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Here's American health care: • I needed refills for two prescriptions that I've been taking for years. This time, for opaque reasons, I needed to talk to a doc

Here's American health care: • I needed refills for two prescriptions that I've been taking for years. This time, for opaque reasons, I needed to talk to a doctor first. • Fine, but I couldn't accommodate an in-person check-in. I chose a "video visit" that, due to logistics, I had to do while away from home. Because they were a half-hour late, I was effectively forced to do this from the couch of a Costco floor display so I could still pick up my kid on time. • The appointment was 8m, at an out-of-pocket cost of $160+. I was not warned that I'd be forced to pay $20/minute for the privilege of being blessed with refills. Land of the fee, baby.

danielschonfeld 3y ago
American healthcare is the epitome of capitalism run amok. It’s terrible and the only thing worse than the exorbitant fees is the complete and utter lack of consideration to the patient’s time.
- DaveExeter 3y ago
  [flagged]
  - cratermoon 3y ago
    Ah yes, of course, https://bitworking.org/news/2008/01/the-free-market-fairy/ https://bitworking.org/news/2008/01/the-free-market-fairy/
    - moralestapia 3y ago
      He's right, though. I moved to Canada recently and caught a flu that I didn't take care of and, in turn, developed into pneumonia. It took me FIVE days to be able sit down with a doctor and get an antibiotic prescribed even thought it was more than evident I needed immediate care. I could have died if I waited another day. But was it free? ... ehrm ... yeah. In Mexico, doctors are as free market as it can get, downsides and upsides of that considered; with cash in hand you can get any kind of attention you need in the exact moment you need it. And it's not even that expensive, after converting MXN <-> USD. I could've dropped by with any of the 1,000s doctors that are available, many of which don't even require appointments. I would've got the attention I needed and the antibiotic prescription in 2-3 hours. That would had cost me ~60 USD.
      - segasaturn 3y ago
        "Canadian healthcare wait times" are mostly a myth invented by the American healthcare lobby [1]. Canadian cities are dotted with walk-in clinics you can go to and see a doctor same day. Or worst case scenario you would go to a hospital ER. Neither of these options will cost you any money and you will get same-day treatment and care. If you made an appointment with a GP then yeah you would wait, since those visits are typically for non-medical emergencies. :) [1]: https://www.washingtonpost.com/outlook/2020/08/06/health-insurance-canada-lie/ https://www.washingtonpost.com/outlook/2020/08/06/health-ins...
        moralestapia 3y ago
        Hey, I'm not a "myth invented by the American healthcare lobby", wtf. I went through that ordeal ~4 months ago, me, personally, I didn't read it on a magazine or whatever.
      - plastic-enjoyer 3y ago
        Germany has socialized healthcare and you can just go to your doctor without an appointment in acute cases like yours. Saying that ~60 USD is not that expensive comes from a privileged position where 60 USD doesn't hurt you.
      - caditinpiscinam 3y ago
        > MEXICO CITY (AP) — Mexico’s president said Friday the country’s minimum wage will rise by 20% in 2024, to the equivalent of about $14.25 per day. > About one-third of Mexico’s registered workers report earning the minimum wage, which will amount to about $1.75 per hour starting Jan. 1. $60 is 4 days wages for 1/3 of workers in Mexico. It's the equivalent of $820 for someone making 75k per year in the US. So it's the same as any other free-market healthcare system: easy access for the wealthy at the exclusion of the poor. https://apnews.com/article/mexico-minimum-wage-increase-peso-dollar-69a48493847a08127e1aff92edc32012 https://apnews.com/article/mexico-minimum-wage-increase-peso...
        moralestapia 3y ago
  - danielschonfeld 3y ago
    Respectfully save me the Ayn Rand. Some of us live in the real world and not the political utopias of our minds.
    - MR4D 3y ago
      I'm going to jump in here and offer up an Ayn Rand because you brought her name up. Ask anyone who has a dog, preferably a big dog, what it costs for a vet visit. Better yet, talk to someone who has had a sick dog. Something terminal, or possibly terminal. Costs are wayyy lower. Same x-ray, same imaging, many similar medicines. I've talked with vets, human doctors, and doctors who own dogs. They all come to the same conclusion: Only ONE key difference - there is no insurance or government regulation involved (obvously stuff like taxes, basic health codes, licensing, but I think you know what I mean). I'm more than happy to agree with you if you could show me a plausible explanation for this enormous disparity in costs.
      - olddustytrail 3y ago
        Because if I kill your dog I don't get charged with murder.
        MR4D 3y ago
        Not at all the same thing.
    - anon-sre-srm 3y ago
      But the Koch's want people to believe libertarianism is a kinder version of hate that believes in weed and unlimited freedom to rake in cash.
  - smallmancontrov 3y ago
    So why is our healthcare twice as expensive as the countries who actually do have socialized health care? When is that competition going to kick in and bring down costs? https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/ https://www.healthsystemtracker.org/chart-collection/health-...
    - EvanAnderson 3y ago
      Because Americans don't want to let people who can't pay for emergency care die (which I'd argue is a good thing) but also can't have a serious conversation about how to pay for that.
      - gnicholas 3y ago
        Is it more about emergency care or the fact that we pay more for prescription drugs and expensive procedures?
        EvanAnderson 3y ago
        I like to say that there's blame enough for everyone to share. There's truth to virtually every argument. The entire "system" is so "sloppy" and filled with points where money just leaks out. The emergency care angle is what drives the socialism / capitalism bickering and that's what I see a the biggest impediment to actually making effective change.
      - FireBeyond 3y ago
        As a paramedic (part-time) and someone who has worked in claims benefit management systems, EMTALA (the rules/laws around emergency stabilizing care) are not what make our healthcare astronomical. It's prescriptions, imaging, and labs. You can easily be charged several thousand dollars for diagnostic imaging. My insurance covers labs 100% but a recent stool sample test charged $780 to see if I had blood in a stool. Speaking of DI, DI is a money-printing machine, with CT and MRI machines that range from a few hundred thousand to over a million have breakeven points well under two years. And the DI companies work to find and gather physicians who want to start a DI practice. Offer financing, consulting, and then, shockingly, we find that physicians who own a DI practice or a share in one tend to over-refer their patients to imaging.
  - EvanAnderson 3y ago
    The American healthcare "system" is dysfunctional because parties who profit from the status quo keep the public bickering about inflammatory issues and distracted from making meaningful change. (My favorite example is "death panels".) Since the American system doesn't allow people who can't pay for emergency care to die the system ends having a socialist component. Socialism is such a hot-button issue that we can't have mature conversation about funding it. Almost any conversation about it gets caught-up in partisan and "personal responsibility" bickering. It would be easier if we just let people who can't pay die. That's repugnant and wrong, but it would certainly make the conversation easier.
