11 ms·

The cost of two weeks in an pediatric/infant ICU

• _huayra_ 5y ago
  I don't understand how people can be so anti-universal healthcare in the US. When you have an $8k deductible, your insurance is basically a gift to the CEO's yacht fund.
  • minikites 5y ago
    The people who are against universal healthcare usually pitch it as an argument for "choice", as if I'm going to compare prices when I have a ruptured appendix. It's also usually couched in anti-government sentiment, where they draw comparisons to "lines at the DMV", as if other countries with universal healthcare have people dying while waiting in line for care, something that also doesn't happen.
    • yerwhat01010 5y ago
      > as if other countries with universal healthcare have people dying while waiting in line for care This absolutely does happen in the UK, although I'd pick our health over the US's any day of the week.
      • avianlyric 5y ago
        It's also worth mentioning that private health care and insurance both exist in the UK. Individuals still get the choice to go to any private doctor they want, they'll just have to pay for it themselves. Just like the US, except the NHS provides an excellent safety net for everyone without private insurance or the means to pay for private care.
        • arethuza 5y ago
          In most cases its the same doctors working in private hospitals and for the NHS.
          • Silhouette 5y ago
            And in some cases it involves NHS facilities too. There are definitely some questionable aspects of our public/private healthcare. But again, this isn't always how it works, and the ethics involved are also complicated.
            • arethuza 5y ago
              I know someone whose condition rapidly deteriorated while receiving treatment in a private hospital and when things were looking really bad they got transferred to an NHS hospital.
              • Silhouette 5y ago
                I hope the person you know was OK. That transfer is actually not surprising. Emergency/intensive care is almost always NHS here. Private options tend to be better in situations like having multiple treatments available where one is significantly more effective or more reliable but also costs a lot more. Sometimes the NHS will only offer a cheaper but inferior alternative, which sounds horrible until you think that there is a huge but ultimately pooled budget and any time policy allows more spending on one treatment there is always someone losing out somewhere else.
        • CountDrewku 5y ago
          The US has safety nets as well, they're just not as generous as the UK's.
      • Silhouette 5y ago
        Agreed on both points. The UK system is far from perfect but for balance we should also say that it is not normal or expected for something as bad as that to happen here. Even in recent times, with the extra pressures of COVID, critical care has mostly kept up and the emergency overflow facilities that were built very quickly in case of overwhelming demand mostly went unused. Obviously there will always be limits and the available resources will run out if one of them is reached. In the aftermath of a major incident or an unusually busy period it can happen. I expect a lot of us from the UK might agree that the limits need to be raised further by investing more into the NHS. But I would still choose this type of system over a US-style one every time. I've never heard of anyone here dying because they couldn't afford tens of thousands for routine medication to treat a common condition.
    • deleted 5y ago
      [deleted]
    • Y_Y 5y ago
      I'm a big fan of universal healthcare, and have made great use of both public and private hospitals in Europe and the US. Everywhere I've lived (except the US) has had a totally free public system, and every time I've still paid for private insurance. I'm not rich by any means, and I don't have any particularly special requirements. I'm not even looking for better doctors or machines, since they are mostly shared or equivalent between public and private care. The only reason it's worth it for me to spend money on private insurance is waiting times. On the private system, I can see a consultant in one month instead of six, or get a surgery in three months instead of three years. This is all for non-emergency care of course. There are lots of elderly people waiting on operations like hip replacement on the public system, and it's expected that some will die before their turn comes up. It's a compromise that's built into the way the government operates their national health system. It not obviously the wrong way to do things, since carrying out all these operations would be very expensive and have limited benefit in terms of quality and quantity of life. It also sucks for the people waiting, especially since others who can afford to skip the line by paying (usually through private insurance) may even be seen by the same surgeon in the same OR. I don't mean to argue for or against this system, but just to point out that people often die waiting for (non-emergency) care in at least several large public healthcare systems in highly-developed countries in Europe.
      • hef19898 5y ago
        The countries I have direct experience with, France and Germany, don't have any issues with people dying while waiting for procedures. Experts are usually readily available, so there are exceptions. I don't know of any public health care system in developed countries that have really these issues. I do know so, that a lot of that comes from a PR campaign run by US insurances against the Canadian system.
        • Y_Y 5y ago
          When you say they don't have any issues, do you mean it doesn't happen? I'm more familiar with the Spanish, Irish and UK systems. I tried to find a nice document giving numbers for what I was describing, but most of what I can find is anecdotal, and the official reports are weren't quantitative. Here's an article from an Irish newspaper last year that gives a rough guess (though of course there are other factors): https://www.irishtimes.com/news/health/are-patient-waiting-lists-shrinking-for-the-right-reasons-1.4147197 https://www.irishtimes.com/news/health/are-patient-waiting-l... I'm certainly open to US insurance companies paying me to shill on hn against Canadian healthcare, but right now I'm only saying these things out of the goodness of my heart.
  • inglor_cz 5y ago
    Single payer healthcare systems in Europe were introduced a long time ago. Back then, politics was different, not least because of an imminent threat of the Soviet Bloc just around the corner and a need to answer it by "carrot", too, not just "stick". They are now status quo, but in another version of history, where such systems would have to be introduced today, I am not certain whether they could clear the political obstacles, much like the U.S.
    • js2 5y ago
      Efforts at introducing single-payer healthcare in the U.S. go back at least as far as 1935. https://www.healthcare-now.org/legislation/national-timeline/ https://www.healthcare-now.org/legislation/national-timeline...
    • intsunny 5y ago
      As an American who immigrated to Europe four years ago, I disagree that modern-Europe would not be able to recreate their healthcare systems under today's polticial climate. Ironically it is because of the USA that many Europeans are keenly aware of the davistating consequences of allowing for a hyper-capitalistic approach to healthcare. People here often assume the worst about that system, and are completely bewildered when I tell them how it actually works. (Especially in regards to having children, parental leave, and childc care.)
    • hef19898 5y ago
      Social security nets in Europe date back to time we used to have Emperors and Kings, before WW1. They are thus older than the USSR.
      • qwytw 5y ago
        Bismarck mainly introduced some rudimentary social security to decrease worker support for socialist parties, so it was a reaction to socialism (albeit not directly the USSR) from the start. However before WW2 it was very limited in all countries (and much smaller scale than for example what's currently available in the US) before the 40's and 50's.
      • 5y ago
  • tiahura 5y ago
    Your comment misses the point. There are two reasons why this bill is so high: 1. Some doctors and some hospitals are make tremendous amount of money - hospital revenue is about $1T and doctor revenue is about .5T. 2. This country has an insatiable demand for expensive healthcare. There’s no country with universal coverage where a child with little chance for survival would have received this level of care.
    • Jenk 5y ago
      The UK gives this level of care to many people routinely.
      • hef19898 5y ago
        As do France and Germany.
