8 ms·

Greg Knauss's 10-year-old son's $23,800 bug bite

133 points by anu_gupta 14y ago

_delirium 14y ago
Even though I've been researching with interest, so far I haven't run across much in the American healthcare system that makes me question my decision (as an American) to move to Denmark. My taxes are higher, but my costs are very predictable, and by design cannot ever bankrupt me: I pay a flat 8% of my income to support the national healthcare system. I won't end up with a charge equal to 20% or 50% or 500% of my income in any circumstance, not even if I get cancer or find myself unemployed. So it's guaranteed that I will always be able to pay my healthcare costs without great hardship. I do hope someday to move back to the USA (mix of language / "feels like home"), and am mildly hopeful that PPACA will make it feasible, by 2014, for an individual to buy private health insurance without worrying about preexisting conditions and rescissions and whatnot. But we'll see. For now, Danish is growing on me. :P Incidentally, this kind of emergency care would be free even for a tourist in Denmark. Regular use of the national health system is only available to legal residents, but acute emergency care is considered a basic service not subject to billing, like police and fire response.
- vegardx 14y ago
  Life saving treatment is usually like this all over the world, and in Denmark they will give you a bill unless you're apart of EU, as you'd have the EU health insurance (EHIC), which is free. This card is also valid in countries in the Schengen Area, like Norway, Switzerland and Lichtenstein.
  - _delirium 14y ago
    Many countries bill for emergency stays. US emergency rooms definitely send bills, even if it's acute live-saving treatment. Even Canada, which has national healthcare for residents, will bill nonresidents who visit an ER. If you're from another country, you may get away with just not paying one of those bills, because if it's life-saving care they have to provide it before verifying you can pay. But they'll still try to collect on it. That's one reason it's common for people to buy travel health insurance that covers emergency care. Afaik, Denmark doesn't require the EHIC for acute emergency care. Anyone is eligible for unbilled emergency care, with some exceptions to combat medical tourism (if you're found to have traveled to Denmark for the specific purpose of entering an ER to treat a health condition). The EHIC qualifies you for some additional care, e.g. childbirth. This is actually a big current sore point in Danish politics, because many other EU countries don't extend a reciprocal courtesy.
    - waqf 14y ago
      > Even Canada, which has national healthcare for residents, will bill nonresidents who visit an ER. Even Canada? Canada by its location would be at acute risk for medical tourism from the US, if it didn't bill for ER treatment. That problem isn't as big for Europe, Australia, etc.
      - _delirium 14y ago
        That makes sense, I agree. The "even" was more given its reputation: most Europeans I know are not surprised that the US sends large bills for ER visits, but don't expect the same from Canada. I could almost imagine a financially manageable system where Canada gave free ER care to anyone except Americans, but that would produce obvious political problems.
    - vegardx 14y ago
      You're still stuck with a bill, if you're a foreigner. They will treat you, like they will in most of the world. But you're still stuck with a bill afterwards. Also, unless my memory is totally off, each country has to pay up for EHIC, depending on who used what, and visa versa. So the cost should be evened out. Edit, because I cannot reply to you later down: I think we have a different view on what emergency medical care is. In most of the world you will get fixed up so that you are no longer in life threatening condition, this is the case in USA, Denmark and Norway. But afterwards you will have to pay, even in Denmark, as long as you're not apart of EU and have the European Health Insurance Card or a citizen of any of the Nordic countries, which has a special agreement.
      - _delirium 14y ago
        That isn't the case; Denmark simply does not charge for acute emergency visits, and does not send a bill. In addition, they pay for their own residents who incur such bills within the EU on trips under 30 days [1], which is part of the controversy: a French person who ends up in a Danish ER is not billed, but a Danish person who ends up in a French ER is billed, with the bill paid by the Danish government. Most Danes would prefer that each country provide free emergency care to all, like they do with fire and police. [1] http://www.sos.dk/en/Corporate/OurNetwork/ForMedicalFacilities/TheDanishTravelHealthInsuranceScheme/ http://www.sos.dk/en/Corporate/OurNetwork/ForMedicalFaciliti...
- marquis 14y ago
  Having experienced emergency care in both Denmark and the U.S., this is also the main reason I won't relocate to the U.S. until this is sorted out. I had what was thought to be a broken ankle in Denmark thanks to icy conditions and I was so well looked after, and charged nothing, I was awe inspired and wish there had been some way to pay it back. I sliced a finger in the U.S. and was made to feel like a statistic, with a $1000 bill. Thanks to inexpensive travel insurance that cost me just $100, but how I am supposed to feel when my travel insurance is less than quarter of the price that actual insurance would be if I lived there? (Edit from reading other comments: probably not charged in Denmark because of European health reciprocity, but they never verified this at the hospital).
  - encoderer 14y ago
    It's not fair, and not right, but it is a fact that for the most part, most of us here don't have to worry about that. If you're a software engineer or systems administrator or similar type of professional earning a fair living it's not at all uncommon to have completely free health insurance for yourself, and affordable options to cover your family. I haven't worked for a place with an individual premium in 5 years. Again, not saying the system isn't broken, but rather that there's a reason all Americans aren't vocally supporting the ACA and the president: this is mostly a lower-middle-class-and-below problem
    - _delirium 14y ago
      I agree, and I feel it used to work even better in that respect, when educated Americans typically had lifetime employment. I would guess that's one reason the debate is growing louder lately. The West basically solved the healthcare problem via collective coverage, but in different ways: the European countries did it nationwide, but the US did it with employer group plans. That was almost equivalent, for people with good jobs, as long as people stayed in jobs for life: having the IBM group plan was about as good as having state health coverage, as long as the IBM job was more or less for life. It's more broken if you're middle-class-or-below (as you mention) or an entrepreneur who isn't either early-20s-and-healthy or raking in huge piles of cash. The part that seems most out of keeping with the American ethos is how anti-entrepreneur it is: you get good collectivized coverage if you work for IBM or Microsoft or Google (because it's socialized across their employee base), but if you start your own company or are trying to buy insurance for a 10-person company's employees, well then you're screwed.
- forrestthewoods 14y ago
  8% sounds great. US currently spends around 16% of GDP on health care every year. I think the majority of Americans would support a universal health care system that provides far more coverage at half the cost. Instead our total spend is expected to double by 2020. Source: http://money.cnn.com/2011/07/28/news/economy/healthcare_spending_forecast/index.htm http://money.cnn.com/2011/07/28/news/economy/healthcare_spen...
  - vegardx 14y ago
    Should be noted that there is not a direct correlation between tax paid for health care and cost of health care. It's heavily subsidised by the government, from taxes taken elsewhere. In Norway it's like this: Senior citizen: 4,7% Employed: 7,8% Self-employed: 11% Last time I checked we spent around 9% of GDP on healthcare.
  - anonymoushn 14y ago
    The great thing is that this expense grows at a rate of 9%/year while the economy is stagnant. If GDP miraculously and immediately begins to grow at 5%/year, health care spending will completely eclipse it in 50 years. If it does not, health care spending will completely eclipse it in 28 years.
    - lesterbuck 14y ago
      Herbert Stein's Law: "If something cannot go on forever, it will stop." The only question is how the rate of growth will slow/stop.
  - tptacek 14y ago
    Worth noting that the US leads Europe in outcomes for serious illnesses (particularly cancer), and the US provides access to specialists in days where other countries often have multi-week or even multi-month delays.
    - olefoo 14y ago
      Yes, but, europeans generally see a healthcare provider more often and are more often diagnosed before they reach an acute stage. If you look at the graphs [1][2][3] that compare per capita expenditures per country with life expectancy per country. You'll see that they are generally getting equivalent or better outcomes at less than half the cost. And I can tell you that for my own part, even with health insurance, the deductible is so high that it might as well not exist as far as basic checkups and doctor visits go. 1 http://ucatlas.ucsc.edu/spend.php http://ucatlas.ucsc.edu/spend.php 2. http://blogs.ngm.com/blog_central/2009/12/the-cost-of-care.html http://blogs.ngm.com/blog_central/2009/12/the-cost-of-care.h... 3. http://www.economist.com/blogs/buttonwood/2011/03/health_costs_and_life_expectancy http://www.economist.com/blogs/buttonwood/2011/03/health_cos...
- fernly 14y ago
  What is your legal status in Denmark, and how did you achieve it? Are you a "resident alien" or an immigrant or what? What restrictions/hoops did you have to jump to get permanent residence status? What did it cost?
  - _delirium 14y ago
    Unfortunately it's not the most friendly country for immigration, partly as a result of the right-wing coalition that tightened rules over the past few years (Sweden is better, as far as the Scandinavian countries go). But there are some exceptions: it's easy for EU citizens (due to being in the EU), and it's easy if you have a professional-level job offer (no US-style H1B quotas). I'm a researcher hired by a Danish university, which made for a fairly easy fast-track visa under the "researchers scheme" [1]. In fact the entire process was by mail and took one round-trip: I mailed my passport, offer letter, photos, and application to the NYC consultate, and they mailed back my passport with a visa pasted into it. Most professionals with an offer will also be able to get a visa; it's not nearly as restricted as getting U.S. visas is. If you have an offer that pays more than 375,000 DKK ($63,500), you qualify under the "pay limit scheme" for similarly preferential treatment [2]. Getting permanent residency depends on if you're an EU citizen. If yes, it's just a matter of remaining in the country as a legal resident for at least 5 uninterrupted years. If you're from outside the EU, there are more requirements [3], including that you must be employed for 3 of the 5, and must pass a language exam establishing basic competence in the language (which is unfortunately quite difficult to speak, though the grammar and vocabulary are not particularly difficult). I must also give them kudos for giving all of this information in not only English, but straightforward, non-legalese English. Dealing with the Danish state is generally not a horrible experience so far, even for someone who speaks no Danish. [1] http://www.nyidanmark.dk/en-us/coming_to_dk/work/researchers.htm http://www.nyidanmark.dk/en-us/coming_to_dk/work/researchers... [2] http://www.nyidanmark.dk/en-us/coming_to_dk/work/pay-limit-scheme.htm http://www.nyidanmark.dk/en-us/coming_to_dk/work/pay-limit-s... [3] http://www.nyidanmark.dk/en-us/coming_to_dk/permanent-residence-permit/ http://www.nyidanmark.dk/en-us/coming_to_dk/permanent-reside...