  - recursive 3y ago
    How much time would you spend shopping around while you're bleeding out from a head wound? What would you use for negotiation leverage?
    - nightski 3y ago
      Typically one would not do that. You'd shop around ahead of time, sign up for a plan and then if/when the emergency came it would already be taken care of.
      - recursive 3y ago
        That's what we have now. I hope you're conscious enough to tell the ambulance driver which hospital to drive to.
        anon-sre-srm 3y ago
        SF Bay Area south bay -> Good Samaritan (anything but Valley Med) SF Bay Area peninsula -> Stanford Austin -> St David's
  - avgDev 3y ago
    Tell me you don't know anything about healthcare without telling me you don't know anything about healthcare.
  - Matheus28 3y ago
    It’s been a long time since I’ve seen someone say something this wrong on HN. Calling the American health care system socialist in any way is laughable.
    - DaveExeter 3y ago
      That's just a reflection of how thick the wool over your eyes.
  - mindslight 3y ago
    I'm in agreement that healthcare is sorely lacking many individualist incentives, including market ones [0], but can we not pigeonhole anything we don't like as "socialism" ? It just makes for a terrible time talking past one another. [0] hint: receiving bills for charges you never assented to is not a foundation of a working market, and should obviously be illegal.
  - Ekaros 3y ago
    It is perfect example of crony-capitalism... Under socialism basic care would come from one pot. And state would tell what everything can costs.
- aeturnum 3y ago
  I have a partner who's a nurse practitioner in primary care and I just want to emphasize how hellish it is for people on the inside as well. The economic model of running a healthcare business is entirely based on their ability to bill for provider time. Healthcare providers have very high costs to match their very high fees and also pay a bunch of people to 'help' providers see more patients. A big part of this mix is also that it is not enough to provide healthcare - you are actually paid for providing documentation that you carried out the specific care that you "should have done" given the case notes. Ensuring you properly annotate the files of patients (for the benefit of generating the right charge codes! Nothing to do with patient care) is another burden that's required to sustainably provide care. As a result the costs "per provider" are much higher than the provider themselves - you also need medical assistants who do every piece of work the provider isn't legally required to do, billing staff to properly bill that work, admin staff to manage their schedule in detail, etc. The lack of regard for patient schedules is a direct result of how insanely packed the schedules of providers are. Fifteen minutes per patient is luxurious and my partner spends a lot of time after work entering notes for patients she saw that day (she "works" 32 hours / 4 days a week, which is really closer to 40-45 all told). My understanding is that the clinic does not have a high profit margin (serving medical / medicare patients + high overall costs), so every patient counts, and the admin staff will add people w/o permission. It's common for her to find patients scheduled over her breaks or for her to be scheduled after she should have left the building. Burnout has always been bad but it's reaching epidemic levels now in the wake of covid, which further restricts the supply of healthcare and makes people wait longer to be seen.
  - mindslight 3y ago
    I think people tend to get stuck on the ridiculous charges/billing and don't often get to the point where they appreciate just how bad the provided healthcare is, and how much it utterly destroys patient agency by replacing it with bureaucracy. The provider/"insurer" dynamic is really the deep set home of the rot. As a table stakes reform, health "insurance" companies need to be prevented from managing healthcare and relegated to purely financial payers, but doing so would put so many low-level bureaucrats out of work it's politically untenable. For a recent event, I got a whole nurse calling me from the "insurance" company, out of the blue, seemingly just to chat about the medical situation and how things are going. I haven't figured out what her KPIs are, but I doubt she remains so friendly when you bump up against them! And she obviously represents a severe misallocation of labor - the industry would be better off if someone with her education (and likely experience) was actually providing healthcare.
- anon-sre-srm 3y ago
  No, the worst part is dying of a painful terminal illness while being sued into bankruptcy in your dying days having to fight to keep minimal possessions because the hospitals and doctors want money.
- j-j-j-j 3y ago
  None of that stuff would be possible without government. It's a statism run amok. It's the same story every time. Something works relatively OK (US health care before 20 century big-gov), huge changes to incentive structure and overheads are introduced by statists ignoring higher order effects, everything goes downhill, statists blame capitalism. Let me legally not have insurance, pay anyone in cash for my health care (no licensens and government enforced monopolies), and buy any medicine I'd like and opt out of this madness completely and let's compare with real capitalism.
  - deleted 3y ago
    [deleted]
  - wwweston 3y ago
    It's always been legal not to have insurance (though there was a brief period where externalizing costs that way was taxed). You can pay cash for health care as you like now with any provider who cares to negotiate with you on a cash basis. There's even a variety of non-MD providers whose licensure ranges from more accessible through informal to non-existent should you object to credentials as distorting. If you try doing health care this way for long enough, you might even discover which incentives are poorly aligned without collective policy of some kind, but who knows, maybe not.
  - plagiarist 3y ago
    We can surely fix this mess via same invisible hand that sent people down the horses aisle in the farm goods warehouses to use deworming medicine as a preventative antiviral.
- bdzr 3y ago
  It's really not, it's a frankenstein of a system with capitalist and socialist traits. If it were capitalism run amok, a consumer would be able to figure out the price of something as though it were a cup of coffee. Pricing is completely opaque and provides nearly zero demand for providers to compete.
  - alistairSH 3y ago
    It's not socialist (Medicaid/Medicare notwithstanding). But, it's definitely not "ECON-101 free-market capitalism" either. Lots of regulatory capture from both medical and insurance providers. Plus a bunch of self-inflicted dysfunction because we keep electing ding-dongs into Congress.
gnicholas 3y ago
My doctor's office pushes really hard for me to set up a physical if I haven't been in recently and need prescription refills. This includes for allergy and asthma medication, which I have used as-needed since I was a child. This started happening around a decade ago; before that, it was never a problem to have the pharmacy call the doctor's office for the refills, and that was that.
- sp3000 3y ago
  The American sick care system is based around and incentivized to keep you a customer for life. I recommend people find preventative health and longevity specializing medical providers - they prioritize actual health and wellness.
- patwolf 3y ago
  I had a prescription that I used to get updated at my annual physical. I would schedule my next physical when I'd leave the office, but then they started telling me that they couldn't schedule anything more than 6 months out. I waited, and when I tried to finally schedule the physical they couldn't see me for 9 months. So now I order the medicine from India.