        • tiagod 5y ago
          Portugal too. Our system is far from perfect (the best medication is sometimes prohibitively expensive for some people who really need it - chronic patients, pensioners) but there are many examples of our national health system investing heavily in particular individuals with little chance for survival. A recent example is health system paying for Zolgensma, the most expensive medication in the world, leading to millions of expense per year[1][2] on this medication alone for a very small amount of babies. [1] https://tvi24.iol.pt/sociedade/saude/estado-gastou-4-1-milhoes-de-euros-em-medicamento-para-a-atrofia-muscular-espinal https://tvi24.iol.pt/sociedade/saude/estado-gastou-4-1-milho... [2] https://www.politico.eu/article/europe-eyes-arrival-of-worlds-priciest-drug/ https://www.politico.eu/article/europe-eyes-arrival-of-world...
      • simonh 5y ago
        It also does so to anyone who needs it regardless of ability to pay, and at overall half the cost of health care per person in the population compared to the US. You can also still pay for enhanced private health care if you want.
      • 5y ago
  • adrianN 5y ago
    Whether or not a policy with a deductible like that is a gift to the CEO's yacht fund depends on the monthly payments and is, imho, orthogonal to a discussion about universal healthcare.
    • _huayra_ 5y ago
      Considering how hard they actually fight when you actually have to get care (e.g. having the doctor submit tons of justification that you actually need the required treatment vs. some half-assed cheaper approach), I don't think the monthly payments actually matter.
  • wang_li 5y ago
    The US has universal care, it passed in 2009 and it establishes that everyone does their part and buy insurance. It establishes help for low income individuals. There are caps on annual expenses. You may not like how it’s structured. You may not like the amount that people are expected to pay. But twelve years later the only people who don’t have coverage are people who are not meeting their civic obligations. And I’m fine with that.
    • ceejayoz 5y ago
      > But twelve years later the only people who don’t have coverage are people who are not meeting their civic obligations. The folks at the poverty line with a "free" fully subsidized Bronze ACA plan has an enormous deductible that may be $6-12k before that coverage actually starts paying out. The ACA's max out-of-pocket for a family in 2021 is $17,100. (https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/ https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...) That's not meaningful access to healthcare for someone making $30k a year.
      • only_as_i_fall 5y ago
        And people wonder why the us has such poor health outcomes
      • leesalminen 5y ago
        My uncle-in-law just signed up for health insurance under ACA in Colorado. He pays a $22/mo premium and has a $700 max out of pocket. Yes, 2 zeros. I was totally shocked but I reviewed all his paperwork and it’s true. Meanwhile I’m paying $1,200/mo for a young and healthy family of 3 with a $7,000 max out of pocket.
      • wang_li 5y ago
        Out of pocket expenses for any individual is capped $8550 regardless of whether they have family coverage or individual coverage. Additionally, those earning less than 250% the federal poverty level qualify for additional cost sharing reductions (CSR) which dramatically lower the out of pocket expenses, e.g deductibles and copays. Details will vary but a family of four with a household income of $30k with CSR would have their deductible reduced to a few hundred dollars and annual out of packet caps also to the hundreds of dollars range. The same plan without CSR might have a $7000 deductible. But CSR is available in the situation you describe. http://www.healthreformbeyondthebasics.org/cost-sharing-charges-in-marketplace-health-insurance-plans-part-2/ http://www.healthreformbeyondthebasics.org/cost-sharing-char... Regardless, this is arguing over the burden that Obama, Pelosi, et. al. decided was appropriate for Americans. It's not a question of whether there is universal health care in the US. There undeniably is.
  • IG_Semmelweiss 5y ago
    There are really bad things with the current system, but you asked a question. People are exposed on a regular basis to the DMV, the SBA, to Social Security or to Medicare. Then they compare that experience with the avg experience with a commercial insurer, and it does feel like a better experience (of course, if their employer can afford it) Worse, there are stories of friends in places like CAN, where insider doctors hurriedly email their friends about a new doctor X that is available for appointments, in order to skip a 6 month wait... The system in the US is a mess, but those people reason that its the least worst option of the available choices. If they could be given a 3rd or 4th choice, like for example, make take health insurance companies and turn them into public utilities so the "CEO" is not getting his "yatch fund" from taxpayers, that's worth talking about (as longas you don't forget to look to CA, and their wonderful brownouts + utility-enabled wildfires)
    • js2 5y ago
      > People are exposed on a regular basis to the DMV, the SBA, to Social Security or to Medicare. Then they compare that experience with the avg experience with a commercial insurer, and it does feel like a better experience (of course, if their employer can afford it) That’s not what surveys show: > 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. https://news.gallup.com/poll/186527/americans-government-health-plans-satisfied.aspx https://news.gallup.com/poll/186527/americans-government-hea... CMS also publishes assessments of its own performance: https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/CAHPS https://www.cms.gov/Research-Statistics-Data-and-Systems/Res...
      • iammisc 5y ago
        Selection effects. The poor and elderly are likely to be on Medicare and other public programs. If you can't afford healthcare and get it for free of course you'll be happy It's like my charcoal Weber. I found it on the side of the road. Its dirty, dinged, and the wheels are falling off. But it was free and I can grill on it, so I'm extremely happy with it On the other hand if I paid for a Weber and got that, I'd be pissed.
  • nodejs_rulez_1 5y ago
    At least with some caveats, like less funds for 35+ year old parents.
  • cmrdporcupine 5y ago
    There are many problems with our Canadian system, it's certainly not perfect. And single payer is not the only way to approach this problem. But I'm overall happy with its compromises in our system. Like any economic resource, it's rationed. But it's rationed, generally, on the basis of need. And that "from each according to their abilities to each according to their needs" philosophy may be the ideological curse on it that will prevent it from ever having adoption in the US with its virulent anti-communist past. It would never happen in Canada now, it was a product of the 1960s and early 70s and the way things were then. And it's consistently under threat from its ideological foes here, even if it's immensely popular among the Canadian public. What boggles my mind about the US system is the blatant way it makes working people dependant on employment for health coverage. In a way it's a form of feudalism, tying people physically to their employment.
    • minikites 5y ago
      >In a way it's a form of feudalism, tying people physically to their employment. This is a feature, as far as major companies and lobbying organizations are concerned. It's a major reason behind the resistance to universal healthcare because the duress of losing health insurance is the only way some companies keep their employees.
    • gruez 5y ago
      >In a way it's a form of feudalism, tying people physically to their employment. uhh, what? Is employment in general "a form of feudalism" because people depend on it to fund their basic needs?
      • WillDaSilva 5y ago
        People can quit their job, and then meet their needs using their savings (if they have any), or welfare. The same is not true for health insurance.
        • gruez 5y ago
          They can't get health insurance on healthcare.gov?
  • Rucadi 5y ago
    There are countries with private healthcare that works (And IS better than public healthcare). The problem is specific to USA.
    • gruez 5y ago
      >There are countries with private healthcare that works list them?