    - fernly 14y ago
deleted 14y ago
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theoj 14y ago
Hospitals often bill 5x-10x actual costs to make up for the "discounts" that insurance companies force upon them. If you're uninsured and get hit by a huge bill, you need to negotiate with the hospital to bring the amount down. Doubly so, because hospitals have lax tracking of costs, and no one really knows how much your visit really cost. More about this from an actual MD: http://truecostofhealthcare.org/hospital_billing http://truecostofhealthcare.org/hospital_billing
- TheAmazingIdiot 14y ago
  I'd be more for using informed consent laws to argue that you would not have proceeded with treatment had you known how much it cost, or the costs related to failure of procedure. Our medical system is the worst of capitalism, and the worst of socialism. Tell me again: Where are the prices?
kefs 14y ago
As a Canadian, I couldn't imagine having to decide between money and healthcare. I don't know how you guys do it... Relevant reading: http://www.rhrealitycheck.org/article/2012/07/12/how-i-lost-my-fear-universal-health-care http://www.rhrealitycheck.org/article/2012/07/12/how-i-lost-...
- fleitz 14y ago
  I'm Canadian but lets be realistic, there are many things that would cause serious financial hardship due to medical costs in Canada. A friend of mine right now is suffering through intense pain from her teeth that aren't being fixed because she doesn't have money/insurance. She's deciding between healthcare and money. You can also lose your life on a waiting list in Canada. Not much purpose in having $23K in the bank but being dead. For sure you're not going to get a $23K bill for a bug bite but you will pay $3000/month for chemo, etc. Lots of things aren't covered by medicare, and they're quite expensive. Canada is more like a $23K bill for getting cancer, or other long term/terminal illnesses.
  - kefs 14y ago
    Chemo is most definitely covered for me.. just as everything else that would be medically required. http://www.health.gov.bc.ca/msp/infoben/benefits.html#notcovered http://www.health.gov.bc.ca/msp/infoben/benefits.html#notcov... Nothing you have commented with is based on fact. Edit: OP added a ninja-edit to his comment that included the part about teeth-pain... as my link explains, non-emergency dentalcare is not covered by default.
    - cperciva 14y ago
      The BC government doesn't pay for my insulin. As a type 1 diabetic... yeah, I'd say it is medically required.
      - kefs 14y ago
        Medicines, in BC, are covered under a separate plan.. Pharmacare. As far as this goes, insulin is covered: http://www.health.gov.bc.ca/pharmacare/generalinfo/generalinfoindex.html#What http://www.health.gov.bc.ca/pharmacare/generalinfo/generalin...
joni123 14y ago
Silly americans... in my country, it's obligatory to have health insurance and if you cannot afford it, the government will pay your insurance, for god's sake. Not even the most conservative and right-wing politicans who see our freedom in danger when we can't keep fully automatic assault rifles at home anymorehere question this system, because it just makes sense.
- retillit 14y ago
  Can someone please explain to me the purpose of an insurance company when participation in the pool is mandatory? A policy like this seems like it creates a legislated middle-man that just wastes money.
  - nisa 14y ago
    Not sure if you are joking. Having everyone inside the pool makes up for members with chronical illnesses and other illnesses that need a lot of care. Some still healthy young poeple pay maybe a little bit more but everyone can be treated reasonably well. If you run an insurance without mandatory participation people with problematic illnesses are a risky for the business and that is one reason why the op can't get an insurance in the USA.
    - suresk 14y ago
      I think the point retillit is trying to make is, why even bother with private insurance companies if insurance is compulsory? Which is a good question. The answer, I think, is partially politics, but also partly whether you think the competition a system like this (in theory) encourages outweighs the cost of profits.
  - spiralpolitik 14y ago
    Because getting rid of the middle man is considered socialism in these parts and that doesn't fly with Joe and Jill six pack. (Unless of course you are talking about Medicare then its the most patriotic thing since apple pie).
  - 14y ago
T_S_ 14y ago
Reminds me of my kid's $6000 bump on the head. Or the time I had and knee operation and they took five minutes extra to clean out something they spotted and added $3500 to the bill. Or the eye operation where they took fifteen minutes extra because there was a detached retina adding $9000 to the bill. (Insurance wouldn't pay that one. They never said why either.) You are not exactly going to negotiate at moments like these.
- TheAmazingIdiot 14y ago
  Insurance companies make more money if they refuse payment. I've always liked the old Chinese medicine system. You find a doctor who is willing to take you as a client. You pay the doctor money per month when you are well. If you are sick, you do not pay. Of course, refusing treatment is acceptable to get you disqualified, as are a few other things.
  - tylee78 14y ago
    nice system! sounds like it has a market principle built into it...
    - brazzy 14y ago
      Except it breaks down completely when there are expensive drugs and procedures.
abtinf 14y ago
This is an inappropriate article for HN.
- fiatmoney 14y ago
  You know what's a huge barrier to entrepreneurship? Needing the insurance that comes with a BigCo job, so you're not ruined financially when your kid gets bit by a bug. I know many people who have this explicit rationale for not founding or joining a startup.
  - abtinf 14y ago
    Then they are grossly misunderstanding relative risks and shouldn't be launching their own startup. And its terrible reasoning. Existing law already provides for cobra, giving them an 18 month window of coverage in which they can retain your employer's insurance (by paying the full premiums). That's more than enough time to validate an idea and secure insurance in the new company, or fail and spend 6 months finding a new job. Or if you are an engineer, 1 month finding a new job.
    - lsc 14y ago
      sure, if you are using the "build a prototype, get investment, move from there" model... that's fine. Personally, I think bootstrapping, taking no outside investment at all is also a completely reasonable model (and often ends up with a more sustainable business, and can be executed by people that lack the sales skills to get investment) If you are bootstrapping? 18 months is not a reasonable period of time to get something to the point where you can get group coverage. (In most states, to get group coverage, you need at least two employees on that insurance.) also, I think it's quite valid to support yourself doing contract work. same problem; if you don't want a body shop to take half your pay, well, you need two employees before you can get group coverage.
      - bhb916 14y ago
        My company bootstrapped and we just initiated a group policy 13 months after our doors opened. This is, of course, anecdotal, but I think it's very well in the realm of possibility. Regardless, even in states like CA high-deductible plans (i.e. catastrophic care plans) are very much attainable both by small businesses and by individuals. Contractors in the US get hit with a fairly sizable self-employment tax. This tax would no doubt go up to fund any sort of universal health insurance. Regardless, I don't see the need to 'scratch your entrepreneurial itch' as a valid reason to stick you neighbor with your medical bills.
ojiikun 14y ago
Every time a healthcare discussion comes up and everyone gets derailed on whether (or how much) to socialize things, I wonder the following: from a technology, taxation, and moral standpoint, what the hell led to a system where some heavy-duty antibiotics cost about 10-15X what they should? More importantly, why do generally intellegent audiences get caught up in arguments over socialism rather than correcting the cost issue first? Is it sue-happy lawyers, is is an anti-competitive marketplace, or is it the pushing of the very concept of insurance that has given us such an unsustainable system? I truly want to put out a call to geeks: for every healthcare dollar you spend, grill your provider. Haggle them down, and make them justify the price, or we're all screwed, no matter who is paying for things.
- abtinf 14y ago
  The reason is simple. Many folks, myself included, hold the view that it is government intervention that has led to the insane system currently in place. Eliminating the perverse healthcare system forced on us by current policy IS the way to control the cost issue.
  - cma 14y ago
    Most other industrialized countries have heavy government involvement and pay half what we do with the same outcomes. We just have a hybrid system with capitalism applied in the stupidest way..
    - bhb916 14y ago
      This statement sounds totally odd to me on both ends. First, the US pays more in a lot of markets. By and large, that's because we can. Second, capitalism isn't applied. That sounds like it's some sort of regulatory tool that just isn't being used correctly. Capitalism is the absence of government force in an economic market with the notable exception of enforcing private property rights. You can say a lot about the US healthcare situation, but "applied capitalism" it is not.
      - 14y ago
davidf18 14y ago
In the US there are many community health centers. NYC alone takes care of 450,000 people without any insurance at all through CHCs and other sources. The very poorest generally have Medicaid in NY State, so the uninsured might be people like waiters. At any rate, there are community health centers throughout the country. One issue that I have with the Obama Affordable Care Act is that they should have put much, much more money into the CHCs.
jellicle 14y ago
If he's still in the hospital and thinks the bill is $23K he's got a surprise coming. The bills will keep coming for months. Many items may be billed multiple times. Writer is going to have to invest several man-weeks in dealing with this, minimum. I talked to a friend of mine who received some treatment recently. He made sure the hospital was "in network", but apparently someone who came in to give a shot was "out of network" - personally, for herself only - so he received a huge out of network bill for the services of one nurse in giving one shot. He asked the insurer if he was supposed to quiz each medical person in the hospital about whether they were in a particular insurance network before allowing them to provide treatment. The insurer's answer was "yes", with no irony.
- russell 14y ago
  Anesthesiologists are the worst offenders. My experience is that none of them are in network. You think you have everything covered and along comes this bill that is as big as everything else. Woe to you if you are uninsured. I had minor heart surgery nearly two decades ago. The bill was something over $80K. The insurance company disallowed most of it, bringing it down to $20K of which I had to pay $2K. Except for the Anesthesiologist.
  - ysopex 14y ago