TheNorthman 3y ago
A danish perspective: Primary care doctors are paid (by the state) based of a fixed list. A 15 min video consultation pays 162.99 DKK (~24 USD) [1]: https://laeger.dk/media/mjpbsm2a/honorartabel-2023-januar.pdf https://laeger.dk/media/mjpbsm2a/honorartabel-2023-januar.pd...
codegeek 3y ago
Talk to me when you get a $4000 bill for 2 hours in ER where the actual doc saw you for 5 mins and then the nurses did band-aid and over the counter burn ointment. This with Insurance (biggest mafia). AMerican Healthcare system baby!!
- FireBeyond 3y ago
  I was in one hospital ER for a kidney stone, but they had no urology available, so they sent me via ambulance ("thankfully", as a paramedic, one of our company benefits was that if we were ever transported, they'd bill our insurance and waive any charges to us) to another hospital. Ambulance crew wheeled me into the ER bay, where a 'transport' gurney from surgery, was waiting, and I slid from one to the other, and was wheeled to pre-op. At no point did the ER staff ever talk to me. At no point was I in a room. Or in an ER bed, hallway or otherwise. Just ambulance, transport, and then to pre-op. But, because the transfer physically happened in the ER, that second hospital tried to bill my insurance for an ER visit to the tune of $2,800 which I appealed (successfully, at least).
  - anon-sre-srm 3y ago
    My elderly disabled mom on a fixed income is being billed for an ambulance ride from a hospital to a long-term care facility because Medicare deemed it "unnecessary" even though the shuttle couldn't take her.
    - FireBeyond 3y ago
      I'm sorry. Hospital staff are notoriously bad for incorrectly filling out the paperwork that Medicare requires to justify ambulance transport, such that we (paramedics and EMTs) are constantly explaining it to them. Shock, horror, you actually need to read through the form and select the appropriate checkboxes (around ability to stand, need for oxygen, fall risk and hazard, danger to self or others, etc., etc.) Too many of them literally fill out patient demographics and a signature and say "here you go". We push back because our organization policy is that we will transport those patients, BUT we would also much rather bill Medicare than the patient (our billing staff and C-suite may disagree, but EMTs and paramedics wholeheartedly understand that routine privately paid ambulance transport is not a viable option for 99.998% of the elderly).
bachmeier 3y ago
Back in 2020, my son needed a Covid test for some event related to school. We called his doctor's office and made an appointment for the test. We showed up for the appointment, and we had to wait an extra 20 minutes because the doctor was late, only to be told "we don't do that testing". Then got a bill for $100 for a doctor's appointment.
- anon-sre-srm 3y ago
  Change doctors. Don't reward abuse or failure.
  - Libcat99 3y ago
    I'd go further and not pay the bill, document why (failed to provide the agreed service?) and send them a notice of it. At least. It's effectively a scam, don't give in to scammers.
- ToucanLoucan 3y ago
  I went for a covid and strep test during the tail end of the pandemic, and happened to pick the closest clinic, cuz you know, I felt like shit and didn't want to go far. This costed me $240, which seemed slightly fucking insane, so I called. Because the place was understaffed, I had to be seen by a doctor instead of a nurse, which for added fun was an out of network doctor. I didn't even KNOW he was a doctor at all, and never bothered to check the network status of the clinic because, again, it was a fucking covid and strep test. The strep test costed me about $20, the covid test was free, and the doctor who spent about 60 seconds reading me the results on the page was $220. Fucking. Ridiculous.
- Gibbon1 3y ago
  I think we need to go back to having Nurse Practitioners at schools.
AlienRobot 3y ago
In my country (Brazil) it's illegal for doctors to require an appointment just to give a prescription. I see them doing it all the time anyway. It's sad.
bilater 3y ago
The whole prescription business is such a grift. Doctors deliberately give you max 2 years of a prescription that you know you will need for longer (such as allergy meds, eye prescriptions) and then you have to waste your time and spend money just to renew it.
- gnicholas 3y ago
  Is this part of the reason those online pharmacy platforms (which include a doctor who will do a very quick exam/diagnosis) took off in recent years? I mostly heard about them with regard to ADHD meds but wonder if they are also useful because they don't require you to have checkups all the time for maintenance medication.
  - sithadmin 3y ago
    Most of those platforms seem to require the patient to pay for a virtual visit for every refill, or require some kind of a monthly fee.
    - Someone1234 3y ago
      That is accurate. But those virtual visits are 50% cheaper than full telemedicine visits and 70% cheaper than in-person renews. It should be noted their virtual visits are mostly performative. You're filling in a survey beforehand and the doctor is just there to read the survey and push a big green button.
      - gnicholas 3y ago
        How long do the refills last? I would think that even with the cheaper cost of medicine, and the discounted telemedicine visit, it would still be more expensive than seeing a doctor annually and getting refills for all prescriptions for the rest of the year without needing additional appointments. But perhaps I'm underestimating how cheap these platforms are (both the meds and the docs)?
JTbane 3y ago
Call me old-fashioned but I really hate the idea of telemedicine.
- gnicholas 3y ago
  It can be good for some things, and is more convenient to schedule (don't have to drive there, no risk of getting sick from other patients). Plus, there's a chance that in the future it could enable people in HCoL areas to get medical care from providers in LCoL areas, which would lower costs dramatically. I think for now the state-by-state cartel is still quite strong though. But I agree that for some appointments it obviously doesn't work because you can't examine the patient or take vitals the same way/at all.
- Libcat99 3y ago
  My son takes ADHD meds and it would be great if we could do the med checks (which are almost entirely questions for the parents) remotely, instead of taking him out of school and one of us out of work for several hours.
- Someone1234 3y ago
  It is a mixed bag. For certain things, like common illnesses, it is pretty good. But that being said, use caution. I had something minor turn into an ER visit because I used telemedicine instead of going to my GP. Telemedicine prescribed antibiotics, which was correct, but GP would have done a drain too. Lack of drainage caused uhh unpleasant problems down the road.
- dghlsakjg 3y ago
  Totally context dependent. Call me new-fashioned, but I don't want to spend a few hours of a workday several times per year to see a doctor for less than 5 minutes for prescription refill for a drug that I have been taking for years. Why in the world would either of us need to see each-other in person when he can ask me the same 3 questions he always does over the phone?
  - symlinkk 3y ago
    It sounds like you shouldn’t need to meet with him at all.
resource_waste 3y ago
[dead]
stuckindoors 3y ago
