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I live in north Texas, and the situation here is pretty much on par with the article. Urgent Care & Emergency Room combos are here on every corner. It’s a lucr

• titanomachy 2y ago
  $300 is your part of a regular doctor visit? Or the total bill? Do you have one of those high-deductible plans designed to discourage people from seeking any healthcare?
  • ghaff 2y ago
    When I was covered by an employer plan, a lot of people seemed to gravitate towards high deductible plans because they were cheaper so long as you didn't consume a lot of healthcare. (Personally, I never did but a lot of people were adamant that you saved money that way.)
    • AlphaSite 2y ago
      You really need to look at how the employer funds it but often those are cheaper no matter what.
      • ghaff 2y ago
        I won't argue. I'd have saved a lot of money over the years with a high deductible plan.
      • dingnuts 2y ago
        not if you have a chronic illness. my wife hits her deductible every year just getting the annual MRI she's required to get.
        • BugsJustFindMe 2y ago
          My high deductible maximum out of pocket is lower than the available other plan's premiums+deductible with equivalent care policies. I save money on a high deductible plan no matter what happens to me medically.
    • philwelch 2y ago
      I’ve long been a proponent of high deductible plans. The part you’re missing is that you also get the opportunity to contribute pre-tax money to a Health Savings Account, which is money that you get to keep (and even invest) over the long term. You can spend that HSA money on medical expenses but if you save it, it turns into another tax-advantaged savings account like your IRA and 401(k).
      • ghaff 2y ago
        I agree. I think I just had a very conservative mindset with respect to medical insurance which led me to a traditional plan. HSA would certainly have been a better choice in retrospect given that deductibles were never really an issue.
      • ryandrake 2y ago
        It's kind of silly they tie these together. Why can't I also open an HSA if I'm on a traditional PPO plan? Or if I have no health insurance as all.
        • phil21 2y ago
          Because a healthcare plan isn’t insurance. You used the correct term. If you want a prepaid healthcare plan that’s fine, just stop calling it insurance since it’s not. Totally agree it should be available for cash pay.
          • ghaff 2y ago
            It's insurance in the sense you have annual out-of-pocket maximums--which is really the key feature for a lot of people. I can cover $5K or $10K for a year but not, say, $100K or more.
      • eadmund 2y ago
        HSAs can be wonderful, but you absolutely have to have a good one. Some of them still pay less than 1% interest and charge monthly fees. The ones which can be invested and have no fees are an amazing savings tool.
  • tbrownaw 2y ago
    > high-deductible plans designed to discourage people from seeking any healthcare This is in fact not the purpose of those plans. They try to actually be insurance (ie, in case of unexpected high expenses) rather than a combination of insurance plus pre-payment of typical expenses.
    • ryandrake 2y ago
      It may not be the intent of those plans, but if it's the result, then that's what matters.
    • alistairSH 2y ago
      But do they actually have that result? Or do they simply put people off of all early care
      • PaulDavisThe1st 2y ago
        as they say on the internet .. por que no los dos? 1. they do (post-ACA) function as effective bankruptcy insurance 2. they likely deter the people enrolled to avoid early/minor/preventive medical visits.
  • phil21 2y ago
    High deductible plans are great. They are designed to allow you to take pretax money out and use it to either invest like an IRA or spend it on healthcare. In other words they are actually insurance. Not a prepaid healthcare plan. No one should be using “insurance” to cover every day expected expenses like random doctor visits for the flu. They are a small fight against the massive principal agent problem which is the sole issue anyone should be focusing on if they care about healthcare costs.
    • PaulDavisThe1st 2y ago
      > No one should be using “insurance” to cover every day expected expenses like random doctor visits for the flu. The inhabitants of just about developed industrial/post-industrial society other than the USA seek to differ.
      • ghaff 2y ago
        That's largely how, e.g. dental works. You (outside of certain company insurance) pay for dental on your own which is also sanely priced.
    • titanomachy 2y ago
      "No one should be using 'insurance' to cover every day expected expenses like random doctor visits for the flu." If it was like $20, sure, but when a "routine doctor visit" costs $300 I'd rather use insurance than deal with the mental load of deciding if it's worth the money. I wonder how many people develop more serious conditions because their high deductible tips the calculus towards avoiding the doctor.
  • 404mm 2y ago
    I was referring to the total bill, in both cases. Sadly, yes, I do have a high deductible plan. The $300+ bill usually gets adjusted to about 50% by the insurance (I’m in network), and then I pay my share, depending on the state of my deductible and out-of-pocket expenses. (So in my case, 90% before deductible is met, then 10%, until I reach my OOP max.) UC bill is processed in a similar fashion, and my actual responsibility tends to be less than from my primary care doctor.
• ghaff 2y ago
  You also have Insta-clinic in chains like CVS. Not sure it's a bad thing. Came back from a trip with minor but persistent cough symptoms that were a LOT like the time I had COVID even though I tested negative. Got an appointment the next day at a clinic with a nurse practitioner who prescribed me an inhaler and said it was a "virus" after listening to my chest, etc. I think I maybe had a $40 bill. Told my primary care at my next appointment and she basically said she'd have done the exact same thing.