    Why is it that you can't go to a medical facility and tell the intake nurse or admin person you're not agreeing to any procedure that's not covered by your insurance. Wouldn't that put the onus back on them? Anything not covered instantly becomes a freebie or a lawsuit? Why do hospitals and clinic get away with this crap when auto mechanics and plumbers can't?
    - eli 14y ago
      What makes you think anyone else would take on the liability of vetting your care for you? And for free?
      - evolve2k 14y ago
anonymoushn 14y ago
The bill would be much higher if he paid with cash than if he paid with insurance. I'm curious to know how much. I expect would be at least 3x the amount the insurance company must pay.
dollar 14y ago
The question no one ever asks is "why is the bill $23,000?". The only question that ever gets asked is "who should pay this $23,000 bill?". I charge $200/hr for my time at a minimum. Did this child really receive an equivalent of 2.8 weeks of my time in services? Or did an unecessary middle man negotiate ridiculous prices with the provider, leaving the consumer out of the equation but responsible for the bill? And yet people seem to think that more unnecessary middlemen will make the situation better.
- kdsudac 14y ago
  You can figure try to figure out the "why" for specific cases but it's tedious work and comes down to subjective opinions that can't be generalized to other cases. The theoretical worth of the shadowy middlemen (whether they gov't or insurance companies) and where the blame lies can be debated. All these arguments rely upon theoretical simplifications of very complex systems--meaning they are almost impossible to model. What's more important is the "what" as in what are our alternatives. Luckily, we have tons of empirical data from other countries and they all tell the same story: America pays more money, with poorer results. So why not just copy the models of other countries?
  - tylee78 14y ago
    After 15min ER due to a strained wrist the bill was $4100 dollars. We demanded detailed itemized bills and send letters to the doctor (billed separately) and the hospital. The doctor dropped his bill from ridiculous $900 dollars (for saying everything was alright and taking 5 mins to open a tiff file on his computer) to $200 after our complaint. His bill and the hospital had up-coded our visit and tried to hide the costs of their ill-managed hospital by billing a piece of cloth (made in Guatemala) with $500, the price of an iPad.
- mikeash 14y ago
  Really? Nobody ever asks? Whenever the subject of American hospitalization comes up, the question of why the bills are so insanely high is pretty much the only question people ask!
petercooper 14y ago
Naïve European who'd pay nothing for this here (ok, taxes, but supposedly we still pay fewer % of our GDP overall) with a question: I’ll have to have to pay less than 6% of that, because I’m lucky enough to still have insurance. Why? If you have insurance, shouldn't that cover the whole expense? Or is it a bit like an excess on a car insurance policy? Can you get insurance that covers everything?
- slap_shot 14y ago
  It depends on the policy. http://en.wikipedia.org/wiki/Deductible http://en.wikipedia.org/wiki/Deductible http://en.wikipedia.org/wiki/Copayment http://en.wikipedia.org/wiki/Copayment
- wmf 14y ago
  Coinsurance/copays prevent moral hazard. If people paid nothing they would have an incentive to overuse insurance.
- smsm42 14y ago
  Did you ever have car insurance or any other kind of insurance? Most insurances have deductibles, and the point of that is that insurance is to prevent catastrophic loss, not every expense. There can be insurance that covers 100% of expenses, but it will be very expensive, especially for health, as it won't be insurance at all. Imagine that 1000 people pay each $100 into insurance pool. Then if somebody has a problem there's $100000 available for him, and if the chance of this problem is 1/1000, then this works. Now imagine each of these people has $50 in regular expenses that they want to be paid from the same pool. Then to get the same coverage one needs either to pay additional $50 into the pool (which then is not insurance but just a very expensive savings account) or accept that his coverage dropped by half. And that's not counting insurance company's cut, which makes it worse.
  - petercooper 14y ago
    Did you ever have car insurance or any other kind of insurance? Yes. I go with the largest excess possible (what I assume is also called a deductible) because the chance of making a claim is low. But it's only 10-20% more to have no excess at all. The logic in your second paragraph makes sense on the surface, but the lack of a deductible in many European-style health systems doesn't seem to result in a larger share of GDP being spent on health (which is notoriously high in the US) or the healthcare being of a lower quality.
api 14y ago
The US healthcare system combines everything that is bad about a state-run socialized system with everything that is bad about privately funded care. To add insult to injury, we do not pay substantially less taxes than, say, Canadians. If we paid Costa Rican taxes I'd be fine with it, but we don't.
- Evbn 14y ago
  Costa Rica has universal health care funded by their not having a military, IIRC
- jerf 14y ago
  This is why I think even if you are in favor of socialized health care, you really ought to be against the PPAFA. It's not "socialized health care", the glorious ideal you have in your head where everybody takes care of everybody and it's all smiles everywhere. It's an ungodly abomination of a thousand pages of hastily thrown together legislation with a bajillion moving parts, dozens of newly created agencies, what is basically gibberish in terms of who is paying for what driven more by what voters needed to hear than any resemblance to reality, and then after all of that, was brutally beaten by the legislative process until it could barely assemble a coalition to drag it across the finish line in a horrifically compromised state. Trying to explain why this is a good idea and trying to explain why socialized health care is a good idea are two things that should not be done at the same time. If you think it's bizarre how many people aren't buying into the whole nothing-but-smiles theme now, wait until after a few years of experience with this turd. The whole "Oh, the monstrous heartless conservatives just want to throw granny over the cliff so they can save a buck" is just a propaganda smokescreen put up so you don't look too much at the actual product you're pitching beyond the catchphrase level. Personally I feel some people are being pretty careless about what will actually happen to real people while they are moving abstract political footballs labelled "socialized healthcare" around without caring what's behind the abstraction. I know the abstract progress may feel good today, but the reality isn't going to stay behind the abstraction boundary.
  - _delirium 14y ago
    I don't really support the outcome (I want real socialized healthcare), but as far as I can tell PPACA is at least better than the status quo. It seems like it'll make it possible to buy individual health insurance, which will actually cover healthcare, and won't be jacked up when you get sick. That's at least one improvement over the current system, which is completely broken unless you're in a quasi-socialized health-coverage pool, like those provided by large corporations' group plans.
clarky07 14y ago
I don't think kidney stones are really going to get someone denied for insurance. There is no reason I should have to pay for your healthcare. I pay for my healthcare. You pay for your own damn healthcare. (note that I am self employed and had no problems getting a high deductible health plan). Now if when you say you are short and stout (or however you worded it) you actually mean you are 500 pounds and obese, then get on treadmill. Absolutely no reason I should have to pay for your healthcare because of your poor life decisions.
michaelochurch 14y ago
This country is still suffering from slavery and racism. We would have had socialized healthcare in 1948 were it not for the fucking asshole racists who didn't want to desegregate the hospitals. Our basketcase of a healthcare system kills 45,000 people per year. That's a 9/11 every 24 days. It's inexcusable.
abtinf 14y ago
For complex reasons, I was without insurance for a couple days last week. I happened to have an appointment schedule. I went into the clinic and, since it was my first time there, I filled out a stack of paperwork. And then they told me my insurance was inactive. So I figured, whatever, I'll pay it out of pocket and file for reimbursement. I asked how much the specific service I was requesting would cost. And they had no idea. They refused to tell me, other than to say "well, we charge a hundred dollars up front and then you pay the rest of the bill after you are done". I ask to see their cash price list, because every sane facility I've ever been to has a cash price list with prices that are 1/2 to 1/4 of the insurance price. And they don't have one. So I ended up leaving. It's amazing just how perverse health insurance has become, that it can so affect the delivery of medical care that the facility cant/wont give an up front estimate. I wasnt even there for anything complex - just a standard glucose diabetes test. They probably do ten a day.
- sehugg 14y ago
  I have also seen these places. Some of them will tell you the doctor has gone to lunch when you tell them you have individual insurance. There are "direct access" clinics that can perform lots of blood tests without a doctor's help at a low cost -- $5 to $20 per panel. Fill out a form, draw a couple vials, go home and your results come in the next day. What's frustrating is that you aren't typically told about these options, and so you end up paying five times as much out of pocket to have the doctor be your gatekeeper. So then you're tempted to say screw the doctors and use the internet to perform your own diagnoses. It's a shame we have such an antagonistic healthcare system, and I don't see how it can get better as long as the medical industry expects to book profits at a faster rate than the growth of the population.
- tptacek 14y ago
  Last year, my daughter caught a stomach bug and for a few days woke up each morning nauseous. We took her to her pediatrician and were surprised to find out that "waking up nauseous" is a Big Deal; it can be a neurological symptom. We were pretty sure that wasn't it (there were... other symptoms... corroborating our "stomach bug" hypothesis) but the doctor was adamant: if she kept waking up and puking, she'd need to get imaged. She got better and we cleared her to go on vacation with her grandparents, and were just about to get on a plane to go give a talk at Black Hat, when we got a call from our parents in Michigan telling us she was puking again. We called the doctor, who demanded we retrieve her and scheduled a CAT scan. We are at this point freaked out for a variety of reasons, some of them logistical (trip to conference, driving back/forth to Michigan, &c) but also from the fact that our doctor knew what an epic inconvenience all was and was absolutely clear "daughter needs CAT scan" --- so in the back of our heads there's gnawing "something could really be wrong" (Adia had seizures when she was 4, which, by the way, GUESS WHAT DING DING DING UNINSURABLE ON PRIVATE MARKET NOW, and now 7 years later I still can't even hear she has a headache without taking an inventory of all other possible symptoms.) So anyways, we want that CAT scan done now now now yesterday now. We get to the hospital for our appointment and: problem with our insurance card. No big deal, we'll just resched--- fuck that, I'm paying cash. Head scratching ensues, long story short, very large hospital in Chicago doesn't have any price list for a CAT scan at all. Not even an insurance cost to pass on to me, let alone a cash-basis discounted price. Getting imaging done at a top hospital in Chicago without insurance: unheard of. They ended up just making up a price on the spot; $1000.