Just go to Mexico or an online pharmacy and get your meds at cost. /s The US healthcare system is completely broken. Hospital systems and doctors offices in general lost a shit ton of money last year. There has been massive layoffs throughout this sector. There will continue to be this year. This year they all are going to try to survive by recouping their prior losses. Get ready for more fees. In addition - there is consolidation in the physicians groups. Mom and pop groups are almost unfeasible at this point. Look for venture capitalists to scoop in. Guess what - you won't have better care with after those changes - I can promise that. Lastly, the pharmaceutical industry is out of control. They hike prices on any and all medications that they are able to. They recently hiked flovent to a cost that no insurance companies or hospital will pay for it. There are limited alternatives at least for kids. This is medications that that has been out since the mid 80s. It is a controlled market, with high barriers to entry - you can either permit a wide west time of pharmaceutical environment or you can understand the need for a regulated marketplace and meet with with equivalent regulation in terms of pricing. Finally the insurance companies are the worst. I don't know anyone with a good experience...the only ones that have a positive experience are those that don't use it. I try not to hate any single group but I hate insurance companies. The system needs to be burned to the ground. It is fragmented and burdensome for healthcare providers and for patients. It benefits no one at this point. It creates additional workload for providers hospitals and patients alike. I am afraid of what will come in it's place but can't we worse that this shit.
- wolverine876 3y ago
  > Hospital systems and doctors offices in general lost a shit ton of money last year. It costs 2-3x of healthcare in equivalent countries, with worse results. Where is that money going? > In addition - there is consolidation in the physicians groups. Mom and pop groups are almost unfeasible at this point. Look for venture capitalists to scoop in. Private equity already has, from what I've read.
- EVa5I7bHFq9mnYK 3y ago
  Maybe we need a revolution, or at least an outsider rule breaker in the office from time to time, to break established monopolies, cartels etc. Any system gets rotten given enough time. Just went out and bought a bottle of Avamys (more modern version of Flovent) for $15 without any hassle. Shed a tear for poor Americans.
ktosobcy 3y ago
Uhm... in Poland there are usually "refill forms" at your chosen / doctors office, you fill it out, drop at the reception and then you get prescription code via sms with which you can claim it at any pharmacy (that has the drug)
- betaby 3y ago
  [flagged]
  - bdunks 3y ago
    Only 10% of the increase in medical cost in the US is attributable to doctor salaries. The remainder is administrative overhead, Rx costs, insurance administration, etc. There are now 10 administrators for every 1 doctor. Since 1970, the number of physicians has increased by 2x. The number of administrative staff has increased by 38x. If each administrator is making 100k+ - 150k+, that's significant cost. Some of these crazy billing practices are due to the private equity buy-ups and consolidation, creating workflows and fee structures that are hostile to patients and doctors, but benefit the PE firms. https://www.commonwealthfund.org/publications/issue-briefs/2023/oct/high-us-health-care-spending-where-is-it-all-going https://www.commonwealthfund.org/publications/issue-briefs/2... Lots more data here: https://www.healthsystemtracker.org/ https://www.healthsystemtracker.org/
    - Eric_WVGG 3y ago
      That kind of lazy thinking drives me up the wall. There's a huge swatch of America that thinks elementary school teachers are bringing home FAT BUCKS because college tuition costs are high. It's the corporations, stupid.
      - bdunks 3y ago
        Absolutely. I used the number of administrative personal * administrative salaries because it's a quick mental visualization. I just reviewed United Healthcare's 2022 10k. In 2022, they had $324B in revenue, and paid $210B in medical expenses. Of the $114B remaining, $85.5B was various operating costs, $28.5B (25%) was corporate profit / operating income (before interest & taxes). Even if all 40,000 employees of UnitedHealth Group were making 200k (they're not), that'd only account for $8B of their $85.5B in non-medical costs. https://www.unitedhealthgroup.com/content/dam/UHG/PDF/invest https://www.unitedhealthgroup.com/content/dam/UHG/PDF/invest...
ClarityJones 3y ago
Prescriptions should not be required.
twobitshifter 3y ago
Had an eye doctor set up a follow visit appointment for my wife. We went for the follow up and he said “I don’t know why i’m seeing you for this” said it looked fine and then asked us to come back again in a month.
QuantumGood 3y ago
One Medical charges $9/month (through Amazon), all video visits are free (if you click the proper link), and I've had multiple prescriptions renewed that way. Three times waited less than a minute, longest wait was 15 minutes, and the app will call you back if you wish so you don't have to keep the app open.
- CoffeeOnWrite 3y ago
  +1. They also will write new prescription for low-risk things. And you don't necessarily need video, they do it over messages and just ask for photos of symptoms, in some cases.
- kettro 3y ago
  My company pays for One Medical, and it’s honestly the best practice I’ve been to in the US. I can typically get an appointment the next day, there are tons of offices (in SF), and everyone is kind and efficient. They ask you to set a primary care doctor, but I have had more success with seeing a small group of their more available non-MD physicians.
  - gnicholas 3y ago
    What is a non-MD physician? Is that a physician assistant?
deleted 3y ago
[deleted]
derbOac 3y ago
This is why I think US medicine should be deregulated, especially licensing laws. Everything you're describing is screaming monopoly and artificial lack of competition. If providers of class X are too busy to see you, then there's plenty of people who could, or you're just going to do it on your own. It needs to be more like that. Obviously there are some limits, but educational pathways could be much more diverse, and there are many things that patients are capable of accessing on their own or through providers like pharmacists.
- gnicholas 3y ago
  One easy step is to allow telemedicine visits across state lines.
kelnos 3y ago
Reading a lot of the responses here, I've realized another reason why the fight for a better health care system in the US goes so poorly. People are so used to the costs and being jerked around by the system that they've completely normalized it. "Oh, you should have known those symptoms didn't require an ER visit; it's your fault you got such a large bill." "Every hospital or doctor is going to try to push extra charges like that; you have to contest them or just not pay and hope the problem goes away; that's just how it is." Then someone from outside the US says, "that would never happen in my country; here's how it works here..." and it's immediately assumed there's some sort of huge catch, that never, nowhere could a health care system work that well without some sort of major trade off or downside. No! Stop this! A health care system should work for patients, not against them! Injured or suddenly-sick people are not in the best head space to make rational, informed decisions as to what level of care they need in the moment. Even if they were, nearly all lack the specific medical training that would always allow them make that decision with a comfortable level of certainty. And even if someone should have known better, I just don't get the ire. Why should we put people into tenuous financial situations just because they made a mistake in how they sought medical care? Medical care! What the hell is wrong with people? The US health care system is awful, despite having so many great and talented doctors, nurses, and staff! Let's get that through our heads! We pay so much more than other developed countries, for so much less care. And the reason we don't have something better is because the right public policy is labeled "socialism". This is so exhausting.

