
Seattle coronavirus survivor gets a $1.1M, 181-page hospital bill - deegles
https://www.seattletimes.com/seattle-news/inspiring-story-of-seattle-mans-coronavirus-survival-comes-with-a-1-1-million-dollar-hospital-bill/
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perl4ever
"because Flor has insurance including Medicare, he won’t have to pay the vast
majority of it"

Did they really use stuff that truly cost $1.1M on him, and did they _need_
to? If they're charging some absurd amount for a room, maybe it's just a way
of rationing at some level, not what is being consumed.

I wish people would look at more what was spent in resources than what the
dollar amount of the treatment was - if the patient didn't pay, then what
matters to society is what was spent by society, not what number was written
down as part of weird accounting.

The article acknowledged "hospitals get paid only a portion of the amount they
bill". It's not helpful or necessary to write anguished stuff based on your
conviction that the accounting style is wrong. What matters is the effect on
real people.

On the other hand, if the reason that drug costs for instance were so high was
because unnecessary drugs were used, or because they were wasted, or because
the manufacturing of them was inefficient, that's a real problem and I wish
that an article like this would focus on it, delve into it. Just...don't write
stuff about how America is terrible because big numbers are scary.

I can't tell if the article is meant to be pro or con universal coverage, or
if the point is, America is terrible and always will be and universal coverage
won't fix it. If the point is the latter, I think it's a cheap effort in
support. If people take it seriously, it's very demotivational and makes me
want to find a scapegoat for catharsis. Which for me, the default is adtech
incentives these days.

~~~
Terretta
At 400K hospitalizations per 30 days, and $1M per patient, that’s nominally
$400B transfer of wealth _per month_ from citizens (via patients, patients’
insurance, or taxpayers) to healthcare industry, with significant percentages
extracted as income and profits at each step.

Imagine if there were some way to cut out duplicative overhead and
administrative costs from all these counter-parties and cut-outs...

~~~
perl4ever
I think impugning or debating the legitimacy of the entire healthcare industry
based on ignorance of the details is not productive. It disgusts me. Nearly
everybody has a job in modern society that a random person on the street
wouldn't understand, and yet too many people spend their time on the internet
declaring most other people have "bullshit jobs". That _is_ toxic bullshit.
First the narrative was private insurance companies are useless, now it's the
whole healthcare industry.

You can't say that in fact $400B is being transferred, just because a number
that big can be or is written down, and if it is, that it's inappropriate,
without reference points and context. Anything that affects large numbers of
people involves big numbers, so negative reactions to billions or trillions in
and of themselves are useless or harmful.

~~~
indemnity
You’re welcome to visit any other developed country where people don’t live in
fear of getting sick and don’t treat massive bills as an inevitability, even
after having insurance.

Their health systems are as competent as those in the states, despite the fear
mongering by your health industry of years-long wait times, queues, etc.

So yeah, if the job we don’t understand results in massive underserving of
your nation’s health needs, perhaps your disgust is misdirected.

~~~
disabled
Correct. In the US, the 3rd leading cause of death is believed to be
preventable medical errors [1]. It is an absolutely atrocious statistic, that
only mirrors developing countries. Statistically, this sort of thing only
happens in developing countries, and never developed/industrialized countries.
Americans should see the irony in that.

A good resource, that I suggest all Americans consult so that they can stay
alive is: [http://HealthData.org](http://HealthData.org)

I consulted that website for years for trusted data on global health systems.
Ironically, it is the same group that runs the IMHE coronavirus predictive
models in the US. It is an amazing group, run by the University of Washington,
which has a phenomenal public medical school.

Anyways, the wild part is that countries like Croatia compete with the US, for
overall quality of care as a whole (not medical errors!). You know, a former
Yugoslav war-torn, economically damaged country, that is up and rising thanks
to being a new member to the European Union. It also has its geographic
challenges in distributing care, due to having about 50 inhabited islands. One
island is a 2 hour and 45 minute ferry ride away. If you get extremely sick,
it is a 5 hour boat ride back to the mainland. There is no air ambulance
service.

The US is really going the wrong way, and for shocking reasons. Also,
Americans are generally unaware of how low the bar has been actually set,
which is actually extremely low. It is also the system's fault, not the
doctors. We really do have incredible doctors in the US.

