5 ms·

This bugs me every time I read about free clinics and/or ER costs. It seems most Americans with limited or no healthcare is: 1. Go to the ER and pay $X000 2.

This bugs me every time I read about free clinics and/or ER costs. It seems most Americans with limited or no healthcare is: 1. Go to the ER and pay $X000 2. Wait in line at a free clinic for 9+ hours and maybe/maybe not see a doctor This seems like a gigantic need for a middle ground to be filled. I know that CVS and WalMart have done things like the $60 Physician's Assistant visit at retail locations but that always seems as though it's only available in a small percentage of locations. Are the fixed costs of having even 2-3 doctors so high that this just not an economic option at anything less than $X000 per visit? I would also imagine that if you take a Total Cost of Ownership approach, it's in society's best interest to subsidize some of this cost. I'm basing this on past articles/studies that show that some huge portion of medical care costs go to issues that were largely left unaddressed at first presentation. P.S. As I wrote this, I thought of Urgent Care providers but even those seem high cost for folks with no healthcare.

notch656c 4y ago
It's probably only available in some locations because every state has rapidly different scope of practice and prescribing rights for PAs / NPs.
BurningFrog 4y ago
Even an online $60 "ask a doctor" service should be able to help a lot of people. My guess is that, despite in some sense being a "free market" system, US health care is hyper regulated, and almost everything is either mandatory or forbidden, sometimes both.
rediguanayum 4y ago
> 1. Go to the ER and pay $X000 Agreed most people think that the ER is $X000. What people don't realize is that the hospital then attempts to recoup the cost by charging paying patients and their insurance companies more. This is where those $20,000 ER visits comes from. While insurance companies push back, the other folks paying out of pocket lose. Some of them go bankrupt. Hospitals lose too and ultimately the community. Because emergency services almost always lose money for the hospital, many rural hospitals also go bankrupt or get bought out by private equity groups (https://www.nbcnews.com/health/health-care/private-equity-firms-now-control-many-hospitals-ers-nursing-homes-n1203161 https://www.nbcnews.com/health/health-care/private-equity-fi...).
louison11 4y ago
Even without insurance and without social security help, the cost of medical care in most of the world for the same services is dramatically lower. To give you an idea, I got an ECG (heart test), X-Ray and complete blood panel done at a local clinic here in Europe for 29 euros. The key to addressing what you’re pointing at is mostly fixing the scam that US college education has become. It’s the crazy tuition that gets trickled down in the bill, and acts as a bottleneck guaranteeing scarcity of doctors and thus super high wages. A doctor in the US makes BANK, like lawyer money, not so much the case in Europe, where they’re upper class but not crazy rich.
- MarkSweep 4y ago
  It’s not just the cost of college that limits the supply of doctors. There is an explicit limit on how many people can become doctors each year in the US: http://blog.petrieflom.law.harvard.edu/2022/03/15/ama-scope-of-practice-lobbying/ http://blog.petrieflom.law.harvard.edu/2022/03/15/ama-scope-... In addition, in many states in the US you have to get permission to open a new medical facility: https://en.m.wikipedia.org/wiki/Certificate_of_need https://en.m.wikipedia.org/wiki/Certificate_of_need Often the people on the board own existing medical facilities, so you literally have to get permission from your potential competition to compete with them. https://www.justice.gov/archive/atr/public/press_releases/2008/237153a.htm https://www.justice.gov/archive/atr/public/press_releases/20... For example from the above link: “ In 2006, the Antitrust Division alleged that a hospital in Charleston, West Virginia used the threat of objection during the CON process, and the potential ensuing delay and cost, to induce another hospital seeking a CON for an open heart surgery program not to apply for it at a location that would have well served Charleston consumers.”
  - landemva 4y ago
    To summarize, much of the price problem could be solved within each State.
    - dsfyu404ed 4y ago
      So why hasn't it been solved in the states in which this kind of stuff is a priority? Some states have really good healthcare for the poor but even they have exorbitant costs for everyone who's too well off to quality. You'd think at least one of them would tackle this.
harimau777 4y ago
I wonder if there would be a role for someone specialized in diagnosis/triage? I'm a martial artist, so it's not uncommon for me to go to the Dr. when all I really need to know is if an injury is a normal "take a break and let it heal" injury or one that needs actual treatment. I imagine there's similar cases for questions like "is this the common cold or something else?" or "is this something babies just do or a sign of a problem?".
sershe 4y ago
My impressions seems to be it's the combination of the 2 (1) people in the US will balk at paying others' healthcare if you ask them directly, so it "has to" be subsidized in a roundabout, inefficient way. ER is obliged to treat you regardless of money (and people do go there with routine concerns from my limited experience), but someone has to pay, so other patients get charged extra. That is really annoying in a way, and it's pure politics - nobody can come out and say "hey, you are paying for the poor anyway, so why don't we at least cut out all the middlemen - private and public, and just pay them openly"?. (2) But the main one I think is that public option is basically impossible as long as you allow a viable private option, because everyone will take private option if they can and public option will get the worst-off, health-wise and financially, and as it gets worse as a result more people will bail, etc. You can look at schools as an example - private school parents literally pay double price, public system is easy to abuse via de-facto neighborhood class-based segregation, and private schools STILL thrive because private option is just THAT MUCH BETTER (in the consumers' opinion, at least). If you really consider the implications of the 2, you can understand also how regulation drives up cost in another way than its actual overhead and supply-limiting effects - it regulates options out of existence. If I could go to a "private semi-ER" where they (1) get a good doctor, pay him double, but are let's say (2) not obliged to treat before payment and do not take Medicare, or maybe any insurance, (3) aim for 20-80 principle as far as equipment is concerned (i.e. somewhere in between ER and Urgent Cares), it would be the obvious, better, and cheaper choice. I'm pretty sure an "uber for Urgent Care" based on this would make bank AND benefit tons of people. Of course, it's regulated out of existence. Or consider a startup that would offer "Indian/Russian/Turkish/..." quality facilities, with an obvious price trade-off - it's impossible, because if it were possible the existing public-private frankenstein would simply die. You can see the same with schools, with activists constantly trying to stifle school choice, because with viable school choice public schools will simply die. As a result, the system is both terribly inefficient and creates the worst incentives. Take me as an example. If I decide to retire early, I'd be helped greatly by ACA, and would optimize paper income and (ab)use it to the max. I do feel like it's justified because I am paying for it now in taxes; but I didn't do the math, so mostly it's just bad incentives + it was the govt who screwed up healthcare in the first place. So hey, ACA is good for me. If they had universal healthcare I'd stop working even earlier. But is that good for society? To be clear, I support a fully free market option for both healthcare and schools, and the only redistribution allowed should be cash, and catastrophic insurance limiting total spend.