danielschonfeld 3y ago

American healthcare is the epitome of capitalism run amok. It’s terrible and the only thing worse than the exorbitant fees is the complete and utter lack of consideration to the patient’s time.

DaveExeter 3y ago
[flagged]
- cratermoon 3y ago
  Ah yes, of course, https://bitworking.org/news/2008/01/the-free-market-fairy/ https://bitworking.org/news/2008/01/the-free-market-fairy/
  - moralestapia 3y ago
    He's right, though. I moved to Canada recently and caught a flu that I didn't take care of and, in turn, developed into pneumonia. It took me FIVE days to be able sit down with a doctor and get an antibiotic prescribed even thought it was more than evident I needed immediate care. I could have died if I waited another day. But was it free? ... ehrm ... yeah. In Mexico, doctors are as free market as it can get, downsides and upsides of that considered; with cash in hand you can get any kind of attention you need in the exact moment you need it. And it's not even that expensive, after converting MXN <-> USD. I could've dropped by with any of the 1,000s doctors that are available, many of which don't even require appointments. I would've got the attention I needed and the antibiotic prescription in 2-3 hours. That would had cost me ~60 USD.
    - segasaturn 3y ago
      "Canadian healthcare wait times" are mostly a myth invented by the American healthcare lobby [1]. Canadian cities are dotted with walk-in clinics you can go to and see a doctor same day. Or worst case scenario you would go to a hospital ER. Neither of these options will cost you any money and you will get same-day treatment and care. If you made an appointment with a GP then yeah you would wait, since those visits are typically for non-medical emergencies. :) [1]: https://www.washingtonpost.com/outlook/2020/08/06/health-insurance-canada-lie/ https://www.washingtonpost.com/outlook/2020/08/06/health-ins...
      - moralestapia 3y ago
        Hey, I'm not a "myth invented by the American healthcare lobby", wtf. I went through that ordeal ~4 months ago, me, personally, I didn't read it on a magazine or whatever.
    - plastic-enjoyer 3y ago
      Germany has socialized healthcare and you can just go to your doctor without an appointment in acute cases like yours. Saying that ~60 USD is not that expensive comes from a privileged position where 60 USD doesn't hurt you.
    - caditinpiscinam 3y ago
      > MEXICO CITY (AP) — Mexico’s president said Friday the country’s minimum wage will rise by 20% in 2024, to the equivalent of about $14.25 per day. > About one-third of Mexico’s registered workers report earning the minimum wage, which will amount to about $1.75 per hour starting Jan. 1. $60 is 4 days wages for 1/3 of workers in Mexico. It's the equivalent of $820 for someone making 75k per year in the US. So it's the same as any other free-market healthcare system: easy access for the wealthy at the exclusion of the poor. https://apnews.com/article/mexico-minimum-wage-increase-peso-dollar-69a48493847a08127e1aff92edc32012 https://apnews.com/article/mexico-minimum-wage-increase-peso...
      - moralestapia 3y ago
- danielschonfeld 3y ago
  Respectfully save me the Ayn Rand. Some of us live in the real world and not the political utopias of our minds.
  - MR4D 3y ago
    I'm going to jump in here and offer up an Ayn Rand because you brought her name up. Ask anyone who has a dog, preferably a big dog, what it costs for a vet visit. Better yet, talk to someone who has had a sick dog. Something terminal, or possibly terminal. Costs are wayyy lower. Same x-ray, same imaging, many similar medicines. I've talked with vets, human doctors, and doctors who own dogs. They all come to the same conclusion: Only ONE key difference - there is no insurance or government regulation involved (obvously stuff like taxes, basic health codes, licensing, but I think you know what I mean). I'm more than happy to agree with you if you could show me a plausible explanation for this enormous disparity in costs.
    - olddustytrail 3y ago
      Because if I kill your dog I don't get charged with murder.
      - MR4D 3y ago
        Not at all the same thing.
  - anon-sre-srm 3y ago
    But the Koch's want people to believe libertarianism is a kinder version of hate that believes in weed and unlimited freedom to rake in cash.
- smallmancontrov 3y ago
  So why is our healthcare twice as expensive as the countries who actually do have socialized health care? When is that competition going to kick in and bring down costs? https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/ https://www.healthsystemtracker.org/chart-collection/health-...
  - EvanAnderson 3y ago
    Because Americans don't want to let people who can't pay for emergency care die (which I'd argue is a good thing) but also can't have a serious conversation about how to pay for that.
    - gnicholas 3y ago
      Is it more about emergency care or the fact that we pay more for prescription drugs and expensive procedures?
      - EvanAnderson 3y ago
        I like to say that there's blame enough for everyone to share. There's truth to virtually every argument. The entire "system" is so "sloppy" and filled with points where money just leaks out. The emergency care angle is what drives the socialism / capitalism bickering and that's what I see a the biggest impediment to actually making effective change.
    - FireBeyond 3y ago
      As a paramedic (part-time) and someone who has worked in claims benefit management systems, EMTALA (the rules/laws around emergency stabilizing care) are not what make our healthcare astronomical. It's prescriptions, imaging, and labs. You can easily be charged several thousand dollars for diagnostic imaging. My insurance covers labs 100% but a recent stool sample test charged $780 to see if I had blood in a stool. Speaking of DI, DI is a money-printing machine, with CT and MRI machines that range from a few hundred thousand to over a million have breakeven points well under two years. And the DI companies work to find and gather physicians who want to start a DI practice. Offer financing, consulting, and then, shockingly, we find that physicians who own a DI practice or a share in one tend to over-refer their patients to imaging.
- EvanAnderson 3y ago
  The American healthcare "system" is dysfunctional because parties who profit from the status quo keep the public bickering about inflammatory issues and distracted from making meaningful change. (My favorite example is "death panels".) Since the American system doesn't allow people who can't pay for emergency care to die the system ends having a socialist component. Socialism is such a hot-button issue that we can't have mature conversation about funding it. Almost any conversation about it gets caught-up in partisan and "personal responsibility" bickering. It would be easier if we just let people who can't pay die. That's repugnant and wrong, but it would certainly make the conversation easier.