rkischuk 14y ago
This is putting things exactly backwards. The argument is roughly "Treating a minor condition cost $24k, which could wipe people out financially, therefore PPACA is important." Where is the outrage over this price? What part of PPACA does ANYTHING to reduce this cost? PPACA does essentially 2 things: 1) It makes insurance "affordable" for people who previously couldn't obtain it at all. 2) Drastically increases demand for health care, without adding to supply or controlling costs any other way. Insurance is simply a distribution of cost over a risk pool. If relatively mundane life happenings cost $24k, and nothing is being done to fix that, we're in real trouble, and I think we are. Nothing done to increase the pool of doctors. Nothing done to control medical lawsuit costs, which transfer money from the insurance pool to individuals. Nothing done to control the cost of drugs (and in some cases, aggravated by making more expensive drugs "free"). Bring the cost down to $2,400 and "wiping people out" isn't as big a concern.
- zaphar 14y ago
  It wasn't a minor condition. It was a staph infection. Don't let the term bugbite mislead you. His son wasn't in the hospital for a bugbite. He was in the hospital for a life threatening infection from an antibiotic resistant infection. That is far from minor. Disclaimer: I'm not arguing for PPACA in any way but if you are going to base you argument on billing for a "minor" condition then make sure it's actually a minor condition.
  - rkischuk 14y ago
    So... MRSA Staph Infection... what is the cost to correctly diagnose? And what is the cost of the antibiotics? I'm not a doctor, but most non-boutique antibiotics are dirt cheap. I didn't intend to trivialize the illness. I more meant that this could happen to _anyone_. And if this is the cost for things that can happen to anyone, we have a real problem on our hands. Much like it's a problem that a basic, no-complications, baby delivery costs $15-20k. Insurance is math, and the math gets scary quickly unless costs are controlled.
    - zaphar 14y ago
tptacek 14y ago
A young coworker had an ATV accident. It was ugly, but not so bad that they weren't on IM within days talking about work. Total bill: just shy of $100,000. A friend's son had appendicitis. Uneventful appendicitis. Total bill: neighborhood of $35,000. Add to this: tens of millions of people are, despite any debilitating medical conditions or even better-than-even likelihood of incurring anomalous medical expenses at all, actuarially precluded from getting insurance on the private market. There are very long lists of widespread health conditions, most of them "chronic", most of them minor, that will land you on automatic exclusion lists (not "we will cover you but not for this condition", but, "we will not issue a policy for you at all"). Particularly if you are a woman with a functioning reproductive system. Once again I say: I cannot understand how anybody who runs a software business or who aspires to run a software business could possibly oppose guaranteed-issue health insurance. I dealt with many dramatic problems during the operation of the company I cofounded in 2005, but the only one that was almost intractable was trying to obtain private coverage for my family. Fortunately, my wife Erin got a tech job with group health coverage and we dodged the bullet until Matasano got its own group plan. Employer-sponsored group health insurance is a terrible system. It increases costs on new businesses and adds uncertainty to their financial planning, while at the same time retarding labor mobility. It introduces a principal/agent problem between the people selecting plans and the people who use them. Because this idiotic scheme is tax-advantaged, it incentivizes the creation of a bizarre slush fund with warped, collusive prices. At the same time, because users of health care never directly pay for it, it encourages people to make dumb decisions about their own care. People should buy their own insurance. Insurance companies should be forbidden to decline applicants, or to constructively deter them with shady pricing schemes. People should not be allowed to exploit that requirement by waiting until they get sick to apply for coverage. The requirement should be nationwide, so that states that offer sane insurance regulations don't get sabotaged sick refugees from other states without sane insurance regs. Minus the Medicaid expansion, which I'm ambivalent about, this is what we worked out in 2010.
- whirlycott1 14y ago
  One solution (which obviously won't for everybody): live in Massachusetts. We have excellent health insurance plans available here: https://www.mahealthconnector.org/ https://www.mahealthconnector.org/ I'm using one now.
deleted 14y ago
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noonespecial 14y ago
The (big) problem isn't really that there are people who may or may not have insurance to protect them from 24 kilobuck bug bites, its that we've let so much friction build up in our system that it has come to cost this much to treat even simple maladies. We're so busy worrying about who should pay what we don't ask the big one: why the hell does it cost so much in the first place?
douglee650 14y ago
join my battle cry: just stay alive until 2014 portability is a key provision will take away the chains employers use to bind, threaten, and subjugate employees; using their families health.
useful 14y ago
It costs $121/month for 100% coinsurance, no copay, and a 3000 yearly maximum cost in network. Can no one spend <10% of their income on their health?
- _delirium 14y ago
  Maybe if you're in your 20s and were lucky enough to have no childhood health conditions. In the real world, that isn't the case for many people. How much does individual health insurance cost if you were born with a congenital heart defect? Or if you were diagnosed as a child with autism?
Stratoscope 14y ago
> We’ve got a strategy for dealing with the COBRA expiration, but it’s complicated and requires a lot of hoop jumping and is more than a little silly. Whatever the author's strategy is, it sounds like he's quite misinformed. There are no hoops required to get HIPAA guaranteed issue coverage when COBRA runs out. All insurers are required to offer it regardless of preexisting conditions. It will cost more, but coverage is automatic with no medical information required. The usual procedure is to simultaneously apply for underwritten coverage and guaranteed issue. If the underwritten policy is declined, the guaranteed issue takes effect. If you know you'll be declined, you can skip the medical history on the application and apply for guaranteed issue only. You have 60 days after COBRA runs out to apply. You are also eligible if your insurance ends because the company goes out of business without making COBRA available. Any insurance company or agent can give you more information, or search for: California HIPAA guaranteed issue
- rdtsc 14y ago
  To someone from a country with a sane health care policy this whole procedure sounds ridiculous.
SoftwareMaven 14y ago
The people who think the US health care world is A-OK are the people who have never been uninsured nor been uninsurable. As much as I want to build my own company, my life and job revolve around my ability to get insurance because I had the gaul to have surgery once upon a time. People should not expect something for nothing, but there has to be a better place than we are at now. Because this place sucks!
amalag 14y ago
I think we have to start with the American Medical Association. It is in their interests to keep prices high and keep doctors in their McMansions. First follow the money, who benefits from high prices? Insurance companies, medical suppliers, and the American Medical Association gets to enforce the medical monopoly.
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wavesounds 14y ago
Im interested how people feel about hacking the ER. I personally have never had to do it but I know quite a few people who will give fake names and social security numbers to avoid such situations. Obviously this makes it more expensive for everyone else and one could argue the Affordable Care Act is a way to fix this security whole as much as anything. Morally if you're stuck between lying to a doctor and losing your child's college fund what is the best choice really?
clarky07 14y ago
This thread has a lot of socialism vs free-market talk, but the real problem with American health care is the lack of transparency, and the middle-man, be it government or insurance doesn't change that. We have so many pointless things done, and the prices are not known ahead of time. Unless we are talking about life and death, the cost of the procedure you are doing to me should be known before I decide whether I want it or not. The number on the bill also isn't ever really the bill. The insurance company or government negotiating says no I won't pay that amount, this is the real amount you should be charging so we are going to pay this. Doctors and hospitals charge X because that is what insurance companies and government decided they would pay. If you were negotiating this care for yourself, you could almost certainly get it cheaper (as you have a much bigger vested interest in your savings account than the government etc does), and we would not get nearly as many unneeded procedures done. Most of the time it's not even a question, and it should be. They don't say, we think maybe you should have this done and this is why. They say, we're going to do a X. Maybe they tell you why, if you ask them, otherwise it's just assumed that since I'm sick I should do what they say. I broke my arm a few years ago playing softball. I had an extra 90 degree angle in my arm. People in the bleachers heard it snap. It was 100% broken no question about it. The hospital wouldn't give me any pain killers until they had an x-ray to see if it was broken or not. Now I suspect getting an x-ray is useful for the guy doing the surgery to fix it, and he did several as well, but there was 0 reason for the x-ray in the emergency room. It cost me (and the insurance company) money, it wasted valuable time for the nurses/doctors who could have been onto the next patient sooner, and most important it made me absolutely miserable for another hour waiting on it when all i needed was some pain killers and nice splint until I could have the surgery. Socialism doesn't solve this problem. It just makes you pay for my x-ray.
nahname 14y ago
Even with insurance it cost $1400 for a bug bite? I just had a baby (my wife) and we paid $40 for a private room. This is pretty much why I will never live in the USA. Which is unfortunate because I do like the country and could see myself living there except for this.
FixThisPOS 14y ago
"to Texas, for a “better business environment” than you can apparently find in California. I think that means that the CEO doesn’t have to pay state taxes and is allowed to hunt low-level employees for sport." Um, no. California is an offensive rip-off, which practically begs businesses to leave with such maneuvers as charging an $800 annual "tax" on ZERO OR NEGATIVE income. And that's not counting any municipal taxes, such as Los Angeles trolling around for another handout.
rdtsc 14y ago
> an accident or a disease or any of a billion other random, faultless happenstances — isn’t going to send them to the poor house. What is he talking about? It doesn't make sense. He complains about high costs. Then he praises the health care act but I don't see how health care act controls costs. Not having a single payer option, not having cost controls make it a stupid and broken.