  • cameldrv 2y ago
    For some reason these all seem to be closing down. I don't think there any of the CVS Minute Clinics left in California. They used to be in every third CVS or so.
    • ghaff 2y ago
      There are still plenty in Massachusetts. Maybe there's some regulation in CA that makes them financially unattractive.
• swatcoder 2y ago
  3. Demand for immediate care is high. The next "one level up" might explore how much is because the community is quite morbid and unwell, because modern culture has displaced traditional home/self care with consumerized services, or because of other things. There are people I know who are largely healthy and who consult paid medical services many times per year for everyday disturbances, and others who take decades to overcome procrastination to even get a physical. The demand for commercialized health services is very much a cultural thing, especially for everyday wellness, and that culture has been evolving quite dramatically. Meanwhile, there's no ignoring that obesity and sedentary living are rampant, that a recent pandemic spooked people about infectious disease and its possible consequences, etc. You're thinking about the pocketbook economics, here, but looking at it through these other lenses might provide further perspective too.
  • vouaobrasil 2y ago
    It's a shame that we have not preserved more local, "community medicine" that you mention. Unfortunately, the reason is that we have destroyed the community by moving to a model where advanced technology is our primary aid instead of other human beings.
  • ryandrake 2y ago
    > traditional home/self care Not sure what you mean by this? If I have a broken bone, I'm not going to set it myself at home and take a few aspirin. Same if I'm puking my guts out. If you just mean getting exercise and eating healthy then I fully agree with you. But, when you're actually sick, and need to see a professional, that is the right time for "consumerized services".
    • swatcoder 2y ago
      You're welcome to take it as foolish pre-modern ignorance if it strikes you that way, but actually yes: many people do not think to go to a doctor for minor bone injuries or vomiting, and many more than that wouldn't think to do so for more common everyday illnesses like a familiar sore throat, rash, nosebleed, fever, etc For some, this is rooted in a confidence in their own personal-community care, for others its an insight into what few actions a doctor might take themselves for these issues, etc There's lots of ways to explain it, and certainly many of them can be easily criticized by people who see professionalized medicine differently, but you may as well let go of the idea that everybody out there approaches it in the same way that you do. It's probably not even all that consistent among your own circle of family, friends, and acquaintences. We're still only in the beginning of what seems to be a sweeping cultural transformation around how people see health and medicine and the perspectives people bring are still quite diverse. At the same time, the overall direction in recent decades is definitely towards seeking commercial medical care for more concerns as well asserting that this is an entitlement that all people should have access to.
• agentcoops 2y ago
  It's funny, my first job out of college was machine learning for a company processing medical bills to detect fraud on the part of hospitals. It was a very eye-opening process for me as to how American health care is perhaps the worst designed system conceivable by man -- as in, it's genuinely difficult to imagine how the various regulations, incentives etc could be made worse from any perspective (left or right) or measure (human care, cost, equality, whatever). Medical diagnoses are systematized in a rigorous manner through a series of codes (ICD9s, CPTs, DRGs etc), but there is no real set or expected pricing for each code apart from Medicare and these strange agreements between particular insurance providers and particular hospitals (i.e. what defines "in-network" or "out-of-network", where pricing is more or less random). Bills also have an explicit location type (Inpatient, Outpatient, Emergency room, Ambulance etc) and Urgent/Emergency Room care is significantly and consistently the most expensive to the insurer (most American insurance is, after all, high deductible emergency insurance) and thus one of the major vectors of fraud was passing bills off as such. One of the real aspects of madness in the whole system is the pricing disconnect and lack of transparency between all participants: hospitals ask an agreed upon price to insurers who pay it with few questions asked, as hospital pricing drifts up insurers raise premium prices, employers keep paying premiums, and individuals either pay something contractually determined by their insurance company or an essentially random price if uninsured. TLDR; it isn't at all surprising to me that yet another vulture on American health care expenditure has discovered how profitable emergency rooms can be and that we see such a mad proliferation of urgent care facilities on every corner.
• kevin_thibedeau 2y ago
  The FTC really should put a stop to labeling community ERs as Urgent Care when they aren't subject to the same billing regulations and are just an excuse for a predatory money grab.
  • 404mm 2y ago
    From what I see around me, they advertise that they are both Urgent Care and Emergency Room. UC hours of operation end in the evening, and coming in past the COB automatically puts you to ER billing and pricing. But if you come in during UC hours and the procedures are outside of UC, you can still end up being billed as an ER customer. The difference is usually in thousands.
• hakfoo 2y ago
  Triage is hard. People may be mis-judging which is the appropriate service provider for their needs. If they don't know what's wrong they may worry that they stumble into a GP, and he just calls the ambulance/steers you to the ER anyway.
• Cthulhu_ 2y ago
  These pain points are present in the UK as well; a ton of people have to go to A&E and wait for hours there because their primary caregiver / GP is booked full. 1-2 days wait up to a week for non-urgent care sounds fine to me, but at $300 it's a bit ridiculous. People end up getting worse and cost the system more, so the cycle continues.