      • mabub24 5y ago
        Switzerland has a system that basically works like a beefed up and less hogtied ACA. It's a very heavily regulated private market that would likely not be considered ideal for America, though some have suggested it as an option.
        • _huayra_ 5y ago
          Basically the LaMal basic insurance is not allowed to make a profit, so you get them aggressively trying to upsell you on complementary insurance.
      • iammisc 5y ago
        Israel has a private system with lots of regulations. It is private though
      • pseudoramble 5y ago
        Agreed - I'd like to see the list too, because I'm genuinely interested in trying to find a better health care system than what the US has. I like poking around through here to compare and contrast options: https://www.commonwealthfund.org/international-health-policy-center/system-profiles https://www.commonwealthfund.org/international-health-policy.... Some things I notice mainly are that the countries with private health insurance have at least two other things the US lacks: 1. They provide universal health care. 2. They have regulations of the market. How they go about doing that varies a bit, but I believe these are critical points we miss for all the various reasons we see in this link and in many other discussions on the topic. I think often in the US when we talk about private-sector, we also implicitly also mean for-profit, whereas many of the other options require them to be private non-profits. I think it's notable they are de-prioritized or outright banned, though I'll admit I don't really know if this is a critical detail or not. So I think to the GP point, perhaps this is a way to change private sector options for the better?
  • xienze 5y ago
    > I don't understand how people can be so anti-universal healthcare in the US. Because I have zero faith that it will end up costing me less, and have a similar level of quality. I’m in tech. Combined HHI is something in the $200s. I pay about $300 per month for the entire family, $5K out of pocket max. So in a worst case scenario, let’s say healthcare costs me $9K per year. That’s what, 4% of my HHI? Will a universal healthcare plan hit me via taxes for 4% or less? Fat fucking chance. And again, we’re not even talking about quality of care, just price. In the end, the poor will benefit greatly, the rich will carry on as usual, and people in the middle will get squeezed to death.
    • bananapub 5y ago
      yikes, dude.
    • gambiting 5y ago
      I....just have no words. Do you really believe everything you wrote? And like....that's probably the worst example of individualism and "me first" attitude I've seen on this website.
      • disgruntledphd2 5y ago
        My favourite assumption is that people with 200k household income are in the middle. Mind you, that kind of belief is super common amongst people (like me) who are in the top decile of income.
    • ceejayoz 5y ago
      > Because I have zero faith that it will end up costing me less, and have a similar level of quality. The US spends 2-3x per capita (counting both public and private spending; https://data.oecd.org/healthres/health-spending.htm https://data.oecd.org/healthres/health-spending.htm) than the rest of the OECD, with remarkably similar health outcomes. > I pay about $300 per month for the entire family, $5K out of pocket max. You're just paying your healthcare tax to your employer (in the form of lost salary; they're not chipping in the other $1-2k/month out of charity) instead of the government. It's silly to only count your contribution instead of the overall per-capita cost of healthcare.
  • failuser 5y ago
    $8k deductible might be reasonable if $250k bills are the norm. It is not spoken out loud a lot (more during COVID), but the people who are against universal healthcare are likely pro high birth rate and survival of the fittest (unless they have money, of course).
    • EvRev 5y ago
      You need a high birthrate to continue to suppress wages, don't forget about that! Once to population curve starts to flatten out, I do not see private insure prices going down as they will not be able to let go of the profit hence driving prices up higher.
  • marcinzm 5y ago
    I've heard a lot of negative stories about the British health system including people waiting 6+ months to see doctors (while in pain or having other symptoms that lower quality of life significantly). If you think an American universal health system will be somehow better than that then I suspect you're a lot more optimistic about the US government than most people. edit: I do love echo chambers, someone asks a question about why a certain groups thinks a certain way, you answer and you get downvoted. Why bother being on a discussion forum if you don't ever want to hear what the other side sees things as even when directly asked? Especially amusing since I do support universal healthcare but actually try to understand why people oppose it rather than covering my eyes and ears whenever they talk.
    • qmmmur 5y ago
      Because it's been decimated by the Tories for ten years now.
      • marcinzm 5y ago
        And the US elected Trump, why do you think the same thing wouldn't happen in the US within a decade?
        • qmmmur 5y ago
          I'm not going to argue hypotheticals,, but even a decimated NHS is far better than the US system.
          • marcinzm 5y ago
            Many American's don't however since they hear the bad stories but are perfectly happy with the care they get under their insurance. Which was the question asked and not "which health system is objectively better."
    • adrianN 5y ago
      Shouldn't the point of comparison be the current state of US healthcare, were many people don't get to see a doctor at all because they're uninsured and poor? (Or at least that's the impression I get as an outsider from discussions on the Internet about the topic)
  • forgingahead 5y ago
    The issue is less about coverage and more about the insane, opaque, and fradulent medical care pricing in the US. No other industry has such a black box cost structure to it. Coverage is very important, but it must be done in tandem with cost transparency and freedom to choose different insurance plans.
  • shados 5y ago
    Because in the US, if you're reasonably healthy, employed, live in a city with good hospitals and have private insurance, it "feels" better. It's easier to get better care. I'm Canadian, now living in the US, and I'll be honest: for the first couple of years, where I had some medium sized health issues, the US system felt so much better. The hospital I was treated at was leagues better than anything I saw in Canada. The amount I had to pay on my paychecks was lower than the complementary insurance I had in Canada. I had dental insurance everywhere I worked! My teeth are a trainwreck from the years I didn't have access to good dental insurance). So if someone was to dig in my old social media posts, they'd see my old stance of "I would prefer universal healthcare because its more fair, but if I was only thinking about myself, the US system is better". Then, as anyone who knows better could have predicted, it went downhill and I was proven wrong. If you have something that's hard to diagnose, the insurance starts fighting against you/your provider to get lesser care (eg: getting a full sleep study is super hard because insurance companies will just want you to take a cheap at home sleep apnea test. If you have a sleep disorder that's not sleep apnea, good fucking luck). Some providers will not talk to you if they're not in contract with your insurance. Good luck getting behavioral health care. Lots of clinics are in bed with very specific insurance, and will not even take self pay. So you have to call 15 of them because even the ones on your insurer's website may not want to speak with you. The paperwork. Holy shit the paperwork. I had surgery once, and I was still getting bills for it 6 months later. SO MANY BILLS. Some of them were absolute bullshit, but who has time to call insurance and hospitals over and over and over to fight every single one when there's douzens for a single procedure. So I just paid the co-insurance fees and suck it up. I never had a way to tell when I was getting "the last bill". In the end, I'm reasonably well off, and I have pretty much the best insurance one can have (no deductible, no employee contribution on paycheck, covers virtually everything), and it's STILL a pain in the ass. A pain enough that I've offered some providers to just pay cash to avoid the bullshit. THEY SAID NO and sent me on my way. Oh, and if I want to start a business, work for a pre-seed startup, or just want to take some time between jobs, I need to coordinate with my significant other to make sure they are not planning on quitting any time soon so we don't have to deal with COBRA or worse. Yeah, give me the Canadian system any day now.