133 points by anu_gupta 14y ago

Even though I've been researching with interest, so far I haven't run across much in the American healthcare system that makes me question my decision (as an American) to move to Denmark. My taxes are higher, but my costs are very predictable, and by design cannot ever bankrupt me: I pay a flat 8% of my income to support the national healthcare system. I won't end up with a charge equal to 20% or 50% or 500% of my income in any circumstance, not even if I get cancer or find myself unemployed. So it's guaranteed that I will always be able to pay my healthcare costs without great hardship. I do hope someday to move back to the USA (mix of language / "feels like home"), and am mildly hopeful that PPACA will make it feasible, by 2014, for an individual to buy private health insurance without worrying about preexisting conditions and rescissions and whatnot. But we'll see. For now, Danish is growing on me. :P Incidentally, this kind of emergency care would be free even for a tourist in Denmark. Regular use of the national health system is only available to legal residents, but acute emergency care is considered a basic service not subject to billing, like police and fire response.

vegardx 14y ago
Life saving treatment is usually like this all over the world, and in Denmark they will give you a bill unless you're apart of EU, as you'd have the EU health insurance (EHIC), which is free. This card is also valid in countries in the Schengen Area, like Norway, Switzerland and Lichtenstein.
- _delirium 14y ago
  Many countries bill for emergency stays. US emergency rooms definitely send bills, even if it's acute live-saving treatment. Even Canada, which has national healthcare for residents, will bill nonresidents who visit an ER. If you're from another country, you may get away with just not paying one of those bills, because if it's life-saving care they have to provide it before verifying you can pay. But they'll still try to collect on it. That's one reason it's common for people to buy travel health insurance that covers emergency care. Afaik, Denmark doesn't require the EHIC for acute emergency care. Anyone is eligible for unbilled emergency care, with some exceptions to combat medical tourism (if you're found to have traveled to Denmark for the specific purpose of entering an ER to treat a health condition). The EHIC qualifies you for some additional care, e.g. childbirth. This is actually a big current sore point in Danish politics, because many other EU countries don't extend a reciprocal courtesy.
  - waqf 14y ago
    > Even Canada, which has national healthcare for residents, will bill nonresidents who visit an ER. Even Canada? Canada by its location would be at acute risk for medical tourism from the US, if it didn't bill for ER treatment. That problem isn't as big for Europe, Australia, etc.
    - _delirium 14y ago
      That makes sense, I agree. The "even" was more given its reputation: most Europeans I know are not surprised that the US sends large bills for ER visits, but don't expect the same from Canada. I could almost imagine a financially manageable system where Canada gave free ER care to anyone except Americans, but that would produce obvious political problems.
  - vegardx 14y ago
    You're still stuck with a bill, if you're a foreigner. They will treat you, like they will in most of the world. But you're still stuck with a bill afterwards. Also, unless my memory is totally off, each country has to pay up for EHIC, depending on who used what, and visa versa. So the cost should be evened out. Edit, because I cannot reply to you later down: I think we have a different view on what emergency medical care is. In most of the world you will get fixed up so that you are no longer in life threatening condition, this is the case in USA, Denmark and Norway. But afterwards you will have to pay, even in Denmark, as long as you're not apart of EU and have the European Health Insurance Card or a citizen of any of the Nordic countries, which has a special agreement.
    - _delirium 14y ago
      That isn't the case; Denmark simply does not charge for acute emergency visits, and does not send a bill. In addition, they pay for their own residents who incur such bills within the EU on trips under 30 days [1], which is part of the controversy: a French person who ends up in a Danish ER is not billed, but a Danish person who ends up in a French ER is billed, with the bill paid by the Danish government. Most Danes would prefer that each country provide free emergency care to all, like they do with fire and police. [1] http://www.sos.dk/en/Corporate/OurNetwork/ForMedicalFacilities/TheDanishTravelHealthInsuranceScheme/ http://www.sos.dk/en/Corporate/OurNetwork/ForMedicalFaciliti...
marquis 14y ago
Having experienced emergency care in both Denmark and the U.S., this is also the main reason I won't relocate to the U.S. until this is sorted out. I had what was thought to be a broken ankle in Denmark thanks to icy conditions and I was so well looked after, and charged nothing, I was awe inspired and wish there had been some way to pay it back. I sliced a finger in the U.S. and was made to feel like a statistic, with a $1000 bill. Thanks to inexpensive travel insurance that cost me just $100, but how I am supposed to feel when my travel insurance is less than quarter of the price that actual insurance would be if I lived there? (Edit from reading other comments: probably not charged in Denmark because of European health reciprocity, but they never verified this at the hospital).
- encoderer 14y ago
  It's not fair, and not right, but it is a fact that for the most part, most of us here don't have to worry about that. If you're a software engineer or systems administrator or similar type of professional earning a fair living it's not at all uncommon to have completely free health insurance for yourself, and affordable options to cover your family. I haven't worked for a place with an individual premium in 5 years. Again, not saying the system isn't broken, but rather that there's a reason all Americans aren't vocally supporting the ACA and the president: this is mostly a lower-middle-class-and-below problem
  - _delirium 14y ago
    I agree, and I feel it used to work even better in that respect, when educated Americans typically had lifetime employment. I would guess that's one reason the debate is growing louder lately. The West basically solved the healthcare problem via collective coverage, but in different ways: the European countries did it nationwide, but the US did it with employer group plans. That was almost equivalent, for people with good jobs, as long as people stayed in jobs for life: having the IBM group plan was about as good as having state health coverage, as long as the IBM job was more or less for life. It's more broken if you're middle-class-or-below (as you mention) or an entrepreneur who isn't either early-20s-and-healthy or raking in huge piles of cash. The part that seems most out of keeping with the American ethos is how anti-entrepreneur it is: you get good collectivized coverage if you work for IBM or Microsoft or Google (because it's socialized across their employee base), but if you start your own company or are trying to buy insurance for a 10-person company's employees, well then you're screwed.
forrestthewoods 14y ago
8% sounds great. US currently spends around 16% of GDP on health care every year. I think the majority of Americans would support a universal health care system that provides far more coverage at half the cost. Instead our total spend is expected to double by 2020. Source: http://money.cnn.com/2011/07/28/news/economy/healthcare_spending_forecast/index.htm http://money.cnn.com/2011/07/28/news/economy/healthcare_spen...
- vegardx 14y ago
  Should be noted that there is not a direct correlation between tax paid for health care and cost of health care. It's heavily subsidised by the government, from taxes taken elsewhere. In Norway it's like this: Senior citizen: 4,7% Employed: 7,8% Self-employed: 11% Last time I checked we spent around 9% of GDP on healthcare.
- anonymoushn 14y ago
  The great thing is that this expense grows at a rate of 9%/year while the economy is stagnant. If GDP miraculously and immediately begins to grow at 5%/year, health care spending will completely eclipse it in 50 years. If it does not, health care spending will completely eclipse it in 28 years.
  - lesterbuck 14y ago
    Herbert Stein's Law: "If something cannot go on forever, it will stop." The only question is how the rate of growth will slow/stop.
- tptacek 14y ago
  Worth noting that the US leads Europe in outcomes for serious illnesses (particularly cancer), and the US provides access to specialists in days where other countries often have multi-week or even multi-month delays.
  - olefoo 14y ago
    Yes, but, europeans generally see a healthcare provider more often and are more often diagnosed before they reach an acute stage. If you look at the graphs [1][2][3] that compare per capita expenditures per country with life expectancy per country. You'll see that they are generally getting equivalent or better outcomes at less than half the cost. And I can tell you that for my own part, even with health insurance, the deductible is so high that it might as well not exist as far as basic checkups and doctor visits go. 1 http://ucatlas.ucsc.edu/spend.php http://ucatlas.ucsc.edu/spend.php 2. http://blogs.ngm.com/blog_central/2009/12/the-cost-of-care.html http://blogs.ngm.com/blog_central/2009/12/the-cost-of-care.h... 3. http://www.economist.com/blogs/buttonwood/2011/03/health_costs_and_life_expectancy http://www.economist.com/blogs/buttonwood/2011/03/health_cos...
fernly 14y ago
What is your legal status in Denmark, and how did you achieve it? Are you a "resident alien" or an immigrant or what? What restrictions/hoops did you have to jump to get permanent residence status? What did it cost?
- _delirium 14y ago
  Unfortunately it's not the most friendly country for immigration, partly as a result of the right-wing coalition that tightened rules over the past few years (Sweden is better, as far as the Scandinavian countries go). But there are some exceptions: it's easy for EU citizens (due to being in the EU), and it's easy if you have a professional-level job offer (no US-style H1B quotas). I'm a researcher hired by a Danish university, which made for a fairly easy fast-track visa under the "researchers scheme" [1]. In fact the entire process was by mail and took one round-trip: I mailed my passport, offer letter, photos, and application to the NYC consultate, and they mailed back my passport with a visa pasted into it. Most professionals with an offer will also be able to get a visa; it's not nearly as restricted as getting U.S. visas is. If you have an offer that pays more than 375,000 DKK ($63,500), you qualify under the "pay limit scheme" for similarly preferential treatment [2]. Getting permanent residency depends on if you're an EU citizen. If yes, it's just a matter of remaining in the country as a legal resident for at least 5 uninterrupted years. If you're from outside the EU, there are more requirements [3], including that you must be employed for 3 of the 5, and must pass a language exam establishing basic competence in the language (which is unfortunately quite difficult to speak, though the grammar and vocabulary are not particularly difficult). I must also give them kudos for giving all of this information in not only English, but straightforward, non-legalese English. Dealing with the Danish state is generally not a horrible experience so far, even for someone who speaks no Danish. [1] http://www.nyidanmark.dk/en-us/coming_to_dk/work/researchers.htm http://www.nyidanmark.dk/en-us/coming_to_dk/work/researchers... [2] http://www.nyidanmark.dk/en-us/coming_to_dk/work/pay-limit-scheme.htm http://www.nyidanmark.dk/en-us/coming_to_dk/work/pay-limit-s... [3] http://www.nyidanmark.dk/en-us/coming_to_dk/permanent-residence-permit/ http://www.nyidanmark.dk/en-us/coming_to_dk/permanent-reside...
  - fernly 14y ago

deleted 14y ago

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theoj 14y ago

Hospitals often bill 5x-10x actual costs to make up for the "discounts" that insurance companies force upon them. If you're uninsured and get hit by a huge bill, you need to negotiate with the hospital to bring the amount down. Doubly so, because hospitals have lax tracking of costs, and no one really knows how much your visit really cost. More about this from an actual MD: http://truecostofhealthcare.org/hospital_billing http://truecostofhealthcare.org/hospital_billing

