6 ms·

I dont know why you are downvoted but bad faith compliance is absolutely a thing. whats to stop city from sending such a patient to nearby private hospital in t

I dont know why you are downvoted but bad faith compliance is absolutely a thing. whats to stop city from sending such a patient to nearby private hospital in the name of 'medical necessity'. who decides who needs to forcibly hospitalized? if you fall into a puddle and somebody calls an ambulance would you rely on the ambulance driver's judgement to decide if you need the $10k ride to hospital? with healthcare you always have to think about bad faith operators because there is zero transparency and no free market there.

CrackerNews 4y ago
It would come down to the law to dictate who has the final say in sending someone to a hospital. Or else the people making the decision they shouldn't be making open themselves up to being subject to legal punishment. (Which opens up another question of who can afford to...?) The free market could incentivize bad faith operators even more because of the greater potential of the profit motive. Free market doesn't necessarily mean greater transparency or ethics.
jstarfish 4y ago
> if you fall into a puddle and somebody calls an ambulance would you rely on the ambulance driver's judgement to decide if you need the $10k ride to hospital? In the US, the fire department shows up first and administers first aid. Private transport to the hospital is arranged after that if needed. The problem is all the advance-fee bullshit. You're billed $1000 per minute starting with your occupation of a gurney, and that doesn't guarantee you will receive any sort of treatment once you get to the hospital. If you're not destined for a trauma ward, you'll sit in a room for six hours, be discharged without even a diagnosis (or the lolworthy "mild concussion"), and have incurred a debt equal to the cost of a new car for the experience. These days, you don't even get a bottle of Oxy as a consolation gift-- you get nothing. It's exploitative even when good faith operators are involved.
nobody9999 4y ago
>would you rely on the ambulance driver's judgement to decide if you need the $10k ride to hospital? $10k for an ambulance ride? Is there any documentation for that claim, or is it just hyperbole? According to the San Francisco Fire Department[0], an ambulance ride is ~$2400 (which includes lifesaving services), plus $46/mile[1.61km]. By my calculation, an ambulance would need to transport a patient ~165 miles (266km) to make an ambulance ride cost $10k. For some perspective, It's ~160 miles from San Francisco to Fresno[1]. I'd expect that San Francisco EMTs don't deliver patients to Fresno, or even outside the San Francisco city limits[2]. Since San Francisco is 46.9 sq miles (121 sq km) in area, a $10k ambulance ride is incredibly unlikely at best. N.B: I do not live in the Bay Area. It took less than 30 seconds to confirm the costs above via DDG. Not sure how GP (and others) came up with a number 400% higher. [0] https://sf-fire.org/services/ambulance-billing https://sf-fire.org/services/ambulance-billing [1] https://www.distancecalculator.net/ https://www.distancecalculator.net/ [2] https://en.wikipedia.org/wiki/Nota_bene https://en.wikipedia.org/wiki/Nota_bene Edit: Added Nota Bene[2].
- teachrdan 4y ago
  This comment is hopelessly obtuse. Most Americans can't even afford a $1000 emergency expense; the $2400 expense you cite is already unaffordable. Add in any ER fees the hospital charges -- which can easily be part of what GP refers to -- and you'll probably get to that $10K figure anyway. Don't believe me? Here's what happened right here in SF when a bicyclist with a broken arm was taken to the local public hospital, SF General: "A few months later, Dang got a bill for $24,074.50. Premera Blue Cross, her health insurer, would only cover $3,830.79 of that — an amount that it thought was fair for the services provided. That left Dang with $20,243.71 to pay, which the hospital threatened to send to collections in mid-December." > came up with a number 400% higher. A moment with a calculator would show you that the number GP uses is 300% higher, not 400% :) https://fortune.com/recommends/banking/57-percent-of-americans-cant-afford-a-1000-emergency-expense/ https://fortune.com/recommends/banking/57-percent-of-america... https://www.vox.com/policy-and-politics/2019/1/7/18137967/er-bills-zuckerberg-san-francisco-general-hospital https://www.vox.com/policy-and-politics/2019/1/7/18137967/er...
  - nobody9999 4y ago
    >This comment is hopelessly obtuse. Most Americans can't even afford a $1000 emergency expense; the $2400 expense you cite is already unaffordable. Add in any ER fees the hospital charges -- which can easily be part of what GP refers to -- and you'll probably get to that $10K figure anyway. I didn't say there weren't problems with the system, or that most folks (let alone homeless folks) could afford such things, but 400% more than the published cost? That's hyperbolic and, more importantly, incredibly imprecise. I see you disagree with that. I agree that you disagree with me. Have a lovely day. Edit: removed extraneous text.
    - handoflixue 4y ago
      > That's hyperbolic and, more importantly, incredibly imprecise. In common USA English, use of a figure like "10K" suggests imprecision - it's a magnitude of order ballpark, a gesture at the logarithmic scale. This convention is useful because it's easy to remember a rough ballpark, but precise figures are going to quickly get muddied in details. It seems strange to complain about imprecision when someone has already clearly indicated that they're talking about a rough estimate.