    • stackbutterflow 5y ago
  • da_big_ghey 5y ago
    Healthcare is scarce and i prefer market allocation to a wait list for allocation. Nation with government health care is also having scarcity problem, some things on waitlist. With a market i can throw more money at health problems, waitlist i am at the mercy of bureaucrat. This is better for me since I have worked very hard on making money and these days i have some extra i can spend for this. I am healthy also, young somewhat, and wanting to be in healthy young risk pool to lower my costs not be in giant all-nation pool where I am accepting more financial burden.
  • CountDrewku 5y ago
    How much do you think gets taken out of your paycheck before you get it in country's with universal healthcare? And that happens even if you don't use it. And who the hell has an 8k deductible? This choice isn't 8k deductible or "free" healthcare. That's a farce.
    • ceejayoz 5y ago
      > How much do you think gets taken out of your paycheck before you get it in country's with universal healthcare? Less. https://data.oecd.org/healthres/health-spending.htm https://data.oecd.org/healthres/health-spending.htm has a chart of all OECD healthcare spending, both public and private. The US clearly stands out at the end. Employer-provided healthcare "gets taken out of your paycheck" all the same, just less visibly. This is a significant part of the political problem in the US; the true costs are hidden. > And who the hell has an 8k deductible? Most folks on an ACA Bronze plan. https://news.ehealthinsurance.com/insights-blog/lower-premiums-but-higher-out-of-pocket-costs-for-2020-aca-consumers https://news.ehealthinsurance.com/insights-blog/lower-premiu... "For a family of four, average Bronze plan deductibles are rising by 3% (from $13,017 to $13,394), while the average maximum out-of-pocket limit is increasing 4% (from $14,916 to $15,462)."
      • CountDrewku 5y ago
        You realize they choose the bronze plan so they can pay less right? They're not forced into having an 8k deductible. They do this so they can have less taken out of pocket and only really use the healthcare in a major emergency. This would support the idea that people prefer the US system and not universal healthcare.
        • ceejayoz 5y ago
          They choose the Bronze plan because it's literally all they can afford. My family's ACA Platinum plan costs me $2,200/month this year, and there's still $4k of copays a year to meet.
  • Dumblydorr 5y ago
    The simplest answer: the Senate overweights rural voters, who in turn hate government spending and big government. Until the Senate is representative of the US population, we will never have sweeping programs like this. Even if the Senate is fixed, the supreme court could likely strike down any legislation that's too progressive, since it's now 6-3 conservative lean due to the Senate and McConnells robbery of the Garland spot. It's a messed up system, sigh.
  • maccolgan 5y ago
    AFAICT, Universe healthcare is akin to a single monopolist insurer who bases the premium on your income, not your medical profile. (Plus the hospitals and pharma industry self-organizes into a cartel) I don't understand how anyone rational can agree that's fair.
  • refurb 5y ago
    The reason universal wouldn’t work is cost is an issue. You can’t just say, sure, we’ll pay for everything. Recipe for exploding healthcare costs. So how to reign costs in? Cut physician salaries? Not likely. Limit procedures? Maybe. Stop paying for the latest cancer drugs the day the FDA approves them? Probably. Not exactly easy to accomplish.
    • ceejayoz 5y ago
      You know universal coverage exists, right? Europe, Japan, Australia, New Zealand... you can't claim it's impossible to structure when there are dozens of functional examples out there. "Universal coverage" is not "we pay for everything without question or approval process". In both systems, there are people who decide what's covered, and for whom. As for "exploding costs", the US is more expensive - in both public and private spending - than the "universal coverage" spots. https://data.oecd.org/healthres/health-spending.htm https://data.oecd.org/healthres/health-spending.htm
• jzwinck 5y ago
  A quarter million US dollars. Of course the hospital never expects to receive this amount of money. Either they will negotiate it down for uninsured patients, or they will accept a lesser amount from the insurance company. Insurance companies like this over representation of costs because: 1. If you have a percentage copay (edit: "coinsurance"), say 10%, they will tell you to pay $25k because it's 10%, but they might only pay $75k. In this example you clearly paid 25% but they tell you it's only 10%. 2. A quarter million dollars is terrifying and you better not ever lose your insurance.
  • axiosgunnar 5y ago
    > If you have a percentage copay, say 10%, they will tell you to pay $25k because it's 10% [of $250k], but they might only pay $75k [after negotiating the $250k down to $75k]. That's fraud.
    • jzwinck 5y ago
      250k not 2.5M. But yes I agree the practice seems fraudulent.
      • axiosgunnar 5y ago
        oops yes you're right, fixed.
    • londons_explore 5y ago
      If you have enough $$$'s, you can probably argue that in court and win... But you'd just win a refund of some of the copay.
      • Cthulhu_ 5y ago
        Nope, it's fraud and the insurance company will / should be destroyed. But they will probably settle out of court for the damage + a little extra to not be stuck in court for a decade.
    • deleted 5y ago
• jsmith99 5y ago
  5k on sildenafil citrate? That's better known as Viagra.
  • phoe-krk 5y ago
    Sildenafil citrate is also a treatment for other problems - see e.g. [0]. That's very different to the usual problems that are treated with the codename "viagra". [0] https://www.sciencedaily.com/releases/2007/07/070727182359.htm https://www.sciencedaily.com/releases/2007/07/070727182359.h...
    • ceejayoz 5y ago
      I think the point was less "haha idiot doctors gave a baby viagra" - it was originally discovered in a search for a treatment for chest pain, after all - and more "wtf viagra doesn't cost that much".
    • jtbayly 5y ago
      Right, but the point is the cost. Once you know what it is, you can get a mental model of what it usually costs.
    • avianlyric 5y ago
      It's the same chemical regardless of brand name. GP was clearly pointing out that Sildenafil citrate bought over the counter as Viagra is extremely cheap, not that they gave a baby Viagra.
  • iamadog1029 5y ago
    $1400 for cholecalciferate - aka Vitamin D-3 $700 for sterile water I don't comprehend how charges like that are even remotely feasible for anything other than the deferal of liability from the hospital to the mfg., who charges a premium. But I suppose that goes under the liability insurance domain. But that's only half of the story. Billing is a negotiation process between the practitioners or their institution and the insurance providers, so naturally the hospital is going to wring every penny out that they can which means they'll "charge" you $500 for a $10 bag of saline, and leave you at the mercy of wolves. Just another perverted feedback loop, the insurance industry is so well established that it's become necessity, and treatment is made expensive by insurance, and will presumably continue in that direction because of its huge inertia.
• blakesterz 5y ago
  Anyone who has ever spent any significant amount of time in any hospital knows just how crazy & broken the system is. It's absolute madness. Sometimes it seems like the worse part comes in the months after you get out when random bills start coming and other random bills end up in collections for no apparent reason. I see at the bottom of this article they "are creating a charity to help bring awareness to the issue, to help sick children and their families, and to try improve the system in whatever way we can... we can use all the help with can get." https://sterlingstrong.foundation https://sterlingstrong.foundation
  • kingsloi 5y ago
    hey, thank you for this! I didn't want self promote, and CTA's just seems sleazy in this sense, but I'd be lying if I didn't want people to read about the charity, because we want change!