TheAmazingIdiot 14y ago
I'd be more for using informed consent laws to argue that you would not have proceeded with treatment had you known how much it cost, or the costs related to failure of procedure. Our medical system is the worst of capitalism, and the worst of socialism. Tell me again: Where are the prices?

kefs 14y ago

As a Canadian, I couldn't imagine having to decide between money and healthcare. I don't know how you guys do it... Relevant reading: http://www.rhrealitycheck.org/article/2012/07/12/how-i-lost-my-fear-universal-health-care http://www.rhrealitycheck.org/article/2012/07/12/how-i-lost-...

fleitz 14y ago
I'm Canadian but lets be realistic, there are many things that would cause serious financial hardship due to medical costs in Canada. A friend of mine right now is suffering through intense pain from her teeth that aren't being fixed because she doesn't have money/insurance. She's deciding between healthcare and money. You can also lose your life on a waiting list in Canada. Not much purpose in having $23K in the bank but being dead. For sure you're not going to get a $23K bill for a bug bite but you will pay $3000/month for chemo, etc. Lots of things aren't covered by medicare, and they're quite expensive. Canada is more like a $23K bill for getting cancer, or other long term/terminal illnesses.
- kefs 14y ago
  Chemo is most definitely covered for me.. just as everything else that would be medically required. http://www.health.gov.bc.ca/msp/infoben/benefits.html#notcovered http://www.health.gov.bc.ca/msp/infoben/benefits.html#notcov... Nothing you have commented with is based on fact. Edit: OP added a ninja-edit to his comment that included the part about teeth-pain... as my link explains, non-emergency dentalcare is not covered by default.
  - cperciva 14y ago
    The BC government doesn't pay for my insulin. As a type 1 diabetic... yeah, I'd say it is medically required.
    - kefs 14y ago
      Medicines, in BC, are covered under a separate plan.. Pharmacare. As far as this goes, insulin is covered: http://www.health.gov.bc.ca/pharmacare/generalinfo/generalinfoindex.html#What http://www.health.gov.bc.ca/pharmacare/generalinfo/generalin...

joni123 14y ago

Silly americans... in my country, it's obligatory to have health insurance and if you cannot afford it, the government will pay your insurance, for god's sake. Not even the most conservative and right-wing politicans who see our freedom in danger when we can't keep fully automatic assault rifles at home anymorehere question this system, because it just makes sense.

retillit 14y ago
Can someone please explain to me the purpose of an insurance company when participation in the pool is mandatory? A policy like this seems like it creates a legislated middle-man that just wastes money.
- nisa 14y ago
  Not sure if you are joking. Having everyone inside the pool makes up for members with chronical illnesses and other illnesses that need a lot of care. Some still healthy young poeple pay maybe a little bit more but everyone can be treated reasonably well. If you run an insurance without mandatory participation people with problematic illnesses are a risky for the business and that is one reason why the op can't get an insurance in the USA.
  - suresk 14y ago
    I think the point retillit is trying to make is, why even bother with private insurance companies if insurance is compulsory? Which is a good question. The answer, I think, is partially politics, but also partly whether you think the competition a system like this (in theory) encourages outweighs the cost of profits.
- spiralpolitik 14y ago
  Because getting rid of the middle man is considered socialism in these parts and that doesn't fly with Joe and Jill six pack. (Unless of course you are talking about Medicare then its the most patriotic thing since apple pie).
- 14y ago

T_S_ 14y ago

Reminds me of my kid's $6000 bump on the head. Or the time I had and knee operation and they took five minutes extra to clean out something they spotted and added $3500 to the bill. Or the eye operation where they took fifteen minutes extra because there was a detached retina adding $9000 to the bill. (Insurance wouldn't pay that one. They never said why either.) You are not exactly going to negotiate at moments like these.

TheAmazingIdiot 14y ago
Insurance companies make more money if they refuse payment. I've always liked the old Chinese medicine system. You find a doctor who is willing to take you as a client. You pay the doctor money per month when you are well. If you are sick, you do not pay. Of course, refusing treatment is acceptable to get you disqualified, as are a few other things.
- tylee78 14y ago
  nice system! sounds like it has a market principle built into it...
  - brazzy 14y ago
    Except it breaks down completely when there are expensive drugs and procedures.

abtinf 14y ago

This is an inappropriate article for HN.

fiatmoney 14y ago
You know what's a huge barrier to entrepreneurship? Needing the insurance that comes with a BigCo job, so you're not ruined financially when your kid gets bit by a bug. I know many people who have this explicit rationale for not founding or joining a startup.
- abtinf 14y ago
  Then they are grossly misunderstanding relative risks and shouldn't be launching their own startup. And its terrible reasoning. Existing law already provides for cobra, giving them an 18 month window of coverage in which they can retain your employer's insurance (by paying the full premiums). That's more than enough time to validate an idea and secure insurance in the new company, or fail and spend 6 months finding a new job. Or if you are an engineer, 1 month finding a new job.
  - lsc 14y ago
    sure, if you are using the "build a prototype, get investment, move from there" model... that's fine. Personally, I think bootstrapping, taking no outside investment at all is also a completely reasonable model (and often ends up with a more sustainable business, and can be executed by people that lack the sales skills to get investment) If you are bootstrapping? 18 months is not a reasonable period of time to get something to the point where you can get group coverage. (In most states, to get group coverage, you need at least two employees on that insurance.) also, I think it's quite valid to support yourself doing contract work. same problem; if you don't want a body shop to take half your pay, well, you need two employees before you can get group coverage.
    - bhb916 14y ago
      My company bootstrapped and we just initiated a group policy 13 months after our doors opened. This is, of course, anecdotal, but I think it's very well in the realm of possibility. Regardless, even in states like CA high-deductible plans (i.e. catastrophic care plans) are very much attainable both by small businesses and by individuals. Contractors in the US get hit with a fairly sizable self-employment tax. This tax would no doubt go up to fund any sort of universal health insurance. Regardless, I don't see the need to 'scratch your entrepreneurial itch' as a valid reason to stick you neighbor with your medical bills.

ojiikun 14y ago

Every time a healthcare discussion comes up and everyone gets derailed on whether (or how much) to socialize things, I wonder the following: from a technology, taxation, and moral standpoint, what the hell led to a system where some heavy-duty antibiotics cost about 10-15X what they should? More importantly, why do generally intellegent audiences get caught up in arguments over socialism rather than correcting the cost issue first? Is it sue-happy lawyers, is is an anti-competitive marketplace, or is it the pushing of the very concept of insurance that has given us such an unsustainable system? I truly want to put out a call to geeks: for every healthcare dollar you spend, grill your provider. Haggle them down, and make them justify the price, or we're all screwed, no matter who is paying for things.

abtinf 14y ago
The reason is simple. Many folks, myself included, hold the view that it is government intervention that has led to the insane system currently in place. Eliminating the perverse healthcare system forced on us by current policy IS the way to control the cost issue.
- cma 14y ago
  Most other industrialized countries have heavy government involvement and pay half what we do with the same outcomes. We just have a hybrid system with capitalism applied in the stupidest way..
  - bhb916 14y ago
    This statement sounds totally odd to me on both ends. First, the US pays more in a lot of markets. By and large, that's because we can. Second, capitalism isn't applied. That sounds like it's some sort of regulatory tool that just isn't being used correctly. Capitalism is the absence of government force in an economic market with the notable exception of enforcing private property rights. You can say a lot about the US healthcare situation, but "applied capitalism" it is not.
    - 14y ago

davidf18 14y ago

In the US there are many community health centers. NYC alone takes care of 450,000 people without any insurance at all through CHCs and other sources. The very poorest generally have Medicaid in NY State, so the uninsured might be people like waiters. At any rate, there are community health centers throughout the country. One issue that I have with the Obama Affordable Care Act is that they should have put much, much more money into the CHCs.

jellicle 14y ago

If he's still in the hospital and thinks the bill is $23K he's got a surprise coming. The bills will keep coming for months. Many items may be billed multiple times. Writer is going to have to invest several man-weeks in dealing with this, minimum. I talked to a friend of mine who received some treatment recently. He made sure the hospital was "in network", but apparently someone who came in to give a shot was "out of network" - personally, for herself only - so he received a huge out of network bill for the services of one nurse in giving one shot. He asked the insurer if he was supposed to quiz each medical person in the hospital about whether they were in a particular insurance network before allowing them to provide treatment. The insurer's answer was "yes", with no irony.

