it comes to the non-super rich - and even for them there are better options - and it needs to be fixed. 1. Edit note: Originally I used "unavoidable" here which was a poor word choice that's been pointed out below.
- lostgame 7y agoUnadvoidable? That’s disgusting, untrue, and exactly what I believe they’d say. It’s unavoidable to charge me $50 for an Advil? When I’ve paid $740 for the doctor to see me and identify the issue? Give me a f*ing break. If you really think that’s the case maybe you should analyze what costs are actually like for health care in other countries. That’s disgusting. Just no. EDIT: Do you work for the US health industry? :/ EDIT 2: Yes, this commenter works for the industry.
- munk-a 7y agoI work adjacent to the industry and can clearly see what a rotten pile of crap it is - I'm also actually a US/Canadian border straddler, I emigrated from the US to come up here in fact. Please don't take any of my statement above as any sort of excuse for the market's behavior, these companies hold profit over the well being of patients - otherwise they wouldn't be so willing to stick poor people with such high bills. But, it is a private market and what's happening is all that can be expected. Again, the US really needs to look at Medicare for All - partially just because it'd end up providing better care for less money. Canada's system isn't perfect, I supported the NDP in their push for national Dental and Pharma, and I'll continue to do so, but it's worlds better than the US.
- deleted 7y ago[deleted]
- paxys 7y agoIt isn't intentionally designed, just a side effect of the system as it exists today. There are two ways to bring healthcare costs down in America: 1. Insure everyone — no exceptions (by the government or through private insurance) 2. Let hospitals (and ERs) deny care to those that can't pay Since neither of them is happening anytime soon, Advil is going to keep costing $50.
- jacobush 7y agoNo. Cost per outcome is still higher. More is wrong.
- tguedes 7y agoI don't see how #1 solves anything. The biggest issue which leads to all the cascading effects is the hospitals can charge a ridiculous amount for goods and services, with some hospitals charging more than 1000% more than what the government thinks they should (https://www.theatlantic.com/health/archive/2015/06/hospitals-that-charge-1000-more-than-they-should/395099/ https://www.theatlantic.com/health/archive/2015/06/hospitals...). I had a colonoscopy done a year ago and the prices pre-insurance ranged anywhere from $7000-$16000 depending on the location, all within network. I ended up paying just $1300 because of my insurance with a couple hundred covered by my HSA account. Why is there such a drastic price difference between places? Why are hospitals and other care providers that have a monopoly over an area able to act like a monopoly and have complete control over pricing? Everything else is just a 2nd order effect.
- paxys 7y agoThe reason hospitals charge more is (1) they need to recoup the cost of the services they are otherwise providing for free and (2) they have no leverage to negotiate with insurance companies and drug manufacturers. Having a national or privatized healthcare system that covers everyone will greatly help with both of them.
- jiveturkey 7y ago> I’ve seen $50 being charged for a pill of Advil - first hand A paper plant was having a problem with their mill. They brought in a consulting engineer to help them with the problem. He took a look at the machine and after a few minutes, drew an X on it in chalk. "Hit it there with a hammer". It worked! "How much do we owe you?" "$10,000" "That's absurd! I can't pay you that for literally 2 minutes of your time! I need a detailed invoice." The engineer wrote up an invoice: chalk mark $5 knowing where to put it $9995 ========= The patient in your example did not pay $50 for an Advil. There is a lot wrong with US healthcare, but this isn't it. It's about misaligned incentives.
- lostgame 7y agoIt’s pathetic you’re defending this, and terribly evident you have never had to live in poverty in the states. It’s also patently, blatantly false. I paid $740 to see the doctor to identify I needed an Advil. I paid $50 for the Advil! Your post literally incited a large amount of rage in me. Defending people like Martin Shkreli- which the pharma industry is full of - or the medical industry itself’s rape of the lower class - is pathetic, selfish and just straight up wrong. EDIT: I’m unsure, as well - how I was unable to downvote this comment.
