5 ms·

Based on how much my little girl’s ICU admission cost, https://kingsley.sh/posts/2021/two-weeks-in-the-icu-as-a-baby-with-heart-disease https://kingsley.sh/pos

Based on how much my little girl’s ICU admission cost, https://kingsley.sh/posts/2021/two-weeks-in-the-icu-as-a-baby-with-heart-disease https://kingsley.sh/posts/2021/two-weeks-in-the-icu-as-a-bab... there is no way (in my mind) that their ICU admission will be free.

retrac98 5y ago
Sorry for your loss, nobody should have to go through that. How do people in the US who don’t have insurance get treatment for themselves or their family members in situations like this? It seems inconceivable to me that they or their kids are just expected to die?
- lotsofpulp 5y ago
  They will get treatment, assuming the hospital has capacity: https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_an... And generally, if you have nothing, the government will pay for you. However, quality and quantity of healthcare will likely not be as high. The rough spot is in the middle when you have some assets, but not enough for a secure life, but do not have insurance, then you will have to forfeit your assets in order for the government aid to kick in, and then you are poor.
  - Ntrails 5y ago
    The interesting concern for me is always "i won't go see anyone about medical issue X because the copay/deductible structure dissuades me from checking". Even if you have a spare $800 for [insert tests here] you're going to be reluctant to spend it unless you're pretty confident it's necessary. Is this the source of significant delay in diagnosis? Does it increase or decrease overall costs of treatment? Does it meaningfully alter expected prognosis of the middle income US patients etc
    - lotsofpulp 5y ago
      Depends on the individual’s finances. Preventative care such as annual wellness exams are mandated to be covered (i.e. free for insured) and you get a blood test with that. So presumably, you are catching most lifestyle or inherited or long term ailments there. By law, annual out of of pocket expenses are capped: https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/ https://www.healthcare.gov/glossary/out-of-pocket-maximum-li... However, based on the median income in the US, many Americans would have to think twice about scheduling a doctor’s appointment and being on the hook for an unexpected hundreds or thousands of dollars. It is all a form of rationing healthcare, so having people think twice about going to the doctor at the expense of some people’s health is part of the system.
  - actually_a_dog 5y ago
    > The rough spot is in the middle when you have some assets, but not enough for a secure life, but do not have insurance, then you will have to forfeit your assets in order for the government aid to kick in, and then you are poor. Which is where a lot of elderly people who need long term care end up.
- gumby 5y ago
  > It seems inconceivable to me that they or their kids are just expected to die? Basically, yes. Hospitals are required by law to treat anyone who presents themselves to the emergency room (thus the ER is the primary entry point for many people, regardless of symptom) but they get triaged to the bottom of the queue. Hospital insurance administrators can and do intervene in doctor decisions on care. Medical debt in the US was already a crisis before the pandemic. It can push people out of their homes and pretty much destroy them. Even some with insurance make gofundme pleas to try to cover their medical bills.
  - actually_a_dog 5y ago
    > ...they get triaged to the bottom of the queue. I can't find any evidence of this happening using Google. Do you have any?
    - gumby 5y ago
      Just talk to anyone who works in an ER. Or read the first link returned by DDG: https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/ https://www.kff.org/uninsured/issue-brief/key-facts-about-th... which looks at the more general case. Key paragraphs to read (in this regard) are “ How does not having coverage affect health care access?” and the immediately following “ What are the financial implications of being uninsured?” Worse is the hospital revenue people intervening in care decisions. There was an expose about this in the NYT a few years ago; as far as I can tell nothing has since changed.
      - actually_a_dog 5y ago
        Those two sections say nothing about getting "triaged to the bottom of the queue." As far as "hospital revenue people intervening in care decisions," that doesn't mean people don't get care. It means they may not get super expensive treatments. That certainly may not be the best care, because, all the ER needs to do, legally, is ensure that the patient's condition is non-emergent before they discharge them, but it's completely unrelated to triage. It is, however, a predictable result of hospitals needing to make a profit. Do you have any hints or keywords I could search to find the NYT article?
rich_sasha 5y ago
This must have been tough, I can't imagine going through it. The bill is eye-opening, thank you for sharing. I have no hard data, but I believe private medical care in the UK is so much cheaper, simply because there is the alternative of totally free health care from the state. It's not perfect, but any condition you have, they (eventually) do, and to a high level of professionalism (exceptions notwithstanding). I know treating people requires highly trained, dedicated stuff, advanced technology and medication, and those aren't cheap, but I can't help but feel that something is broken in the US. One of the few things putting me off jumping across the pond.
- kingsloi 5y ago
  It was rougher/tougher than I ever thought it would be, not for me/my family, but the pain and suffering my little girl endured - to then receive a bill at the end of the day, is just insulting, imo. I'm actually British, I moved to the US in 2016. Me/my family have used our fair share of the NHS - my mom suddenly died when I was 12, my dad is in remission from prostate cancer after treatment, I've had kidney stone surgeries, 8 years of orthodontics, major jaw surgery, broken bones, bad childhood asthma, etc. https://kingsley.sh/posts/2021/staggering-cost-of-surviving-heart-disease-in-the-usa https://kingsley.sh/posts/2021/staggering-cost-of-surviving-... I agree, I got world-class care, by world-class medical professionals, but, I also earn 2x than the average worker, I can afford to pay $700/m, the highest plan my employer offers. We still got a mistake $2.5 million dollar bill, we went to collections 3 times for less than $50, etc, etc. The icing on the cake was my daughter being denied Medicaid because I earn too much. They skipped over HER 1-in-700m to 1-in-2b diagnosis, and her many disabilities, to deny me because I earned too much. I was told I'd need to spend the GoFundMe money (which ultimately paid for my baby's funeral), my 401k, any/all savings, and maybe even consider getting divorced (I'm here on a marriage green card). I like the good, but despise the bad.
  - caseysoftware 5y ago
    Good God man, I'm sorry. We lost a baby early on too and would never wish that on my first enemy. And yes, the financial aspects are just a slap in the face.