• sumthinprofound 5y ago
  my sibling was born premature and spent 78 days in the hospital when born. I was a young child myself so I haven't a clue as to cost but it put my parents into bankruptcy.
  • minikites 5y ago
    Your story is very common in the USA. Medical bankruptcy is a menace and should be made illegal. This is a completely avoidable issue, we just need to make the choices to change our system. https://www.nasdaq.com/articles/medical-bankruptcy-is-killing-the-american-middle-class-2019-02-14 https://www.nasdaq.com/articles/medical-bankruptcy-is-killin... >When it comes to bankruptcy, the study cited court records of bankruptcy filers from 2013 to 2016, with the end result showing that 66.5 percent were tied to medical issues.
• 55555 5y ago
  5,000 USD for sildenafil. In India this would cost 1 dollar. That's the generic/chemical name for viagra. A complete scam.
  • RHSeeger 5y ago
    > 5,000 USD for sildenafil Without insurance, it goes for about $20 for a batch of 30 in the US. You need to go to goodrx to get a coupon, but there's no cost or signin to that. Sure, it's stupid, but the cost is most definitively _NOT_ $5,000. If the hospital is saying it's charging 5,000 for it, then it's an example of "we'll put a huge number here, then bring it way down when it's time to pay". Which is also stupid. But once again, nobody is paying that amount. The two arguments "the system is stupid" and "the price is insane" are different arguments.
    • 55555 5y ago
      Sure, I get it. But I think this is one of those cases, like with identity theft, where you and I are just so used to the status quo that we can't accept how messed up the whole thing is. It feels normal, and we know how to work the system, so it's okay. If aliens landed they'd think we're really strange.
• roland35 5y ago
  My first son spent a week in the NICU since he had to be on antibiotics, otherwise was fine. The hospital entered in my insurance card incorrectly so we were billed as uninsured. Turns out a week at the NICU for a healthy newborn is about $40,000! It took almost 2 years of back and forth with my insurance provider and the hospital to clear up that bill. The hospital kept sending to to debt collectors too which was particularly annoying. And to make it even more annoying, the hospital later changed it's policy on newborns on antibiotics - if they are otherwise healthy they don't need to stay in the NICU anymore. It would have saved us a lot of trouble.
  • modin 5y ago
    > And to make it even more annoying, the hospital later changed it's policy on newborns on antibiotics - if they are otherwise healthy they don't need to stay in the NICU anymore. That sounds like a good policy change thou? Whilst I understand it must've been a grave ordeal to sort it out, I'd try to be glad for the families in similar situations now that wouldn't have to suffer from this any more instead of being annoyed.
    • roland35 5y ago
      Yes, sorry I meant it would have made things much easier. My heart goes out to all the families with babies in the NICU. It is beyond stressful and obviously the financial side is nothing compared to the wellbeing of your baby, but then it hits you a few months later.
      • kingsloi 5y ago
        Yeah, we were there during peak COVID too, so it was our room, her room, and nowhere in between. I worked almost every day from her ICU room. I can still find myself hearing the beeps/alarms without actually hearing them, sort of like symptoms of PTSD.
• PragmaticPulp 5y ago
  For those unfamiliar with the weirdness of the US insurance system: Nobody pays the prices on these bills. This is a pre-insurance bill with inflated values: > Why am I sharing one of her (pre-insurance) bills? Insurance companies have negotiated maximum allowed prices for every line item on this bill. Different insurance companies will have different negotiated rates. The insurance companies will pay either the minimum of their negotiated rate for each service or the hospital’s biller charge, whichever is lower. As such, the hospitals will greatly inflate their costs presented to insurance companies to avoid leaving any money on the table. This bill would go through a round of price reductions with the insurance company that can be very significant (I’ve seen $1000+ pre-insurance bills turn into less than $100 after insurance negotiated rates were applied). I’m not defending the system — Obviously it’s not great. However, it’s a mistake to look at these pre-insurance bills and assume that anyone is actually paying those amounts. Also, US insurance policies have what’s known as an “out of pocket maximum” that is the upper ceiling on how much you can pay for medical services in a year before insurance covers 100%. Also keep in mind that about half of US births are paid for by Medicaid, which is one of our socialized healthcare programs. The issue is often misrepresented as the US not having socialized medicine, but the reality is that a lot of US citizens are already covered by our socialized medicine programs in one way or another. The issue is the people who fall through the cracks by either not qualifying for these programs/subsidies, not being covered by their employers, and not buying a subsidized insurance plan on the ACA market. Again, not defending the system, but I think it’s important to know how these systems work to understand why Americans aren’t actually paying these multi-million dollar pre-insurance bills, which is why the voting public is often so complacent about exploring other options.
  • AlexandrB 5y ago
    Imagine if any other market operated like this. You walk into BestBuy and the price of a TV is $50,000. But if you take it to the cashier you will be charged some lesser amount based on what your credit card company negotiated with BestBuy. Madness.
    • sidewndr46 5y ago
      This kind of actually does describe buying a car in the US. It is generally not permitted to buy directly from the manufacturer, so you need to go through a dealer. It is kind of messed up presently, but in normal times there isn't really a "vehicle shortage" or whatever it is getting called now. The advertised price can be completely disconnected from the actual price you pay.
• lazyjones 5y ago
  FWIW, here's a financial statement of a pediatric hospital. Unsurprisingly, most of the revenue goes to wages (page 4). https://hscrc.maryland.gov/Documents/Hospitals/ReportsFinancial/Audited/FY%202020/MWPH%202020%20Statements.pdf https://hscrc.maryland.gov/Documents/Hospitals/ReportsFinanc...
  • cascom 5y ago
    $500k NI on $60m in rev, not exactly a killing. I think what many people here are missing is that these private insurance patients are subsidizing the indigent, Medicare, and Medicaid patients
• deleted 5y ago
  [deleted]
• tomaszs 5y ago
  This is the single reason why I could not live in the US. Each time I'd receive such bill, even when insured, I'd have a heart attack. How can people in the US think about anything else? It is so daunting and depressing from my point of view.
  • whocares2345 5y ago
    Probably because it’s not a real bill? These numbers bear no relation to money and nobody cares about them. The actual bill will be sent to insurance company, it will be 25-35% of this number, which is realistic given the cost of ultra modern equipment and high salaries for doctors. You will pay up to your maximum out of pocket, which is the real number you look at when shopping for a plan. Insurance for people who know they need lots of care is a bit more per month but has very low max out of pocket per year: $3-4k, super cheap plans for young people who never go to the hospital offer about $7k per year per person max. So this bill was never intended for the patient and there is no reason for this guy posting it except to grab some clicks and pity.
