
I shared my toddler's hospital bill on Twitter - joshrotenberg
https://www.vox.com/first-person/2017/7/7/15934752/health-insurance-heterotaxy-twitter
======
quantummkv
Am i missing something in here or are the costs in that bill really this high?
$22,526 for room boarding for 2 weeks? Over here in India my grandma's bypass
surgery costed somewhat about $10,000. That included everything including the
stent, medicines and boarding, that too at a renowned, premiere private
hospital.

Is this a special case or are healthcare costs generally this high in America?

~~~
justboxing
> are healthcare costs generally this high in America

Yes they are ridiculously high, even after factoring in cost of living /
currency rates or as a %age of monthly salary, if you are comparing it to
costs in a different country. 1 month after coming here (to America) from
India (1999) I had to get wax from my left ear cleaned as it was blocking my
hearing.

They squirted some liquid in my ear and got the wax out. 2 weeks later, I got
the insurance Statement. It cost $ 800. I was astonished. In India a year
before, I'd paid a Doc 100 Rupees (at that time, $2 equivalent in USD) for the
same exact thing.

A month later, I had a chest x-ray taken, and some weird quirk in insurance it
wasn't covered. So I had to boot the bill. $ 576 for 1 single chest x-ray. My
take home at that time as a software engineer was about 2500 / month after tax
and deductions, so this was 23% of my paycheck!

Health Insurance coverage is too closely tied to employment. In order to get
continued coverage, you are more or less working "for the man" till you die.

~~~
tehlike
If you or on high deductible plan, consider hsa :)

~~~
throwaway2016a
Depending on his tax rate with HSA a $1000 bill would still be $750 after the
tex savings. Hardly an improvement.

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hkmurakami
_> It was eye-opening to see just how low our discourse has sunk, to be forced
to acknowledge that what passes for debate in the age of the internet is often
nothing more than spewing venom at the other side. How are we ever supposed to
find a solution that’s better than either Trumpcare or Obamacare if we can’t
even shut up long enough to recognize the humanity in the people on the other
side of the debate?_

So people on one side of the fence are not happy about the very high medical
costs required to keep a child alive. They do not understand the humanity
behind the numbers.

On the other side of the fence are parents who are not happy that some people
think their child is an excessive burden on the system. They (understandably)
do not understand (or at the least, are looking away from) the numbers behind
making their child viable.

The author correctly identifies one side's shortcoming wrt balanced discourse,
but does not see the blindness of her own implied position -- that no cost is
too high to save a life. Nowhere in this piece does she broach the subject of
numbers and real cost [1].

Finding balance is very difficult in any area, especially in areas where you
only have _one shot_ (an example is your child's education, where many parents
feel that no amount of investment is enough, and more is always better). But
since the system does not have infinite resources, it's a necessary
conversation to have (which the author could have brought up, but failed to do
so -- understandably, since this article is a strategic opinion piece meant to
further the author's self-interest, which I completely respect).

A billion dollars to save a child's life, we would likely agree, is too much.
$1,000, we would likely agree, is entirely justified. Where we draw the line,
why, and how we get there (of urgent need is our relationship with end of life
care and treatments) is an important conversation that we are failing to have,
and those of us on both sides of the fence are equally culpable for this
shortcoming.

[1] The large 6 figure bill and post insurance $500 bill is only used
qualitatively in the introduction.

~~~
lstamour
Who sets the numbers and why, though? How much is profit, how much should be
profit, when it comes to human health and rehabilitation whether mental or
physical assistance is required? Or, ignoring profit, why take away public
funding to programs for poor people just to provide tax breaks to rich folks?
How much is a dollar worth to each individual, relatively-speaking? There are
few easy answers, except (almost) everybody wants to see costs lower to the
levels they are in other countries. Setting price or profit caps and limits is
one method, ensuring the system can’t ask for inflated amounts from insurers
is another. This could affect quality of service, but then again, it might
not. All stores might charge the same price for some brand name item but not
all stores offer equal customer service or trained staff... The same is surely
true of medical facilities.

~~~
RcouF1uZ4gsC
> Just to provide tax breaks to rich folks

Your statement illustrates one of two competing views. The following
statements are extremes of the two positions.

1) The government by default owns all your money, and any money you get to
keep after taxes is just a tax break.

2) You own your money by default, and the government should not take your
money except to provide things that the market is unable to (some examples of
which are law enforcement, military).

Those who espouse one of these views, tend to see people who espouse the other
as morally wrong and evil.