- recursive 3y ago
  How much time would you spend shopping around while you're bleeding out from a head wound? What would you use for negotiation leverage?
  - nightski 3y ago
    Typically one would not do that. You'd shop around ahead of time, sign up for a plan and then if/when the emergency came it would already be taken care of.
    - recursive 3y ago
      That's what we have now. I hope you're conscious enough to tell the ambulance driver which hospital to drive to.
      - anon-sre-srm 3y ago
        SF Bay Area south bay -> Good Samaritan (anything but Valley Med) SF Bay Area peninsula -> Stanford Austin -> St David's
- avgDev 3y ago
  Tell me you don't know anything about healthcare without telling me you don't know anything about healthcare.
- Matheus28 3y ago
  It’s been a long time since I’ve seen someone say something this wrong on HN. Calling the American health care system socialist in any way is laughable.
  - DaveExeter 3y ago
    That's just a reflection of how thick the wool over your eyes.
- mindslight 3y ago
  I'm in agreement that healthcare is sorely lacking many individualist incentives, including market ones [0], but can we not pigeonhole anything we don't like as "socialism" ? It just makes for a terrible time talking past one another. [0] hint: receiving bills for charges you never assented to is not a foundation of a working market, and should obviously be illegal.
- Ekaros 3y ago
  It is perfect example of crony-capitalism... Under socialism basic care would come from one pot. And state would tell what everything can costs.
aeturnum 3y ago
I have a partner who's a nurse practitioner in primary care and I just want to emphasize how hellish it is for people on the inside as well. The economic model of running a healthcare business is entirely based on their ability to bill for provider time. Healthcare providers have very high costs to match their very high fees and also pay a bunch of people to 'help' providers see more patients. A big part of this mix is also that it is not enough to provide healthcare - you are actually paid for providing documentation that you carried out the specific care that you "should have done" given the case notes. Ensuring you properly annotate the files of patients (for the benefit of generating the right charge codes! Nothing to do with patient care) is another burden that's required to sustainably provide care. As a result the costs "per provider" are much higher than the provider themselves - you also need medical assistants who do every piece of work the provider isn't legally required to do, billing staff to properly bill that work, admin staff to manage their schedule in detail, etc. The lack of regard for patient schedules is a direct result of how insanely packed the schedules of providers are. Fifteen minutes per patient is luxurious and my partner spends a lot of time after work entering notes for patients she saw that day (she "works" 32 hours / 4 days a week, which is really closer to 40-45 all told). My understanding is that the clinic does not have a high profit margin (serving medical / medicare patients + high overall costs), so every patient counts, and the admin staff will add people w/o permission. It's common for her to find patients scheduled over her breaks or for her to be scheduled after she should have left the building. Burnout has always been bad but it's reaching epidemic levels now in the wake of covid, which further restricts the supply of healthcare and makes people wait longer to be seen.
- mindslight 3y ago
  I think people tend to get stuck on the ridiculous charges/billing and don't often get to the point where they appreciate just how bad the provided healthcare is, and how much it utterly destroys patient agency by replacing it with bureaucracy. The provider/"insurer" dynamic is really the deep set home of the rot. As a table stakes reform, health "insurance" companies need to be prevented from managing healthcare and relegated to purely financial payers, but doing so would put so many low-level bureaucrats out of work it's politically untenable. For a recent event, I got a whole nurse calling me from the "insurance" company, out of the blue, seemingly just to chat about the medical situation and how things are going. I haven't figured out what her KPIs are, but I doubt she remains so friendly when you bump up against them! And she obviously represents a severe misallocation of labor - the industry would be better off if someone with her education (and likely experience) was actually providing healthcare.
anon-sre-srm 3y ago
No, the worst part is dying of a painful terminal illness while being sued into bankruptcy in your dying days having to fight to keep minimal possessions because the hospitals and doctors want money.
j-j-j-j 3y ago
None of that stuff would be possible without government. It's a statism run amok. It's the same story every time. Something works relatively OK (US health care before 20 century big-gov), huge changes to incentive structure and overheads are introduced by statists ignoring higher order effects, everything goes downhill, statists blame capitalism. Let me legally not have insurance, pay anyone in cash for my health care (no licensens and government enforced monopolies), and buy any medicine I'd like and opt out of this madness completely and let's compare with real capitalism.
- deleted 3y ago
  [deleted]
- wwweston 3y ago
  It's always been legal not to have insurance (though there was a brief period where externalizing costs that way was taxed). You can pay cash for health care as you like now with any provider who cares to negotiate with you on a cash basis. There's even a variety of non-MD providers whose licensure ranges from more accessible through informal to non-existent should you object to credentials as distorting. If you try doing health care this way for long enough, you might even discover which incentives are poorly aligned without collective policy of some kind, but who knows, maybe not.
- plagiarist 3y ago
  We can surely fix this mess via same invisible hand that sent people down the horses aisle in the farm goods warehouses to use deworming medicine as a preventative antiviral.
bdzr 3y ago
It's really not, it's a frankenstein of a system with capitalist and socialist traits. If it were capitalism run amok, a consumer would be able to figure out the price of something as though it were a cup of coffee. Pricing is completely opaque and provides nearly zero demand for providers to compete.
- alistairSH 3y ago
  It's not socialist (Medicaid/Medicare notwithstanding). But, it's definitely not "ECON-101 free-market capitalism" either. Lots of regulatory capture from both medical and insurance providers. Plus a bunch of self-inflicted dysfunction because we keep electing ding-dongs into Congress.