    • iamadog1029 5y ago
      Do you happen to know how one would be billed for this if they didn't have insurance?
      • whocares2345 5y ago
        I have friends that came over from Europe for hospital stay - they got the bill, sent their objection and the hospital reduced to the usual 35%. If you live in the US you always can buy insurance that will cap your max out of pocket to about $8k pre tax a year. Also if you’re employer doesn’t provide insurance - you’re probably in an “entry level job” that is not meant for long term employment, but rather quick money for young adults, who are still on their parents insurance (up to 27yo)
      • massung 5y ago
        Just noting that ~60% of all US hospitals are non-profit hospitals (although you wouldn't know it from the bills). What this means is that people who have no insurance pay significantly reduced prices via payment plans, or pay nothing at all. To be clear, it's not like the hospital won't attempt to collect payment from them; they will. And some are downright assholes about it and will resort to scare tactics (usually farming the work out to a 3rd party). But, to maintain their tax breaks as a non-profit, etc. they are required to work with - and even forgive - patients who cannot pay. Note: some hospitals are also assholes with the services they provide. They can't let someone die because they can't pay, but once "stable", then can boot you out. Below this point is possible misinformation. It's my current understanding, but if someone with more direct knowledge can weigh in, I'd be very appreciative. The above is where a large chunk of the costs for everyone else comes from. Basically, those who can pay are expected to pay for those who can't. Where it really hurts is for those people who are - what I'll call - barely middle class. They probably make ~$50k / year and if they have health insurance, it's probably not a great plan: very high deductible and/or max out of pocket. Since they are insured, they will get a much higher bill (initially sent to the insurance company) designed to compensate for everyone else who is getting cheap/free treatment. And, because they insured, legally the hospital doesn't have to reduce the cost or forgive the debt.
• cheaprentalyeti 5y ago
  My mom was in an ICU quality rehab hospital for six weeks while recovering from covid. The nominal cost was some 200,000.00, which they settled with medicare as per a long-running contract for 60,000.00. Somewhere in the medical cost bureaucracy is a lump of pitchblend hooked up to a geiger counter being used as a random number generator.
  • kingsloi 5y ago
    I'm sorry buddy, getting COVID & having a sick child, as the insurer, was my worst nightmare. I feel for you. For sure, it could well be a lil Math.floor(Math.random() \* 999999999);
• rakmos 5y ago
  This hits home for me.. my son (now 4 years old) was born very premature at 29 weeks and some change. He spent 7 weeks and 4 days in the NICU. The total hospital bill that was charged to insurance (before settling it between themselves) was roughly 960_000$. If you include the additional services and whatnot in the few months following being discharged from the hospital he was a million dollar baby. Complete insanity frankly.. few things make my blood boil more than the sad state of health insurance in the US. Sure, it has gotten better since the ACA… but there is soo much more that needs to change.
  • enriquec 5y ago
    By what metric have things gotten better since the ACA?
    • ceejayoz 5y ago
      One very clear one: Access to insurance for folks with expensive preexisting conditions.
    • rakmos 5y ago
      Well for one, my son could be labelled as having a pre-existing condition as a result of the premature birth.
    • swashboon 5y ago
      availability, coverage, cost
      • dexterdog 5y ago
        Um, not cost.
        • only_as_i_fall 5y ago
          Depends on who you ask. Before Obamacare if your employer didn't pick a great insurance plan and you got seriously sick the insurance could cut you off after you hit a lifetime maximum and then future policies wouldn't cover that specific condition because it was considered pre-existing. This happened to my parents in the 90s and we went through multiple lifetime maximums and had to pay hundreds of thousands of dollars over the course of 10 years. Obamacare is great for making health insurance actually act like insurance.
• tyingq 5y ago
  >sodium chloride 3 % nebu soln - qty 33@$104 total $3,432 Ouch. $104 for 3ml of saline that goes in a nebulizer. These are $0.16 if you buy them yourself ($16 for a pack of 100).
  • whocares2345 5y ago
    Maybe, just maybe it also includes the cost of actually administering it by a professional and? Scotty aint gonna beam it into ya… So once it’s negotiated down to $800 - it’s mostly labor of people involved in the process of taking it from pharmacy all the way inside you
    • tyingq 5y ago
      >Maybe, just maybe it also includes the cost of actually administering it by a professional Nope. That's a separate line item. Appreciate the weird sarcasm though, as if I thought it would be magically administered for free? >resp tx initial or subsequent qty 33@$318 total $ 10,494 (note: "tx" == therapy) Also, 3ml takes 5 to 15 minutes to administer. So, even if I'm generous, that respiratory therapist costs $1272/hour.
      • whocares2345 5y ago
        No it’s not a separate line item. The administration part includes getting the instruction to do so, retrieving medicine from storage, going to the patient, administering the drug, going back to nursing station and filling in the paper work for the action (there are actually several forms to be filled out). So in reality it takes more like 40 min per IV.
        • tyingq 5y ago
          You seem confused. This is saline for a nebulizer. It would be pretty weird to do that with an IV :) The line item is for the saline ampoule only, NHRIC item 0487-9003-60. It's in the "Pharmacy" category on the page. The respiratory therapist charges, I already mentioned, are separate.
• chmod775 5y ago
  So I'm having a look at that cost breakdown... How does a pharmacy charge someone more than $5000 for things such as sodium chloride? Actually pretty much everything on that list is complete bullshit. This is fraud and taking advantage of people in distress. These criminals should be behind bars.
• coldcode 5y ago
  What would be even more informative is (1) what does the hospital/doctors actually receive from the insurance company (2) what would the hospital/doctors get if the parents had zero insurance (3) what would a hospital in each of the 99%+ other countries' hospital/doctors with a national system get for the same issue and timeframe. That's essentially the argument of the US getting some kind of single payer system that works (Medicare atm is only semi-working as it doesn't completely function due to political interference and bureaucratic inertia). In the US the system is designed to ensure profits are higher than the cost of treating patients who have no insurance, and patients on Medicare/Medicaid/VA where negotiated pricing is limiting to profits. So the major task for healthcare companies is to do everything to maximize the profits and minimize costs that don't support higher profits, and for the insurance companies to collect more from companies and individuals to cover the healthcare companies need for profits, while maximizing their profits as well. While healthcare in other countries may also wish to keep costs under control, if there is no profit requirement, they have much more flexibility. Of course there is no universal solution to healthcare, but the incentive outside the US is different as long as profit is not the only thing that matters.