~~~
lstamour
I’ve found most nations settle on: if you’re not making much, keep it. It
means more to you. In fact, here’s a few hundred more for sales taxes you
might have paid. If you’re making enough to “get by,” we’ll skim off the top
and give you tax breaks as incentives. From there it’s a sliding scale up to
some cut off. For example: If you’re making more than 3-5x the “getting by,”
rate mentioned above, we’ll split it – you keep half, we’ll take half. And
again, that’s only on top of other tax breaks, so 50% is an asymptotic upper
bound for most people.

I may not like it come tax time, but it makes sense to me. I consider the half
I don’t keep another sort of contribution to society. And of course look for
ways to minimize it–money doesn’t save itself. But I don’t fight over the
concept– I rely on services paid directly from taxpayer money each day. The
one thing I would hope for is efficiency– but I don’t think starving and
cutting systems inherently improves them. It’s just a shell game.

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mnm1
It's depressing to me to think that people hate others so much that they would
go to such great lengths to keep others from getting healthcare and ensure
their demise. These same people would have no problem accepting healthcare
from others if it was their lives that were in danger. I truly cannot fathom
the hypocrisy, hate, and cruelty that must exist in these people's hearts
towards their fellow citizens.

~~~
wyager
In what way does wanting to keep what I earn mean I "hate others"? I feel sad
when I walk by homeless people, but I don't stop and give them everything I
can afford until I'm impoverished. Do you? If not, why do you hate others so
much that you want to "keep them from getting housing"?

Hopefully you see why your argument is disingenuous. If you're really so hard
on hypocrisy, you should go out right now and give every last penny to someone
else's medical expenses. Or are you only generous enough to spend other
people's money?

~~~
siidooloo
Maybe you didn't read the story but people were sending her death threats.

~~~
tnzn
who cares about reading the whole story w hen you're a libertarian (not you)
who thinks every penny he makes is due to his own merit and he is entitled to
this no matter the life of others though :/

~~~
wyager
Ah, I see you're of the much more enlightened opinion that everything you earn
is due to and owned by the government, and anything they let you have is due
to their own benevolence and good grace.

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Aloha
Part of why healthcare is so expensive today, is we're capable of saving so
many more lives than before. As little as a generation ago, many more would
have died, people who now go on to live fruitful productive lives.

~~~
toomuchtodo
America spends more per capita than any other first world country for worse
outcomes [1]. Healthcare is expensive because of the profit motive. Single
payer isn't implemented for (mostly) the same reason.

60% of Americans want single payer [2].

"A majority of Americans say it is the federal government’s responsibility to
make sure all Americans have health care coverage. And a growing share now
supports a “single payer” approach to health insurance, according to a new
national survey by Pew Research Center.

Currently, 60% say the federal government is responsible for ensuring health
care coverage for all Americans, while 39% say this is not the government’s
responsibility. These views are unchanged from January, but the share saying
health coverage is a government responsibility remains at its highest level in
nearly a decade.

Among those who see a government responsibility to provide health coverage for
all, more now say it should be provided through a single health insurance
system run by the government, rather than through a mix of private companies
and government programs. Overall, 33% of the public now favors such a “single
payer” approach to health insurance, up 5 percentage points since January and
12 points since 2014. Democrats – especially liberal Democrats – are much more
supportive of this approach than they were even at the start of this year.

 _Even among those who say the federal government is not responsible for
ensuring Americans have health care coverage, there is little public appetite
for government withdrawing entirely from involvement in health care coverage.
Among the public, 33% say that health care coverage is not the government’s
responsibility, but that programs like Medicare and Medicaid should be
continued; just 5% of Americans say the government should not be involved at
all in providing health insurance._ "

Emphasis mine.

[1]
[http://www.npr.org/sections/goatsandsoda/2017/04/20/52477419...](http://www.npr.org/sections/goatsandsoda/2017/04/20/524774195/what-
country-spends-the-most-and-least-on-health-care-per-person)

[2] [http://www.pewresearch.org/fact-tank/2017/06/23/public-
suppo...](http://www.pewresearch.org/fact-tank/2017/06/23/public-support-for-
single-payer-health-coverage-grows-driven-by-democrats/)