notch656c 4y ago

It's probably only available in some locations because every state has rapidly different scope of practice and prescribing rights for PAs / NPs.

BurningFrog 4y ago

Even an online $60 "ask a doctor" service should be able to help a lot of people. My guess is that, despite in some sense being a "free market" system, US health care is hyper regulated, and almost everything is either mandatory or forbidden, sometimes both.

rediguanayum 4y ago

> 1. Go to the ER and pay $X000 Agreed most people think that the ER is $X000. What people don't realize is that the hospital then attempts to recoup the cost by charging paying patients and their insurance companies more. This is where those $20,000 ER visits comes from. While insurance companies push back, the other folks paying out of pocket lose. Some of them go bankrupt. Hospitals lose too and ultimately the community. Because emergency services almost always lose money for the hospital, many rural hospitals also go bankrupt or get bought out by private equity groups (https://www.nbcnews.com/health/health-care/private-equity-firms-now-control-many-hospitals-ers-nursing-homes-n1203161 https://www.nbcnews.com/health/health-care/private-equity-fi...).

louison11 4y ago

Even without insurance and without social security help, the cost of medical care in most of the world for the same services is dramatically lower. To give you an idea, I got an ECG (heart test), X-Ray and complete blood panel done at a local clinic here in Europe for 29 euros. The key to addressing what you’re pointing at is mostly fixing the scam that US college education has become. It’s the crazy tuition that gets trickled down in the bill, and acts as a bottleneck guaranteeing scarcity of doctors and thus super high wages. A doctor in the US makes BANK, like lawyer money, not so much the case in Europe, where they’re upper class but not crazy rich.