• almostvindiesel 5y ago
  I'm sorry for your loss OP. We had premature twins who both stayed in the NICU for around three months. Our total hospital bills came out to just under five million dollars. Fortunately we also had great insurance and received great care. We fought with the insurance/hospital/vendors for over a year and was on the phone with them every single week for hours to get the covered procedures included. An annoyance, but we were able to navigate it. Our twins are thriving today. Other families were not so lucky. We watched under or uninsured parents have to make decisions between the health of their sick children and their own financial livelihood. As educated privileged workers, the system worked for us. But it fails many. There has got to be a better way
  • kingsloi 5y ago
    That's exactly who I am advocating for, not for myself, my wife, child, family were all loved and taken care of, which isn't the case for some children. My wife and I walked by ICU beds daily that had children just starring at the ceiling, during the peak of their development, they have nothing/no one (except the love of hospital staff), for whatever reason, either in the care of the state, of their parents are at work to afford their child's ICU stay. We learnt we couldn't judge.
• hi41 5y ago
  Most important parts of human existence have been colonized. I don’t know how we will be able to recover our freedom. Who would have thought 50 years ago that drinking water is something we would pay for. Healthcare which citizens need most has also been colonized. I read a sad story where a devout husband had to divorce his very sick wife so that she could get medicaid payment to pay her bills.
  • maccolgan 5y ago
    Do you think drinking water is free?
• j-krieger 5y ago
  I feel a lot of empathy for OP, but there are some choices I find very difficult to understand. > our child, with life-saving intervention, surgeries, and therapy, could, and should live a happy, healthy, fulfilled life, at least until adulthood Sorry, but I can't grasp why you would condemn a 24 weeks old fetus to a life of a) possibly not suffering and b) only living until you're 20 or so years old, when you have the choice of termination. Even if (and that's a big if) you try your best and your child lives until she's a young adult, all of that will be taken from her in her young age because you made the decision to give birth to her regardless, even if you knew all the hardships that would be coming for her. I am very sorry for her death, but a lot of suffering could have been avoided if they had listened to their medical professionals.
  • lucretian 5y ago
    > condemn a 24 weeks old fetus diagnosed at 21 weeks, in fact. important because the difference between 21 and 24 weeks crosses the boundary of legality in many states. furthermore, right wing activists are constantly agitating to lower the threshold even further. had that been the case here, this family would have discovered the congenital defect at the anatomy scan only afterwards. > listened to their medical professionals it's highly unlikely that their care team would have actively recommended termination. standard is to explain the diagnosis, the prognosis, and the options to continue the pregnancy or terminate. then leave it to the family to decide.
    • kingsloi 5y ago
      Thank you, this is exactly my argument. Early COVID, late appointment, we had days to decide, and once the limit had passed, I/we no longer considered it an option and the only other options were to intervene with surgeries, or, to have her live out her natural life.
      • lucretian 5y ago
        are you the parent in the link? i'm sorry you went through this. nobody should judge you for your choice. it is exactly that - your choice - which pro-choice people advocate for. for you and other parents in these incredibly difficult circumstances to be fully educated, fully informed, and empowered to make whatever decision is right for you.
• IG_Semmelweiss 5y ago
  PSA: If you think you have been the victim of medical overbilling or claims fraud, talk to Adam Russo at Phia Group https://www.phiagroup.com/About-Us/Leadership/Executive-Team https://www.phiagroup.com/About-Us/Leadership/Executive-Team He compensates his staff AND PATIENTS accordingly to the level of fraud that they can detect on hospital bills. So they will leave no stone unturned. DISCLAIMER: I don't know or have ever talked to Adam Russo. I don't work, have any relationship, or financial connection with their firm. I have only heard they do good work and I am only an admirer of what they do.
• justupvoting 5y ago
  I know it makes me a terrible asshole, but reading this makes me seethe about the infant who was brought into existence without her consent only to suffer and die (like all of us, but this is a terrible compression of that sequence with little to distract her from it-- what did this tiny suffering animal know about the beauty of sunsets? Fuckall is what)just as much as it makes me exhausted about the medical insurance system in America. What a perfect example of gambling on the credit of the unborn. And then to be further punished by the absurd healthcare system in this country. Christ what a depressing post to start the day.
• bellyfullofbac 5y ago
  I wonder why the redactions are of the Pentagon standard[1]. Was it on purpose? [1] https://www.zdnet.com/article/thought-to-be-redacted-classified-military-info-exposed-by-cut-n-paste/ https://www.zdnet.com/article/thought-to-be-redacted-classif...
  • kingsloi 5y ago
    Just trying to dodge emails/threats/repercussions D:
• deleted 5y ago
  [deleted]
• alexktz 5y ago
  In 2018, age 31 I emigrated from the UK to the USA. I'd spent my entire life under the NHS and taken it for granted. In Jan 21 my first child arrived, 8 weeks early. This led to a lengthy 49 day NICU stay spread across two hospitals. Ask me to put a price on the work those doctors did to save my families lives (8hrs in the OR and both nearly died several times) and I'd give you all I could. In the end, the bills we've received so far exceed $350k. For the joy and relief that they both made it out the otherside healthy, it's worth every penny. And this speaks to perhaps why Americans rationalise exorbitant healthcare costs - because we're tied up in the emotion of it all. I'm lucky to work for a company who provide a high deductible plan which means my max annual out of pocket cost is $6k. On the face of it, $6k sounds like a lot - but the level of care we received far exceeded anything I've ever experienced in the NHS. Private rooms, appointments with my GP without doing the 8am phone purgatory British Drs surgeries require, world class NICU care at a world renowned facility (Chapel Hill). But we must also factor in that in the UK I pay for healthcare whether I use it or not via taxes. Indeed my take home in the UK was about 15-20% less than here after the government had taken their share. However here, I have the choice to contribute to my HSA up to $7,200 annually. In the end, I feel like I end up paying about the same despite the high sticker price. But the key difference is that in the UK model I look after my neighbour without any choice in the matter. Whereas here, it speaks to the underlying American pysche of individualism. My conclusion is that as an individual, with a good tech job, the system works - for me. But there is a nagging sense of guilt about how the experience I've had is not available to all. A bit like the suburban sprawl discussion I fear that this way of doing things is so deeply ingrained in so many people that they can't even imagine changing the system to work better for all for fear of what might come to pass. I'm very happy in the US on a day to day level, but it truly is a very weird place. Simultaneously a forward looking tech hub, leading the way in the world in many ways. And yet, it's an incredible backwards, self-preserving, individualistic society where dramatic social change is probably impossible.
  • rakmos 5y ago
    Interesting perspective from someone who can legitimately compare the experience… I disagree with how it is characterized that Americans are rationalizing healthcare costs as a result of being wrapped up in emotions. While emotions certainly influenced most decisions being made at the time, the costs didn’t feel even remotely in the realm of something that can be controlled. The nature of emergencies (such as the birth of a child in this context), the fact that the costs aren’t even communicated until months go by, and the fact that healthcare coverage is tethered to your employer (resulting in a spectrum of experiences) are all aspects that I believe serve to maintain the status quo. For instance, with this pandemic… I was laid off, and while I was incredibly fortunate to be able to have multiple options for new employment, it caused unnecessary stress on ensuring health care coverage was continuous. It also played a role in how I ultimately chose which company I decided to work for despite the difficulty I have generally experienced in getting prospective employers to be forthcoming about their health insurance options. And some things just literally aren’t available such as whether your current doctors / specialists are considered “in-network” —- which really matters when in the context of a helping a premature child get “caught up” in life. Oh, and I don’t want to forget pointing out that changing employers also resets those deductibles and max out-of-pockets… In any case, thanks for sharing the perspective.