russell 14y ago
Anesthesiologists are the worst offenders. My experience is that none of them are in network. You think you have everything covered and along comes this bill that is as big as everything else. Woe to you if you are uninsured. I had minor heart surgery nearly two decades ago. The bill was something over $80K. The insurance company disallowed most of it, bringing it down to $20K of which I had to pay $2K. Except for the Anesthesiologist.
- ysopex 14y ago
  Why is it that you can't go to a medical facility and tell the intake nurse or admin person you're not agreeing to any procedure that's not covered by your insurance. Wouldn't that put the onus back on them? Anything not covered instantly becomes a freebie or a lawsuit? Why do hospitals and clinic get away with this crap when auto mechanics and plumbers can't?
  - eli 14y ago
    What makes you think anyone else would take on the liability of vetting your care for you? And for free?
    - evolve2k 14y ago

anonymoushn 14y ago

The bill would be much higher if he paid with cash than if he paid with insurance. I'm curious to know how much. I expect would be at least 3x the amount the insurance company must pay.

dollar 14y ago

The question no one ever asks is "why is the bill $23,000?". The only question that ever gets asked is "who should pay this $23,000 bill?". I charge $200/hr for my time at a minimum. Did this child really receive an equivalent of 2.8 weeks of my time in services? Or did an unecessary middle man negotiate ridiculous prices with the provider, leaving the consumer out of the equation but responsible for the bill? And yet people seem to think that more unnecessary middlemen will make the situation better.

kdsudac 14y ago
You can figure try to figure out the "why" for specific cases but it's tedious work and comes down to subjective opinions that can't be generalized to other cases. The theoretical worth of the shadowy middlemen (whether they gov't or insurance companies) and where the blame lies can be debated. All these arguments rely upon theoretical simplifications of very complex systems--meaning they are almost impossible to model. What's more important is the "what" as in what are our alternatives. Luckily, we have tons of empirical data from other countries and they all tell the same story: America pays more money, with poorer results. So why not just copy the models of other countries?
- tylee78 14y ago
  After 15min ER due to a strained wrist the bill was $4100 dollars. We demanded detailed itemized bills and send letters to the doctor (billed separately) and the hospital. The doctor dropped his bill from ridiculous $900 dollars (for saying everything was alright and taking 5 mins to open a tiff file on his computer) to $200 after our complaint. His bill and the hospital had up-coded our visit and tried to hide the costs of their ill-managed hospital by billing a piece of cloth (made in Guatemala) with $500, the price of an iPad.
mikeash 14y ago
Really? Nobody ever asks? Whenever the subject of American hospitalization comes up, the question of why the bills are so insanely high is pretty much the only question people ask!

petercooper 14y ago

Naïve European who'd pay nothing for this here (ok, taxes, but supposedly we still pay fewer % of our GDP overall) with a question: I’ll have to have to pay less than 6% of that, because I’m lucky enough to still have insurance. Why? If you have insurance, shouldn't that cover the whole expense? Or is it a bit like an excess on a car insurance policy? Can you get insurance that covers everything?

slap_shot 14y ago
It depends on the policy. http://en.wikipedia.org/wiki/Deductible http://en.wikipedia.org/wiki/Deductible http://en.wikipedia.org/wiki/Copayment http://en.wikipedia.org/wiki/Copayment
wmf 14y ago
Coinsurance/copays prevent moral hazard. If people paid nothing they would have an incentive to overuse insurance.
smsm42 14y ago
Did you ever have car insurance or any other kind of insurance? Most insurances have deductibles, and the point of that is that insurance is to prevent catastrophic loss, not every expense. There can be insurance that covers 100% of expenses, but it will be very expensive, especially for health, as it won't be insurance at all. Imagine that 1000 people pay each $100 into insurance pool. Then if somebody has a problem there's $100000 available for him, and if the chance of this problem is 1/1000, then this works. Now imagine each of these people has $50 in regular expenses that they want to be paid from the same pool. Then to get the same coverage one needs either to pay additional $50 into the pool (which then is not insurance but just a very expensive savings account) or accept that his coverage dropped by half. And that's not counting insurance company's cut, which makes it worse.
- petercooper 14y ago
  Did you ever have car insurance or any other kind of insurance? Yes. I go with the largest excess possible (what I assume is also called a deductible) because the chance of making a claim is low. But it's only 10-20% more to have no excess at all. The logic in your second paragraph makes sense on the surface, but the lack of a deductible in many European-style health systems doesn't seem to result in a larger share of GDP being spent on health (which is notoriously high in the US) or the healthcare being of a lower quality.

api 14y ago

The US healthcare system combines everything that is bad about a state-run socialized system with everything that is bad about privately funded care. To add insult to injury, we do not pay substantially less taxes than, say, Canadians. If we paid Costa Rican taxes I'd be fine with it, but we don't.

Evbn 14y ago
Costa Rica has universal health care funded by their not having a military, IIRC
jerf 14y ago
This is why I think even if you are in favor of socialized health care, you really ought to be against the PPAFA. It's not "socialized health care", the glorious ideal you have in your head where everybody takes care of everybody and it's all smiles everywhere. It's an ungodly abomination of a thousand pages of hastily thrown together legislation with a bajillion moving parts, dozens of newly created agencies, what is basically gibberish in terms of who is paying for what driven more by what voters needed to hear than any resemblance to reality, and then after all of that, was brutally beaten by the legislative process until it could barely assemble a coalition to drag it across the finish line in a horrifically compromised state. Trying to explain why this is a good idea and trying to explain why socialized health care is a good idea are two things that should not be done at the same time. If you think it's bizarre how many people aren't buying into the whole nothing-but-smiles theme now, wait until after a few years of experience with this turd. The whole "Oh, the monstrous heartless conservatives just want to throw granny over the cliff so they can save a buck" is just a propaganda smokescreen put up so you don't look too much at the actual product you're pitching beyond the catchphrase level. Personally I feel some people are being pretty careless about what will actually happen to real people while they are moving abstract political footballs labelled "socialized healthcare" around without caring what's behind the abstraction. I know the abstract progress may feel good today, but the reality isn't going to stay behind the abstraction boundary.
- _delirium 14y ago
  I don't really support the outcome (I want real socialized healthcare), but as far as I can tell PPACA is at least better than the status quo. It seems like it'll make it possible to buy individual health insurance, which will actually cover healthcare, and won't be jacked up when you get sick. That's at least one improvement over the current system, which is completely broken unless you're in a quasi-socialized health-coverage pool, like those provided by large corporations' group plans.

clarky07 14y ago

I don't think kidney stones are really going to get someone denied for insurance. There is no reason I should have to pay for your healthcare. I pay for my healthcare. You pay for your own damn healthcare. (note that I am self employed and had no problems getting a high deductible health plan). Now if when you say you are short and stout (or however you worded it) you actually mean you are 500 pounds and obese, then get on treadmill. Absolutely no reason I should have to pay for your healthcare because of your poor life decisions.

michaelochurch 14y ago

This country is still suffering from slavery and racism. We would have had socialized healthcare in 1948 were it not for the fucking asshole racists who didn't want to desegregate the hospitals. Our basketcase of a healthcare system kills 45,000 people per year. That's a 9/11 every 24 days. It's inexcusable.

abtinf 14y ago

For complex reasons, I was without insurance for a couple days last week. I happened to have an appointment schedule. I went into the clinic and, since it was my first time there, I filled out a stack of paperwork. And then they told me my insurance was inactive. So I figured, whatever, I'll pay it out of pocket and file for reimbursement. I asked how much the specific service I was requesting would cost. And they had no idea. They refused to tell me, other than to say "well, we charge a hundred dollars up front and then you pay the rest of the bill after you are done". I ask to see their cash price list, because every sane facility I've ever been to has a cash price list with prices that are 1/2 to 1/4 of the insurance price. And they don't have one. So I ended up leaving. It's amazing just how perverse health insurance has become, that it can so affect the delivery of medical care that the facility cant/wont give an up front estimate. I wasnt even there for anything complex - just a standard glucose diabetes test. They probably do ten a day.

sehugg 14y ago
I have also seen these places. Some of them will tell you the doctor has gone to lunch when you tell them you have individual insurance. There are "direct access" clinics that can perform lots of blood tests without a doctor's help at a low cost -- $5 to $20 per panel. Fill out a form, draw a couple vials, go home and your results come in the next day. What's frustrating is that you aren't typically told about these options, and so you end up paying five times as much out of pocket to have the doctor be your gatekeeper. So then you're tempted to say screw the doctors and use the internet to perform your own diagnoses. It's a shame we have such an antagonistic healthcare system, and I don't see how it can get better as long as the medical industry expects to book profits at a faster rate than the growth of the population.
tptacek 14y ago
Last year, my daughter caught a stomach bug and for a few days woke up each morning nauseous. We took her to her pediatrician and were surprised to find out that "waking up nauseous" is a Big Deal; it can be a neurological symptom. We were pretty sure that wasn't it (there were... other symptoms... corroborating our "stomach bug" hypothesis) but the doctor was adamant: if she kept waking up and puking, she'd need to get imaged. She got better and we cleared her to go on vacation with her grandparents, and were just about to get on a plane to go give a talk at Black Hat, when we got a call from our parents in Michigan telling us she was puking again. We called the doctor, who demanded we retrieve her and scheduled a CAT scan. We are at this point freaked out for a variety of reasons, some of them logistical (trip to conference, driving back/forth to Michigan, &c) but also from the fact that our doctor knew what an epic inconvenience all was and was absolutely clear "daughter needs CAT scan" --- so in the back of our heads there's gnawing "something could really be wrong" (Adia had seizures when she was 4, which, by the way, GUESS WHAT DING DING DING UNINSURABLE ON PRIVATE MARKET NOW, and now 7 years later I still can't even hear she has a headache without taking an inventory of all other possible symptoms.) So anyways, we want that CAT scan done now now now yesterday now. We get to the hospital for our appointment and: problem with our insurance card. No big deal, we'll just resched--- fuck that, I'm paying cash. Head scratching ensues, long story short, very large hospital in Chicago doesn't have any price list for a CAT scan at all. Not even an insurance cost to pass on to me, let alone a cash-basis discounted price. Getting imaging done at a top hospital in Chicago without insurance: unheard of. They ended up just making up a price on the spot; $1000.