CrackerNews 4y ago

It would come down to the law to dictate who has the final say in sending someone to a hospital. Or else the people making the decision they shouldn't be making open themselves up to being subject to legal punishment. (Which opens up another question of who can afford to...?) The free market could incentivize bad faith operators even more because of the greater potential of the profit motive. Free market doesn't necessarily mean greater transparency or ethics.

jstarfish 4y ago

> if you fall into a puddle and somebody calls an ambulance would you rely on the ambulance driver's judgement to decide if you need the $10k ride to hospital? In the US, the fire department shows up first and administers first aid. Private transport to the hospital is arranged after that if needed. The problem is all the advance-fee bullshit. You're billed $1000 per minute starting with your occupation of a gurney, and that doesn't guarantee you will receive any sort of treatment once you get to the hospital. If you're not destined for a trauma ward, you'll sit in a room for six hours, be discharged without even a diagnosis (or the lolworthy "mild concussion"), and have incurred a debt equal to the cost of a new car for the experience. These days, you don't even get a bottle of Oxy as a consolation gift-- you get nothing. It's exploitative even when good faith operators are involved.

nobody9999 4y ago

>would you rely on the ambulance driver's judgement to decide if you need the $10k ride to hospital? $10k for an ambulance ride? Is there any documentation for that claim, or is it just hyperbole? According to the San Francisco Fire Department[0], an ambulance ride is ~$2400 (which includes lifesaving services), plus $46/mile[1.61km]. By my calculation, an ambulance would need to transport a patient ~165 miles (266km) to make an ambulance ride cost $10k. For some perspective, It's ~160 miles from San Francisco to Fresno[1]. I'd expect that San Francisco EMTs don't deliver patients to Fresno, or even outside the San Francisco city limits[2]. Since San Francisco is 46.9 sq miles (121 sq km) in area, a $10k ambulance ride is incredibly unlikely at best. N.B: I do not live in the Bay Area. It took less than 30 seconds to confirm the costs above via DDG. Not sure how GP (and others) came up with a number 400% higher. [0] https://sf-fire.org/services/ambulance-billing https://sf-fire.org/services/ambulance-billing [1] https://www.distancecalculator.net/ https://www.distancecalculator.net/ [2] https://en.wikipedia.org/wiki/Nota_bene https://en.wikipedia.org/wiki/Nota_bene Edit: Added Nota Bene[2].

teachrdan 4y ago
This comment is hopelessly obtuse. Most Americans can't even afford a $1000 emergency expense; the $2400 expense you cite is already unaffordable. Add in any ER fees the hospital charges -- which can easily be part of what GP refers to -- and you'll probably get to that $10K figure anyway. Don't believe me? Here's what happened right here in SF when a bicyclist with a broken arm was taken to the local public hospital, SF General: "A few months later, Dang got a bill for $24,074.50. Premera Blue Cross, her health insurer, would only cover $3,830.79 of that — an amount that it thought was fair for the services provided. That left Dang with $20,243.71 to pay, which the hospital threatened to send to collections in mid-December." > came up with a number 400% higher. A moment with a calculator would show you that the number GP uses is 300% higher, not 400% :) https://fortune.com/recommends/banking/57-percent-of-americans-cant-afford-a-1000-emergency-expense/ https://fortune.com/recommends/banking/57-percent-of-america... https://www.vox.com/policy-and-politics/2019/1/7/18137967/er-bills-zuckerberg-san-francisco-general-hospital https://www.vox.com/policy-and-politics/2019/1/7/18137967/er...
- nobody9999 4y ago
  >This comment is hopelessly obtuse. Most Americans can't even afford a $1000 emergency expense; the $2400 expense you cite is already unaffordable. Add in any ER fees the hospital charges -- which can easily be part of what GP refers to -- and you'll probably get to that $10K figure anyway. I didn't say there weren't problems with the system, or that most folks (let alone homeless folks) could afford such things, but 400% more than the published cost? That's hyperbolic and, more importantly, incredibly imprecise. I see you disagree with that. I agree that you disagree with me. Have a lovely day. Edit: removed extraneous text.
  - handoflixue 4y ago
    > That's hyperbolic and, more importantly, incredibly imprecise. In common USA English, use of a figure like "10K" suggests imprecision - it's a magnitude of order ballpark, a gesture at the logarithmic scale. This convention is useful because it's easy to remember a rough ballpark, but precise figures are going to quickly get muddied in details. It seems strange to complain about imprecision when someone has already clearly indicated that they're talking about a rough estimate.