• Jayakumark 5y ago
  First Bill was $2.5M and the article is here https://kingsley.sh/posts/2021/staggering-cost-of-surviving-heart-disease-in-the-usa https://kingsley.sh/posts/2021/staggering-cost-of-surviving-...
• wonderwonder 5y ago
  I hate how they bleed you via a thousand cuts. My kid saw a urologist at Nemours. Total appointment was maybe an hour and a half. He was experiencing pain while urinating. Turns out he just needed to stop holding his bladder and just go to the bathroom when he felt he needed to go. They took a urine sample, and an ultrasound. Over a year and a half later and I am still getting bills for it. Each bill is between $35 and $100 dollars. I have gotten ~20 of them. Every couple weeks to couple months another one or two come in.
• gwbas1c 5y ago
  In 2011 I had major surgery. The hospital first billed the insurance company for $100,000. The insurance company then paid $20,000. Of course, the insurance rate was negotiated in advance. There was no reason to bill for 5x the negotiated rate. IMO: We need to start fining hospitals for billing errors like this.
  • Cthulhu_ 5y ago
    I'm sure they play tons of games so it's not considered an error. That said, the government needs to step in and set prices for health care. The free market has failed, in this case. Nobody can afford to shop around for a cheaper health care provider in an emergency, and even then there's no real competition.
    • giantg2 5y ago
      "That said, the government needs to step in and set prices for health care." I don't see this working without other substantial changes. They do this with Medicaid and Medicare already. The reimbursement rate is pretty low and the actual costs of some services actually exceed the payment. Without fully going to a government run system, I don't think setting standard prices will work well due to the quality and cost differences from location to location. A better solution might be some sort of truth in advertising/billing that changes how the providers and insurance companies run that process, like presenting actual cost of care, actual payment by insurance, and protecting individuals from any charge that exceeds the cost of care plus some profit limit like 2%. I'm sure there are a lot of details to prevent loopholes, but that's my general view.
      • gwbas1c 5y ago
        Plenty of countries have affordable healthcare. I don't think we need to reinvent the wheel, (in the US,) when we can look at how other countries run their healthcare systems and see what works and what doesn't. The economics of treating rare diseases and is very different than handling a broken leg or a heart attack. Unfortunately, when we talk about healthcare we tend to lump both problems into the same boat, when paying for rare conditions versus common conditions are two very different things with very different solutions. If you've read this far, you probably realize that I'm beating around the bush, but if you understand how technology development starts with an expensive iPad, and then a decade later there are cheap generic tablets, I think you can understand the gist of what I'm saying.
• the_svd_doctor 5y ago
  Well we were billed 200,000$ for a perfectly standard C section with 4 days of recovery and no NICU. So 250,000$ seems cheap!
• nanis 5y ago
  This might sound pedantic, but as an economist, I feel duty bound to point out that "charge", "cost", "value", and "price" are different things. In this case, the amount being charged is the provider's starting position in the negotiation process. It is not relevant to how much it actually cost to provide the service. We are stuck with this system as a consequence of another attempt by government to try to control prices. Because companies were prohibited by government from paying workers above certain amounts, they tried to compete on other dimensions which were not covered by the wage controls. Then, the malady remained endemic long after the wage controls were lifted. There are no rational prices in the U.S. healthcare system. The largest component of the system is Medicare, and it reimburses doctors using RVUs[1] which, if you squint enough, are based on labor theory of value[2] (the "value" of something is determined by how much work went into it rather than how useful it is to the recipient). [1]: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Paymen... [2]: https://labor.alaska.gov/wc/med-serv-comm/CMS_RVU_Calculations.pdf https://labor.alaska.gov/wc/med-serv-comm/CMS_RVU_Calculatio...
• annoyingnoob 5y ago
  My daughter recently had a telemedicine office visit with a specialist at Children's Hospital Los Angeles. For 41 minutes of telemedicine we were billed $1011.00.
• massung 5y ago
  First, it's not front-and-center; it's small at and the end. But, for those of you who may wish to do more other than comment: > My wife and I are creating a charity to help bring awareness to the issue, to help sick children and their families, and to try improve the system in whatever way we can... we can use all the help with can get. https://sterlingstrong.foundation https://sterlingstrong.foundation -- My daughter - at 7 (she's now 12, okay, and quite happy) - had a week-stay in the hospital with Kawasaki Disease. That was easily the worst week of my life. The cost of just the treatment, without the hospital room charges, etc., was $26,000 per dose, and she needed several rounds (3, IIRC). To make matters worse, she was allergic to the IVIg, which added additional complications and costs. I'll be honest, I don't begrudge Doctors and nurses for being paid very well. I'm very good at my job and I expect to be well compensated. I also expect to be better compensated than most SWEs. I also expect SWEs who are better than I am to make more than I do. Nor do I begrudge pharma companies for making some serious bank of some very expensive R&D (without that profit, would we even have a COVID vaccine?). What does bother me is: * Not having a say. When you're rushed to an ER, you can't price shop, you aren't thinking about insurance coverage (if you're conscious at all), and you can't refuse treatment if it's between "bankruptcy or death". * I don't care how much info is out there on the internet. I will never, ever, ever have as much knowledge or experience related to my health care as my Dr. The best I can do is mention things I've read, thumb-in-the-wind, use my spidey senses, ask questions, or get a second opinion. But, at the end of the day, if my doctors say "you need X", they are the expert. * A lot of prices insane due to (IMO) fallacious thinking. Yes, an MRI costs ~$1M. But, at $1000 per image, that sucker has (most likely) paid for itself in months. And the upkeep there-after is not $1M/year. The cost of a single scan should be a small percent of `upkeep + salary of those involved + modest yearly profit`. And that should be normalized and enforced across the entire country. If your hospital bought a better MRI or pays their employees more or have a better Dr interpreting the results? They charge more, but it's likely +/- $50 to the patient. * Pharma prices are obviously a bit different. An individual pill may only cost them $2, but the first pill cost $500M. I do believe there should be supply and demand involved, but not in the typical way. I don't think "demand" - for medicine - should be based on need. For example, it should be illegal to price gouge someone who will die without your cure. However, if there are only 1000 people in the country with a particular disease, the "demand" doesn't exist to justify the cost of developing a cure. So, in that case, yes, I can understand charging more. At the end of the day, I don't know that I want 100% universal coverage in the way Canada and Europe have it. I think what we have sucks, and I do think that coverage for children (say < 18) should be 100% covered. No parent should have to ever weigh the cost of their child's health. But, what the US does have is a system that does encourage doctors to be better, pharma to develop cures, etc. I think we have to be able to come up with something that is the best of both worlds.