retrac98 5y ago

Sorry for your loss, nobody should have to go through that. How do people in the US who don’t have insurance get treatment for themselves or their family members in situations like this? It seems inconceivable to me that they or their kids are just expected to die?

lotsofpulp 5y ago
They will get treatment, assuming the hospital has capacity: https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_an... And generally, if you have nothing, the government will pay for you. However, quality and quantity of healthcare will likely not be as high. The rough spot is in the middle when you have some assets, but not enough for a secure life, but do not have insurance, then you will have to forfeit your assets in order for the government aid to kick in, and then you are poor.
- Ntrails 5y ago
  The interesting concern for me is always "i won't go see anyone about medical issue X because the copay/deductible structure dissuades me from checking". Even if you have a spare $800 for [insert tests here] you're going to be reluctant to spend it unless you're pretty confident it's necessary. Is this the source of significant delay in diagnosis? Does it increase or decrease overall costs of treatment? Does it meaningfully alter expected prognosis of the middle income US patients etc
  - lotsofpulp 5y ago
    Depends on the individual’s finances. Preventative care such as annual wellness exams are mandated to be covered (i.e. free for insured) and you get a blood test with that. So presumably, you are catching most lifestyle or inherited or long term ailments there. By law, annual out of of pocket expenses are capped: https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/ https://www.healthcare.gov/glossary/out-of-pocket-maximum-li... However, based on the median income in the US, many Americans would have to think twice about scheduling a doctor’s appointment and being on the hook for an unexpected hundreds or thousands of dollars. It is all a form of rationing healthcare, so having people think twice about going to the doctor at the expense of some people’s health is part of the system.
- actually_a_dog 5y ago
  > The rough spot is in the middle when you have some assets, but not enough for a secure life, but do not have insurance, then you will have to forfeit your assets in order for the government aid to kick in, and then you are poor. Which is where a lot of elderly people who need long term care end up.
gumby 5y ago
> It seems inconceivable to me that they or their kids are just expected to die? Basically, yes. Hospitals are required by law to treat anyone who presents themselves to the emergency room (thus the ER is the primary entry point for many people, regardless of symptom) but they get triaged to the bottom of the queue. Hospital insurance administrators can and do intervene in doctor decisions on care. Medical debt in the US was already a crisis before the pandemic. It can push people out of their homes and pretty much destroy them. Even some with insurance make gofundme pleas to try to cover their medical bills.
- actually_a_dog 5y ago
  > ...they get triaged to the bottom of the queue. I can't find any evidence of this happening using Google. Do you have any?
  - gumby 5y ago
    Just talk to anyone who works in an ER. Or read the first link returned by DDG: https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/ https://www.kff.org/uninsured/issue-brief/key-facts-about-th... which looks at the more general case. Key paragraphs to read (in this regard) are “ How does not having coverage affect health care access?” and the immediately following “ What are the financial implications of being uninsured?” Worse is the hospital revenue people intervening in care decisions. There was an expose about this in the NYT a few years ago; as far as I can tell nothing has since changed.
    - actually_a_dog 5y ago
      Those two sections say nothing about getting "triaged to the bottom of the queue." As far as "hospital revenue people intervening in care decisions," that doesn't mean people don't get care. It means they may not get super expensive treatments. That certainly may not be the best care, because, all the ER needs to do, legally, is ensure that the patient's condition is non-emergent before they discharge them, but it's completely unrelated to triage. It is, however, a predictable result of hospitals needing to make a profit. Do you have any hints or keywords I could search to find the NYT article?

rich_sasha 5y ago

This must have been tough, I can't imagine going through it. The bill is eye-opening, thank you for sharing. I have no hard data, but I believe private medical care in the UK is so much cheaper, simply because there is the alternative of totally free health care from the state. It's not perfect, but any condition you have, they (eventually) do, and to a high level of professionalism (exceptions notwithstanding). I know treating people requires highly trained, dedicated stuff, advanced technology and medication, and those aren't cheap, but I can't help but feel that something is broken in the US. One of the few things putting me off jumping across the pond.

kingsloi 5y ago
It was rougher/tougher than I ever thought it would be, not for me/my family, but the pain and suffering my little girl endured - to then receive a bill at the end of the day, is just insulting, imo. I'm actually British, I moved to the US in 2016. Me/my family have used our fair share of the NHS - my mom suddenly died when I was 12, my dad is in remission from prostate cancer after treatment, I've had kidney stone surgeries, 8 years of orthodontics, major jaw surgery, broken bones, bad childhood asthma, etc. https://kingsley.sh/posts/2021/staggering-cost-of-surviving-heart-disease-in-the-usa https://kingsley.sh/posts/2021/staggering-cost-of-surviving-... I agree, I got world-class care, by world-class medical professionals, but, I also earn 2x than the average worker, I can afford to pay $700/m, the highest plan my employer offers. We still got a mistake $2.5 million dollar bill, we went to collections 3 times for less than $50, etc, etc. The icing on the cake was my daughter being denied Medicaid because I earn too much. They skipped over HER 1-in-700m to 1-in-2b diagnosis, and her many disabilities, to deny me because I earned too much. I was told I'd need to spend the GoFundMe money (which ultimately paid for my baby's funeral), my 401k, any/all savings, and maybe even consider getting divorced (I'm here on a marriage green card). I like the good, but despise the bad.
- caseysoftware 5y ago
  Good God man, I'm sorry. We lost a baby early on too and would never wish that on my first enemy. And yes, the financial aspects are just a slap in the face.