- jiveturkey 7y agoeh? I grew up in poverty on public assistance and didn't have a decent job until I was 25. I've been hungry. etc etc. I know about being poor, ok. I also didn't defend the behavior. Get out of your personal shell and re-read it. You paid 0.05 for the Advil. You paid $49.95 for everything else that goes along with it, when you get an advil at an advanced medical care facility. You would understand that if you comprehended my post. Do you realize that when you go to any store and buy a coke for $1.50, you are only paying maybe .25 for the soda (incl. the bottle it comes in)? .75 or so is shipping and .50 is to the retailer. Every product has non-production costs associated with it, and that is what you pay for when you get a $50 advil at any kind of medical facility.
- lostgame 7y ago
- thorwasdfasdf 7y agoDefinitely need to start cracking down on predatory hospital billing. 10K billed just for stepping into the ER Room without even getting tested is absolutely insane. AT point do we decide this is criminal and start taking actions against these guys? Normally, I would never be in favor of price ceilings but this is one industry that desperatly needs it.
- solotronics 7y agoI think once the dust has settled from COVID-19 the entire health system in America will be totally changed.
- smacktoward 7y agoI remember studying political science as an undergrad two decades ago. My professors all said the same thing about the Electoral College: “it’s a relic that has long since stopped serving a practical purpose, but people live with it because it never rocks the boat. If there’s ever an election where the winner of the popular vote doesn’t actually win because they lost in the Electoral College, there will be a huge mass movement to finally get rid of it.” Since then we’ve had two elections in twenty years where a candidate who lost the popular vote “won” thanks to the Electoral College. And the Electoral College is still there. In politics, never underestimate the power of inertia.
- mrguyorama 7y agoIt's not about inertia. Look at which party benefits from the electoral college, and then recognize their attempts at voter disenfranchisement.
- smacktoward 7y agoIndeed, this was a key misconception my professors and I all shared: we thought there was a broad consensus in American society that democracy is a good thing. It turns out there are a lot of Americans, disproportionately gathered on one side of the ideological spectrum, who care less about democracy than they do about their team winning.
- robbiep 7y agoThis is unfortunately why the US is going to fail miserably at containing SARS-CoV-2.
- bcrosby95 7y agoThe US healthcare system is best described as a pack of wolves negotiating about whose going to eat the sheep.
- munk-a 7y agoI think that's close to accurate, but a better description would be "A pack of wolves fighting over who is going to eat the sheep". The different market players here, PBMs, Payors, Manufacturers, Providers, Special Interest Groups, Advisory Boards and others - all are trying to bankrupt one another much harder than they're trying to bankrupt customers because customers have nearly no money to take - most of the inflow into this market isn't coming from the consumers but from the employers of the consumers (that are paying truly staggering amounts of money) and a lot of the damage you see to customers ends up being, essentially, collateral damage from one market player trying to stick it to another market player.
- platetone 7y agoWe decided (slash "made the mistake") of going to the emergency room last summer. Spent less than two hours in an exam room before being dismissed with no conclusion and referral to another doctor. Got a $9500 bill about six months later and have been billed a 10% copay on that (insurance paid $5500 already at their negotiated rate). Still fighting it as absolutely absurd, but there's really no hope. This country is fucked. It's an embarrassment.
- CydeWeys 7y agoMeanwhile, I went to the emergency room in a hospital with my girlfriend in London two years ago and it was free for her. We're Americans. Guess which country has better health outcomes.
- makomk 7y agoYeah, here in the UK she could've been told that she wasn't going to get tested for coronavirus over the phone for free. It's a much more civilized system. (Though to be fair, we did a little better at adding Italy to the list of qualifying countries promptly than the USA.)
- Veedrac 7y agoUK tests per million: 387 USA tests per million: 26 Not really the same.
- tedunangst 7y agoThere should be some adjustment for expected exposures, no?
- Veedrac 7y agoIf you believe the numbers, the UK has 6.9 per million infected, and the USA has 4.1, so they're pretty similar. You shouldn't believe the numbers, though, because the USA is barely testing people—and not because they aren't sick; testing in the US is often expensive, as obviously idiotic as that is. I'd expect the USA to have a higher number of infected per capita in actuality.