gnicholas 3y ago

My doctor's office pushes really hard for me to set up a physical if I haven't been in recently and need prescription refills. This includes for allergy and asthma medication, which I have used as-needed since I was a child. This started happening around a decade ago; before that, it was never a problem to have the pharmacy call the doctor's office for the refills, and that was that.

sp3000 3y ago
The American sick care system is based around and incentivized to keep you a customer for life. I recommend people find preventative health and longevity specializing medical providers - they prioritize actual health and wellness.
patwolf 3y ago
I had a prescription that I used to get updated at my annual physical. I would schedule my next physical when I'd leave the office, but then they started telling me that they couldn't schedule anything more than 6 months out. I waited, and when I tried to finally schedule the physical they couldn't see me for 9 months. So now I order the medicine from India.

TheNorthman 3y ago

A danish perspective: Primary care doctors are paid (by the state) based of a fixed list. A 15 min video consultation pays 162.99 DKK (~24 USD) [1]: https://laeger.dk/media/mjpbsm2a/honorartabel-2023-januar.pdf https://laeger.dk/media/mjpbsm2a/honorartabel-2023-januar.pd...

codegeek 3y ago

Talk to me when you get a $4000 bill for 2 hours in ER where the actual doc saw you for 5 mins and then the nurses did band-aid and over the counter burn ointment. This with Insurance (biggest mafia). AMerican Healthcare system baby!!

FireBeyond 3y ago
I was in one hospital ER for a kidney stone, but they had no urology available, so they sent me via ambulance ("thankfully", as a paramedic, one of our company benefits was that if we were ever transported, they'd bill our insurance and waive any charges to us) to another hospital. Ambulance crew wheeled me into the ER bay, where a 'transport' gurney from surgery, was waiting, and I slid from one to the other, and was wheeled to pre-op. At no point did the ER staff ever talk to me. At no point was I in a room. Or in an ER bed, hallway or otherwise. Just ambulance, transport, and then to pre-op. But, because the transfer physically happened in the ER, that second hospital tried to bill my insurance for an ER visit to the tune of $2,800 which I appealed (successfully, at least).
- anon-sre-srm 3y ago
  My elderly disabled mom on a fixed income is being billed for an ambulance ride from a hospital to a long-term care facility because Medicare deemed it "unnecessary" even though the shuttle couldn't take her.
  - FireBeyond 3y ago
    I'm sorry. Hospital staff are notoriously bad for incorrectly filling out the paperwork that Medicare requires to justify ambulance transport, such that we (paramedics and EMTs) are constantly explaining it to them. Shock, horror, you actually need to read through the form and select the appropriate checkboxes (around ability to stand, need for oxygen, fall risk and hazard, danger to self or others, etc., etc.) Too many of them literally fill out patient demographics and a signature and say "here you go". We push back because our organization policy is that we will transport those patients, BUT we would also much rather bill Medicare than the patient (our billing staff and C-suite may disagree, but EMTs and paramedics wholeheartedly understand that routine privately paid ambulance transport is not a viable option for 99.998% of the elderly).

bachmeier 3y ago

Back in 2020, my son needed a Covid test for some event related to school. We called his doctor's office and made an appointment for the test. We showed up for the appointment, and we had to wait an extra 20 minutes because the doctor was late, only to be told "we don't do that testing". Then got a bill for $100 for a doctor's appointment.

anon-sre-srm 3y ago
Change doctors. Don't reward abuse or failure.
- Libcat99 3y ago
  I'd go further and not pay the bill, document why (failed to provide the agreed service?) and send them a notice of it. At least. It's effectively a scam, don't give in to scammers.
ToucanLoucan 3y ago
I went for a covid and strep test during the tail end of the pandemic, and happened to pick the closest clinic, cuz you know, I felt like shit and didn't want to go far. This costed me $240, which seemed slightly fucking insane, so I called. Because the place was understaffed, I had to be seen by a doctor instead of a nurse, which for added fun was an out of network doctor. I didn't even KNOW he was a doctor at all, and never bothered to check the network status of the clinic because, again, it was a fucking covid and strep test. The strep test costed me about $20, the covid test was free, and the doctor who spent about 60 seconds reading me the results on the page was $220. Fucking. Ridiculous.
Gibbon1 3y ago
I think we need to go back to having Nurse Practitioners at schools.

AlienRobot 3y ago

In my country (Brazil) it's illegal for doctors to require an appointment just to give a prescription. I see them doing it all the time anyway. It's sad.

bilater 3y ago

The whole prescription business is such a grift. Doctors deliberately give you max 2 years of a prescription that you know you will need for longer (such as allergy meds, eye prescriptions) and then you have to waste your time and spend money just to renew it.

gnicholas 3y ago
Is this part of the reason those online pharmacy platforms (which include a doctor who will do a very quick exam/diagnosis) took off in recent years? I mostly heard about them with regard to ADHD meds but wonder if they are also useful because they don't require you to have checkups all the time for maintenance medication.
- sithadmin 3y ago
  Most of those platforms seem to require the patient to pay for a virtual visit for every refill, or require some kind of a monthly fee.
  - Someone1234 3y ago
    That is accurate. But those virtual visits are 50% cheaper than full telemedicine visits and 70% cheaper than in-person renews. It should be noted their virtual visits are mostly performative. You're filling in a survey beforehand and the doctor is just there to read the survey and push a big green button.
    - gnicholas 3y ago
      How long do the refills last? I would think that even with the cheaper cost of medicine, and the discounted telemedicine visit, it would still be more expensive than seeing a doctor annually and getting refills for all prescriptions for the rest of the year without needing additional appointments. But perhaps I'm underestimating how cheap these platforms are (both the meds and the docs)?

JTbane 3y ago

Call me old-fashioned but I really hate the idea of telemedicine.

gnicholas 3y ago
It can be good for some things, and is more convenient to schedule (don't have to drive there, no risk of getting sick from other patients). Plus, there's a chance that in the future it could enable people in HCoL areas to get medical care from providers in LCoL areas, which would lower costs dramatically. I think for now the state-by-state cartel is still quite strong though. But I agree that for some appointments it obviously doesn't work because you can't examine the patient or take vitals the same way/at all.
Libcat99 3y ago
My son takes ADHD meds and it would be great if we could do the med checks (which are almost entirely questions for the parents) remotely, instead of taking him out of school and one of us out of work for several hours.
Someone1234 3y ago
It is a mixed bag. For certain things, like common illnesses, it is pretty good. But that being said, use caution. I had something minor turn into an ER visit because I used telemedicine instead of going to my GP. Telemedicine prescribed antibiotics, which was correct, but GP would have done a drain too. Lack of drainage caused uhh unpleasant problems down the road.
dghlsakjg 3y ago
Totally context dependent. Call me new-fashioned, but I don't want to spend a few hours of a workday several times per year to see a doctor for less than 5 minutes for prescription refill for a drug that I have been taking for years. Why in the world would either of us need to see each-other in person when he can ask me the same 3 questions he always does over the phone?
- symlinkk 3y ago
  It sounds like you shouldn’t need to meet with him at all.