~~~
ajmurmann
I used to be for single part until I listened to a recent episode of econtalk
([http://www.econtalk.org/archives/2017/06/christy_ford_ch.htm...](http://www.econtalk.org/archives/2017/06/christy_ford_ch.html)).
Christy Ford described how the current medical system evolved and how the
American Medical Association made the current, insurance based system happen.
Before this we used to for example multi-disciplineray offices of doctors that
you could directly buy health care coverage from. That was made illegal. What
we currently have is the worst of any world. It's a artificially constrained
market that's practically devoid of competition. On top of that we have
insurance which is clearly the wrong model for something you know you are
going to need. And it's employer provided on top of it. How could this market
possibly be less functional? Let's try to fix the market before we pour out
the baby with the bath water.

~~~
toomuchtodo
I have to respectfully disagree. It's time to burn down the current system and
go straight to single payer.

Collect premiums via payroll taxes->fund healthcare providers. That greatly
simplifies it, but there are many other first world models we can pick from.
This is not hard.

~~~
vidoc
> Collect premiums via payroll taxes->fund healthcare providers. That greatly
> simplifies it, but there are many other first world models we can pick from.
> This is not hard.

I entirely agree with you on that and your assessment on how the finance/tax
part of it is not as scary as some would think, it might even perhaps not be
the hardest part of the problem.

My personal belief in single-payer is that it is the only way to create a
leverage to either create a public offer of healthcare goods and service, or
radically modify the power imbalance and drive the prices of goods and
services way down. The thing that worries me is that in both cases, what I
understand as being a total healthcare bubble, which I am sure is a well
organized lobby, won't exactly be thrilled at letting things happen without a
fight :)

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everdayimhustln
Bots and unthinking cyberdisinhibited people competively flame and troll
whomever is the current punching-bag for brownie points, schadenfreude and
negative attention seeking behavior.

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BrandoElFollito
This is one of the reasons I love my country (France) : because I do not even
have a bill to tweet. Literally : there is no obvious financial trace of
serious medical items.

Sure, when I go to the emergency with my child and his swollen ankle, I get
charged 28€ (IIRC), which later get reinbursed. This is the highest medical
bill I can think of (except dental and optical). A 100,000€ bill would not
appear anywhere.

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petraeus
The are children, orphans, families, whole societies that live worse than even
the poorest of americans. Sickening.

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holydude
In my country somewhere in europe you pay ridiculous taxes and you cannot opt
out. The healthcare is shit, corrupt and if you want good care when they do
not treat you like shit you need to go private and pay extra. Beware americans
with your mentality you end up paying more ans getting less with programs like
obamacare.

~~~
callalex
[citation needed]

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RcouF1uZ4gsC
Based on the background of the mother, she would have been able to have had
insurance even without Obamacare, and would have still been able to have
insurance no matter what the Republican Congress passes. In this situation, no
matter what the government did, her child would still have been able to get
the necessary surgery.

In addition, Boston Children's Hospital is one of the premier hospitals in the
world. Given the specialized nature of the problem and the fact that
heterotaxy cases are pretty rare, even without insurance, the chances are high
that the child would still have been treated and the hospital would have eaten
the cost.

Thus, pre/post/no Obamacare, the child still would have had the treatment.
Thus, you cannot derive a political position from this case.

~~~
hkmurakami
I am assuming that your statements are correct.

However, if we examine the author's motives, she seeks a society where any
child who shares her son's ailment (or other life threatening but treatable --
albeit expensively -- diseases) can receive treatment, whether or not they
share her fortunate circumstances or not.

In that light her rhetorical strategy remains reasonable.