- aurelwu 7y agoThe statement from the hospital management boggles my mind: "In addition, there are different parts to a patient bill. One part is what the hospital charges the insurance company, one part is what the insurance company eventually pays [...]" I can't think of any other business transaction where someone just puts a giant number on a bill and then is happy if someone pays ~25% of it. Such companies would be shunned by their customers and they'd go bankrupt. Is there any economic theory which explains how such odd of an system can emerge/survive?
- themagician 7y agoA lot of businesses work like that. There is a retail price and then a discount is applied depending on who you are. That's kind of how all retail works, really. Even working with Amazon or Walmart is kind of like that. You invoice them for one amount, but you get paid much less based on different deductions for things like discounts, co-ops, damage allowance, etc.
- karatestomp 7y agoNothing about hospital billing would fly anywhere else. Bills just showing up after the fact with little ability to verify their accuracy, constant errors one can catch anyway (so how many are missed?), bills showing up months later from a half-dozen different sources when you only had one apparent "vendor", and so on. I bet we received between 100 and 200 pieces of mail for each of our kids' births, including maternal care before the births. Probably averaged 40-60 hours dealing with billing and billing problems with each one, maybe more. And ours were all totally normal and about as easy as it gets, and we had insurance. I think we ended up missing some tiny bill we could easily have paid in each one (oh, yeah, they also like to give you very little time to pay) and had them go to collections.
- beckler 7y agoI found a bill with a mistake on it, as one of my kids was charged twice for a single procedure. I called to get it fixed, but instead of dealing with it they just immediately sent it to collections.
- ksk 7y agoIs there anyone doing work on analyzing current legislation and providing alternate wording to fix the issue?
- toomuchtodo 7y agohttps://www.congress.gov/bill/116th-congress/senate-bill/1129/text https://www.congress.gov/bill/116th-congress/senate-bill/112...
- ksk 7y agoSorry, that's just an impermeable wall of text to me. I'd love to know from someone who groks this, the specific wording in the bill that would address the ER costs issue, and where the current legislation fails. Basically I'm looking for the bug fix, not the entire source code.. :)
- nimbix 7y agoJust yesterday I was reading an interview with the CEO of a German company which produces coronavirus tests about how they charge 2.5EUR for a single testing kit and that reasonable cost for processing it should be around 10EUR. Where does the 1000x multiplier come from?
- tedunangst 7y agoHuh? She wasn't tested. Whatever the ER charges, outrageous or not, why would you assume there's any correlation at all to the cost of a test that wasn't administered?
- mikeInAlaska 7y agoNobody should worry about Covid in the USA, 1) Trumps dead Uncle went to MIT and 2) we have his hunches to keep us safe. Further, as long as we don't test in mass, our case numbers will remain very low.
- munk-a 7y agoIt is depressing that the hyperbole comment is just a list of easily confirmable statements by the administration.
- lultimouomo 7y agoSide note: if you suspect a COVID-19 infection, DO NOT GO TO THE ER. Contact a physician by phone, get instructions. By going to the ER you put a lot of people at risk.
- skeletal88 7y agoThis is the most important thing here. The testing should be done at home.
- joe_the_user 7y agoI'm pretty sure testing not available at home. But you're right, testing should be available at home. We're simply in a lot of trouble.
- joe_the_user 7y agoAt some point, the people who suspect COVID-19 infection are going to be people who have full-on pneumonia. They would need to go to ER under normal circumstance but indeed, that will have a bad result. Basically, we desperately need a special COVID-19 program, not simply a person's regular physician giving instructions. How many physicians are going to be getting calls soon and how much time does that take important activity on their part? Etc. Note that Korea has ER wards set-up with pre-entry tents allowing COVID patients to be routed elsewhere. Some multi-track system like this is going to be necessary or more desirable than Italy, which has shut down the part of its health care system not treating COVID patients and is still mostly watching them die.