resource_waste 3y ago

[dead]

stuckindoors 3y ago

Just go to Mexico or an online pharmacy and get your meds at cost. /s The US healthcare system is completely broken. Hospital systems and doctors offices in general lost a shit ton of money last year. There has been massive layoffs throughout this sector. There will continue to be this year. This year they all are going to try to survive by recouping their prior losses. Get ready for more fees. In addition - there is consolidation in the physicians groups. Mom and pop groups are almost unfeasible at this point. Look for venture capitalists to scoop in. Guess what - you won't have better care with after those changes - I can promise that. Lastly, the pharmaceutical industry is out of control. They hike prices on any and all medications that they are able to. They recently hiked flovent to a cost that no insurance companies or hospital will pay for it. There are limited alternatives at least for kids. This is medications that that has been out since the mid 80s. It is a controlled market, with high barriers to entry - you can either permit a wide west time of pharmaceutical environment or you can understand the need for a regulated marketplace and meet with with equivalent regulation in terms of pricing. Finally the insurance companies are the worst. I don't know anyone with a good experience...the only ones that have a positive experience are those that don't use it. I try not to hate any single group but I hate insurance companies. The system needs to be burned to the ground. It is fragmented and burdensome for healthcare providers and for patients. It benefits no one at this point. It creates additional workload for providers hospitals and patients alike. I am afraid of what will come in it's place but can't we worse that this shit.

wolverine876 3y ago
> Hospital systems and doctors offices in general lost a shit ton of money last year. It costs 2-3x of healthcare in equivalent countries, with worse results. Where is that money going? > In addition - there is consolidation in the physicians groups. Mom and pop groups are almost unfeasible at this point. Look for venture capitalists to scoop in. Private equity already has, from what I've read.
EVa5I7bHFq9mnYK 3y ago
Maybe we need a revolution, or at least an outsider rule breaker in the office from time to time, to break established monopolies, cartels etc. Any system gets rotten given enough time. Just went out and bought a bottle of Avamys (more modern version of Flovent) for $15 without any hassle. Shed a tear for poor Americans.

ktosobcy 3y ago

Uhm... in Poland there are usually "refill forms" at your chosen / doctors office, you fill it out, drop at the reception and then you get prescription code via sms with which you can claim it at any pharmacy (that has the drug)

betaby 3y ago
[flagged]
- bdunks 3y ago
  Only 10% of the increase in medical cost in the US is attributable to doctor salaries. The remainder is administrative overhead, Rx costs, insurance administration, etc. There are now 10 administrators for every 1 doctor. Since 1970, the number of physicians has increased by 2x. The number of administrative staff has increased by 38x. If each administrator is making 100k+ - 150k+, that's significant cost. Some of these crazy billing practices are due to the private equity buy-ups and consolidation, creating workflows and fee structures that are hostile to patients and doctors, but benefit the PE firms. https://www.commonwealthfund.org/publications/issue-briefs/2023/oct/high-us-health-care-spending-where-is-it-all-going https://www.commonwealthfund.org/publications/issue-briefs/2... Lots more data here: https://www.healthsystemtracker.org/ https://www.healthsystemtracker.org/
  - Eric_WVGG 3y ago
    That kind of lazy thinking drives me up the wall. There's a huge swatch of America that thinks elementary school teachers are bringing home FAT BUCKS because college tuition costs are high. It's the corporations, stupid.
    - bdunks 3y ago
      Absolutely. I used the number of administrative personal * administrative salaries because it's a quick mental visualization. I just reviewed United Healthcare's 2022 10k. In 2022, they had $324B in revenue, and paid $210B in medical expenses. Of the $114B remaining, $85.5B was various operating costs, $28.5B (25%) was corporate profit / operating income (before interest & taxes). Even if all 40,000 employees of UnitedHealth Group were making 200k (they're not), that'd only account for $8B of their $85.5B in non-medical costs. https://www.unitedhealthgroup.com/content/dam/UHG/PDF/invest https://www.unitedhealthgroup.com/content/dam/UHG/PDF/invest...

ClarityJones 3y ago

Prescriptions should not be required.

twobitshifter 3y ago

Had an eye doctor set up a follow visit appointment for my wife. We went for the follow up and he said “I don’t know why i’m seeing you for this” said it looked fine and then asked us to come back again in a month.

QuantumGood 3y ago

One Medical charges $9/month (through Amazon), all video visits are free (if you click the proper link), and I've had multiple prescriptions renewed that way. Three times waited less than a minute, longest wait was 15 minutes, and the app will call you back if you wish so you don't have to keep the app open.

CoffeeOnWrite 3y ago
+1. They also will write new prescription for low-risk things. And you don't necessarily need video, they do it over messages and just ask for photos of symptoms, in some cases.
kettro 3y ago
My company pays for One Medical, and it’s honestly the best practice I’ve been to in the US. I can typically get an appointment the next day, there are tons of offices (in SF), and everyone is kind and efficient. They ask you to set a primary care doctor, but I have had more success with seeing a small group of their more available non-MD physicians.
- gnicholas 3y ago
  What is a non-MD physician? Is that a physician assistant?

deleted 3y ago

[deleted]

derbOac 3y ago

This is why I think US medicine should be deregulated, especially licensing laws. Everything you're describing is screaming monopoly and artificial lack of competition. If providers of class X are too busy to see you, then there's plenty of people who could, or you're just going to do it on your own. It needs to be more like that. Obviously there are some limits, but educational pathways could be much more diverse, and there are many things that patients are capable of accessing on their own or through providers like pharmacists.

gnicholas 3y ago
One easy step is to allow telemedicine visits across state lines.

kelnos 3y ago

Reading a lot of the responses here, I've realized another reason why the fight for a better health care system in the US goes so poorly. People are so used to the costs and being jerked around by the system that they've completely normalized it. "Oh, you should have known those symptoms didn't require an ER visit; it's your fault you got such a large bill." "Every hospital or doctor is going to try to push extra charges like that; you have to contest them or just not pay and hope the problem goes away; that's just how it is." Then someone from outside the US says, "that would never happen in my country; here's how it works here..." and it's immediately assumed there's some sort of huge catch, that never, nowhere could a health care system work that well without some sort of major trade off or downside. No! Stop this! A health care system should work for patients, not against them! Injured or suddenly-sick people are not in the best head space to make rational, informed decisions as to what level of care they need in the moment. Even if they were, nearly all lack the specific medical training that would always allow them make that decision with a comfortable level of certainty. And even if someone should have known better, I just don't get the ire. Why should we put people into tenuous financial situations just because they made a mistake in how they sought medical care? Medical care! What the hell is wrong with people? The US health care system is awful, despite having so many great and talented doctors, nurses, and staff! Let's get that through our heads! We pay so much more than other developed countries, for so much less care. And the reason we don't have something better is because the right public policy is labeled "socialism". This is so exhausting.