rkischuk 14y ago

This is putting things exactly backwards. The argument is roughly "Treating a minor condition cost $24k, which could wipe people out financially, therefore PPACA is important." Where is the outrage over this price? What part of PPACA does ANYTHING to reduce this cost? PPACA does essentially 2 things: 1) It makes insurance "affordable" for people who previously couldn't obtain it at all. 2) Drastically increases demand for health care, without adding to supply or controlling costs any other way. Insurance is simply a distribution of cost over a risk pool. If relatively mundane life happenings cost $24k, and nothing is being done to fix that, we're in real trouble, and I think we are. Nothing done to increase the pool of doctors. Nothing done to control medical lawsuit costs, which transfer money from the insurance pool to individuals. Nothing done to control the cost of drugs (and in some cases, aggravated by making more expensive drugs "free"). Bring the cost down to $2,400 and "wiping people out" isn't as big a concern.

zaphar 14y ago
It wasn't a minor condition. It was a staph infection. Don't let the term bugbite mislead you. His son wasn't in the hospital for a bugbite. He was in the hospital for a life threatening infection from an antibiotic resistant infection. That is far from minor. Disclaimer: I'm not arguing for PPACA in any way but if you are going to base you argument on billing for a "minor" condition then make sure it's actually a minor condition.
- rkischuk 14y ago
  So... MRSA Staph Infection... what is the cost to correctly diagnose? And what is the cost of the antibiotics? I'm not a doctor, but most non-boutique antibiotics are dirt cheap. I didn't intend to trivialize the illness. I more meant that this could happen to _anyone_. And if this is the cost for things that can happen to anyone, we have a real problem on our hands. Much like it's a problem that a basic, no-complications, baby delivery costs $15-20k. Insurance is math, and the math gets scary quickly unless costs are controlled.
  - zaphar 14y ago

tptacek 14y ago

A young coworker had an ATV accident. It was ugly, but not so bad that they weren't on IM within days talking about work. Total bill: just shy of $100,000. A friend's son had appendicitis. Uneventful appendicitis. Total bill: neighborhood of $35,000. Add to this: tens of millions of people are, despite any debilitating medical conditions or even better-than-even likelihood of incurring anomalous medical expenses at all, actuarially precluded from getting insurance on the private market. There are very long lists of widespread health conditions, most of them "chronic", most of them minor, that will land you on automatic exclusion lists (not "we will cover you but not for this condition", but, "we will not issue a policy for you at all"). Particularly if you are a woman with a functioning reproductive system. Once again I say: I cannot understand how anybody who runs a software business or who aspires to run a software business could possibly oppose guaranteed-issue health insurance. I dealt with many dramatic problems during the operation of the company I cofounded in 2005, but the only one that was almost intractable was trying to obtain private coverage for my family. Fortunately, my wife Erin got a tech job with group health coverage and we dodged the bullet until Matasano got its own group plan. Employer-sponsored group health insurance is a terrible system. It increases costs on new businesses and adds uncertainty to their financial planning, while at the same time retarding labor mobility. It introduces a principal/agent problem between the people selecting plans and the people who use them. Because this idiotic scheme is tax-advantaged, it incentivizes the creation of a bizarre slush fund with warped, collusive prices. At the same time, because users of health care never directly pay for it, it encourages people to make dumb decisions about their own care. People should buy their own insurance. Insurance companies should be forbidden to decline applicants, or to constructively deter them with shady pricing schemes. People should not be allowed to exploit that requirement by waiting until they get sick to apply for coverage. The requirement should be nationwide, so that states that offer sane insurance regulations don't get sabotaged sick refugees from other states without sane insurance regs. Minus the Medicaid expansion, which I'm ambivalent about, this is what we worked out in 2010.

whirlycott1 14y ago
One solution (which obviously won't for everybody): live in Massachusetts. We have excellent health insurance plans available here: https://www.mahealthconnector.org/ https://www.mahealthconnector.org/ I'm using one now.

deleted 14y ago

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noonespecial 14y ago

The (big) problem isn't really that there are people who may or may not have insurance to protect them from 24 kilobuck bug bites, its that we've let so much friction build up in our system that it has come to cost this much to treat even simple maladies. We're so busy worrying about who should pay what we don't ask the big one: why the hell does it cost so much in the first place?

douglee650 14y ago

join my battle cry: just stay alive until 2014 portability is a key provision will take away the chains employers use to bind, threaten, and subjugate employees; using their families health.

useful 14y ago

It costs $121/month for 100% coinsurance, no copay, and a 3000 yearly maximum cost in network. Can no one spend <10% of their income on their health?

_delirium 14y ago
Maybe if you're in your 20s and were lucky enough to have no childhood health conditions. In the real world, that isn't the case for many people. How much does individual health insurance cost if you were born with a congenital heart defect? Or if you were diagnosed as a child with autism?

Stratoscope 14y ago

> We’ve got a strategy for dealing with the COBRA expiration, but it’s complicated and requires a lot of hoop jumping and is more than a little silly. Whatever the author's strategy is, it sounds like he's quite misinformed. There are no hoops required to get HIPAA guaranteed issue coverage when COBRA runs out. All insurers are required to offer it regardless of preexisting conditions. It will cost more, but coverage is automatic with no medical information required. The usual procedure is to simultaneously apply for underwritten coverage and guaranteed issue. If the underwritten policy is declined, the guaranteed issue takes effect. If you know you'll be declined, you can skip the medical history on the application and apply for guaranteed issue only. You have 60 days after COBRA runs out to apply. You are also eligible if your insurance ends because the company goes out of business without making COBRA available. Any insurance company or agent can give you more information, or search for: California HIPAA guaranteed issue

rdtsc 14y ago
To someone from a country with a sane health care policy this whole procedure sounds ridiculous.

SoftwareMaven 14y ago

The people who think the US health care world is A-OK are the people who have never been uninsured nor been uninsurable. As much as I want to build my own company, my life and job revolve around my ability to get insurance because I had the gaul to have surgery once upon a time. People should not expect something for nothing, but there has to be a better place than we are at now. Because this place sucks!

amalag 14y ago

I think we have to start with the American Medical Association. It is in their interests to keep prices high and keep doctors in their McMansions. First follow the money, who benefits from high prices? Insurance companies, medical suppliers, and the American Medical Association gets to enforce the medical monopoly.

deleted 14y ago

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wavesounds 14y ago

Im interested how people feel about hacking the ER. I personally have never had to do it but I know quite a few people who will give fake names and social security numbers to avoid such situations. Obviously this makes it more expensive for everyone else and one could argue the Affordable Care Act is a way to fix this security whole as much as anything. Morally if you're stuck between lying to a doctor and losing your child's college fund what is the best choice really?

clarky07 14y ago

This thread has a lot of socialism vs free-market talk, but the real problem with American health care is the lack of transparency, and the middle-man, be it government or insurance doesn't change that. We have so many pointless things done, and the prices are not known ahead of time. Unless we are talking about life and death, the cost of the procedure you are doing to me should be known before I decide whether I want it or not. The number on the bill also isn't ever really the bill. The insurance company or government negotiating says no I won't pay that amount, this is the real amount you should be charging so we are going to pay this. Doctors and hospitals charge X because that is what insurance companies and government decided they would pay. If you were negotiating this care for yourself, you could almost certainly get it cheaper (as you have a much bigger vested interest in your savings account than the government etc does), and we would not get nearly as many unneeded procedures done. Most of the time it's not even a question, and it should be. They don't say, we think maybe you should have this done and this is why. They say, we're going to do a X. Maybe they tell you why, if you ask them, otherwise it's just assumed that since I'm sick I should do what they say. I broke my arm a few years ago playing softball. I had an extra 90 degree angle in my arm. People in the bleachers heard it snap. It was 100% broken no question about it. The hospital wouldn't give me any pain killers until they had an x-ray to see if it was broken or not. Now I suspect getting an x-ray is useful for the guy doing the surgery to fix it, and he did several as well, but there was 0 reason for the x-ray in the emergency room. It cost me (and the insurance company) money, it wasted valuable time for the nurses/doctors who could have been onto the next patient sooner, and most important it made me absolutely miserable for another hour waiting on it when all i needed was some pain killers and nice splint until I could have the surgery. Socialism doesn't solve this problem. It just makes you pay for my x-ray.

nahname 14y ago

Even with insurance it cost $1400 for a bug bite? I just had a baby (my wife) and we paid $40 for a private room. This is pretty much why I will never live in the USA. Which is unfortunate because I do like the country and could see myself living there except for this.

FixThisPOS 14y ago

"to Texas, for a “better business environment” than you can apparently find in California. I think that means that the CEO doesn’t have to pay state taxes and is allowed to hunt low-level employees for sport." Um, no. California is an offensive rip-off, which practically begs businesses to leave with such maneuvers as charging an $800 annual "tax" on ZERO OR NEGATIVE income. And that's not counting any municipal taxes, such as Los Angeles trolling around for another handout.

rdtsc 14y ago

> an accident or a disease or any of a billion other random, faultless happenstances — isn’t going to send them to the poor house. What is he talking about? It doesn't make sense. He complains about high costs. Then he praises the health care act but I don't see how health care act controls costs. Not having a single payer option, not having cost controls make it a stupid and broken.