MarkSweep 4y ago
It’s not just the cost of college that limits the supply of doctors. There is an explicit limit on how many people can become doctors each year in the US: http://blog.petrieflom.law.harvard.edu/2022/03/15/ama-scope-of-practice-lobbying/ http://blog.petrieflom.law.harvard.edu/2022/03/15/ama-scope-... In addition, in many states in the US you have to get permission to open a new medical facility: https://en.m.wikipedia.org/wiki/Certificate_of_need https://en.m.wikipedia.org/wiki/Certificate_of_need Often the people on the board own existing medical facilities, so you literally have to get permission from your potential competition to compete with them. https://www.justice.gov/archive/atr/public/press_releases/2008/237153a.htm https://www.justice.gov/archive/atr/public/press_releases/20... For example from the above link: “ In 2006, the Antitrust Division alleged that a hospital in Charleston, West Virginia used the threat of objection during the CON process, and the potential ensuing delay and cost, to induce another hospital seeking a CON for an open heart surgery program not to apply for it at a location that would have well served Charleston consumers.”
- landemva 4y ago
  To summarize, much of the price problem could be solved within each State.
  - dsfyu404ed 4y ago
    So why hasn't it been solved in the states in which this kind of stuff is a priority? Some states have really good healthcare for the poor but even they have exorbitant costs for everyone who's too well off to quality. You'd think at least one of them would tackle this.

harimau777 4y ago

I wonder if there would be a role for someone specialized in diagnosis/triage? I'm a martial artist, so it's not uncommon for me to go to the Dr. when all I really need to know is if an injury is a normal "take a break and let it heal" injury or one that needs actual treatment. I imagine there's similar cases for questions like "is this the common cold or something else?" or "is this something babies just do or a sign of a problem?".

sershe 4y ago

My impressions seems to be it's the combination of the 2 (1) people in the US will balk at paying others' healthcare if you ask them directly, so it "has to" be subsidized in a roundabout, inefficient way. ER is obliged to treat you regardless of money (and people do go there with routine concerns from my limited experience), but someone has to pay, so other patients get charged extra. That is really annoying in a way, and it's pure politics - nobody can come out and say "hey, you are paying for the poor anyway, so why don't we at least cut out all the middlemen - private and public, and just pay them openly"?. (2) But the main one I think is that public option is basically impossible as long as you allow a viable private option, because everyone will take private option if they can and public option will get the worst-off, health-wise and financially, and as it gets worse as a result more people will bail, etc. You can look at schools as an example - private school parents literally pay double price, public system is easy to abuse via de-facto neighborhood class-based segregation, and private schools STILL thrive because private option is just THAT MUCH BETTER (in the consumers' opinion, at least). If you really consider the implications of the 2, you can understand also how regulation drives up cost in another way than its actual overhead and supply-limiting effects - it regulates options out of existence. If I could go to a "private semi-ER" where they (1) get a good doctor, pay him double, but are let's say (2) not obliged to treat before payment and do not take Medicare, or maybe any insurance, (3) aim for 20-80 principle as far as equipment is concerned (i.e. somewhere in between ER and Urgent Cares), it would be the obvious, better, and cheaper choice. I'm pretty sure an "uber for Urgent Care" based on this would make bank AND benefit tons of people. Of course, it's regulated out of existence. Or consider a startup that would offer "Indian/Russian/Turkish/..." quality facilities, with an obvious price trade-off - it's impossible, because if it were possible the existing public-private frankenstein would simply die. You can see the same with schools, with activists constantly trying to stifle school choice, because with viable school choice public schools will simply die. As a result, the system is both terribly inefficient and creates the worst incentives. Take me as an example. If I decide to retire early, I'd be helped greatly by ACA, and would optimize paper income and (ab)use it to the max. I do feel like it's justified because I am paying for it now in taxes; but I didn't do the math, so mostly it's just bad incentives + it was the govt who screwed up healthcare in the first place. So hey, ACA is good for me. If they had universal healthcare I'd stop working even earlier. But is that good for society? To be clear, I support a fully free market option for both healthcare and schools, and the only redistribution allowed should be cash, and catastrophic insurance limiting total spend.