- lultimouomo 7y ago> Some multi-track system like this is going to be necessary or more desirable than Italy, which has shut down the part of its health care system not treating COVID patients and is still mostly watching them die. Please don't spread disinformation, this absolutely not what is happening in Italy. ERs are working, hospitals are working. Planned and elective procedures have been delayed, to spare personnel and rooms and to avoid creating new emergency cases in case the procedure goes wrong. Italy has less than 7000 hospitalized COVID-19 patients. Dealing with those is not a problem. Even the 1000 people in ICU are not a problem themselves, the 600 in Lombardy are. Lombardy had around 900 ICU beds before the crisis (they now have more but the extra ones are makeshift); this means that 2/3rds of the bed are needed for COVID-19 patients only, which is obviously a huge problem. In Bergamo, the city with the worst situation, some people cannot be tubed because of lack of equipment will get will get a NIV instead, which is very very bad, but it's not "wathich people die". BTW, Italy has enforced the dual track system for suspect COVID-19 cases since at least two weeks ago.
- joe_the_user 7y agoWow, this brings home what a huge crisis this is for US health care system. It's not just the huge costs or huge administrative overhead as such. It's that the entire system is built as "we design a giant filter-rationing-marketizing system to dole out services and you pay for both the service and the rationing process". This stuff can't work for the Coronavirus at all. Testing needs to free and fast, not even "free eventually but there's bureaucracy first". Who knows when or if this paradigm will be abandoned but if it isn't, suffering will be tremendous. But either way, the risks discrediting the filter-ration paradigm. If X can be provided for free to everyone, the question of why can't you will loom that much larger.
- munk-a 7y agoLets not forget that the US could dodge a lot of these issues (and increase the chances of a good outcome) by simply putting out a few tens of millions for tests and distributing them to providers free-of-charge with an agreement that there be no administration fee. That is, honestly, sorta what a government should do in a crisis, just eat the cost to make sure everyone is safe - instead the government is "letting the market decide" and continues to dump millions times the cost of resolving this crisis into boondoggle never-gonna-work F-35 fighter jets.
- NoblePublius 7y agoThis story is total fake news. The patient is a teacher with a Cadillac health insurance plan. She paid $75 co-pay. The $10,000 bill is an illusion printed by the insurance company to make her think that her insurance is actually valuable. No one was paid $10,000. The hospital was paid a secret negotiated rate much much much much lower than $10,000.
- munk-a 7y agoThe provider was paid 3,000 by the payor - that's how insurance billing works. It absolutely is a rats nest when it comes to finding out pricing information but the number on the bill is what ended up changing hands (less, possibly, any amount not covered and defaulted on by the patient). I believe you're thinking of the provider's chargemaster and the pricing discrepancies there - this procedure was billable as 10,000 to a patient without insurance with the 7,000 discount being the payor's preferred rate - that 10k is the BS number that (mostly[1]) no one ever pays, while this 3k is the actual amount changing hands - for the patient the out of pocket cost is the most visible portion, but that bill was fully paid. 1. Mostly everyone except for the uninsured or out of network - those folks will get stuck with that BS price 7k price, which is there since payors always want to feel like they're paying discount prices. (edit - corrected numbers to be in line with the actual bill)
- m0zg 7y agoInsurance _never_ pays as much as they bill. This is one of the reasons to have it in the first place: each insurance company has negotiated rates with the hospitals. Even if you have high deductible, you'll still be getting negotiated rates, not the bullshit they (try to) charge people with no insurance at all. IMO, this is one thing that should be made totally illegal, no matter where one lands on the political spectrum: cash customers should be "favored", meaning cash price must match or be lower than the lowest insurance negotiated rate for each procedure. Anything else is just stupid and unfair. That way if the insurance pays five cents for the paper cup the pills come in, you can't charge fucking 13 dollars for the same thing if I pay cash.
- 7y ago
- lukeylunchbox 7y agoThank god ER us free here...
- XorNot 7y agoThe US, judging from Italy, is about 4 weeks away from a complete collapse of its healthcare system due to corona virus. With no serious attempts at mitigation or contact tracing or testing, that thing is going to spread like wildfire.
- Dramatize 7y agoThe American healthcare system is the main reason I'd not want to move there.
- beckler 7y agoI live in the US, and the healthcare system is the primary reason I want to move to another country.
- nojvek 7y agoSerious question, why can’t individual states rollout single payer healthcare ?