[1] [https://www.npr.org/sections/health-
shots/2016/05/03/4766361...](https://www.npr.org/sections/health-
shots/2016/05/03/476636183/death-certificates-undercount-toll-of-medical-
errors)

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jmchuster
A lot of the inflation in medical prices comes from how the incentives in the
US medical system are lined up (e.g. "Usually hospitals get paid only a
portion of the amount they bill, as most have negotiated discounts with
insurance companies."). So, UHC doesn't just mean that the cost is paid for,
but that the price itself wouldn't be so astronomical. I'd really love to see
a comparison between 1) the $1MM bill 2) the "actual" negotiated money that
changes hands 3) what it would cost in other countries with different
healthcare systems.

~~~
indiannotation
I reside in India and I have also lived in the US, so I can comment on 3.

India is going through an interesting phase of aping the "insurance system" of
the US over the last 10 years or so (maybe longer, but that's not the main
point), but a lot of people are too poor to afford health insurance. Only
people who go to the more expensive hospitals use insurance, as a rule of
thumb. And guess what? The costs for many procedures have increased 4-5x over
this period at those hospitals which _do_ ask for insurance, which still beats
inflation handily.

On the other hand, the vast majority of people don't have insurance, which
means people get to pay _actual_ medical costs for the trivial stuff like cold
and fever, and common ailments. These costs generally track inflation.

On seeing this, and realizing that except for some really complicated stuff,
India's healthcare system is generally quite OK, I have come to the conclusion
that the insurance industry in the US is just a complete scam. Insurance is
supposed to be something you use in case of a catastrophe, and I don't know
how it ended up as such a mandatory thing in the US.

~~~
theonemind
I think that inelastic demand and relative difficulty of ability to price
compare lead to it pretty naturally Once you have an insurance layer in the
system. I mean, if you get shot, and the ambulance rushes you off to a
hospital, you (literally) can’t haggle and shop around.

As for it staying like it is, laws in the US radically favor entrenched monied
interests because of lobbying, and we have a huge amount of political
propaganda convincing uneducated voters to vote against their own interest to
the extent that votes even could do anything.

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hedora
They charged him $82,000 to use a ventilator. I wonder if that includes
supplies and labor, because you can buy multiple ventilators for that price,
and they’re reusable.

Also, $400,000 to seal a hospital room seems excessive. I don’t imagine how it
could possibly cost that much. Add a few hepa filters to pull negative
pressure, and you’re already pretty close (not counting decontaminating the
doctors on the way in and out, but still, $400K?)

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baconshirt
As a Swede, I find it hilarious that you get a $1.1M bill at a place referred
as Swedish hospital in the article. In Sweden you would have to pay $130 as
this is our one year cap of personal expenses of hospitalization (high cost
control, performed by the hospitals, not by the insurance companies).

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mikeknoop
Something I don’t understand. Insurance companies seem to have an incentive
(more profit) and collective bargaining power to reduce what they pay. Why
don’t we see a downward pressure on healthcare prices, then?

The typical narrative I hear around large healthcare bills is “racked up large
charges because insurance will pay it” which is the opposite of what I would
expect given the incentives I understand. Do insurance providers have a non-
obvious incentive to keep costs high?

~~~
setr
There's a strange relationship where the bill provided to you is not actually
expected to be paid as-such when given to the insurance company -- they will
generally challenge the bill, and through a court, it will be negotiated to
something more sane -- and this bill will finally be paid out.

So a doctor can charge you 10k, but the insurance company itself will only end
up paying 2k to cover it (and you pay your deductible).

So the charged price is entirely divorced from reality.

You get fucked when you don't have insurance, because you can't participate in
this process

~~~
intopieces
>You get fucked when you don't have insurance, because you can't participate
in this process

This is not accurate. Cash payers just have to go through the administrative
part themselves, cobbling together charity and self-negotiation, eventually
landing on a payment plan that doesn't get reported to credit agencies.

~~~
jmchuster
So the medical industry is based on intentionally giving ridiculous bills that
no one can pay and waiting for people to haggle them down in hopes of not
having their finances crushed?

~~~
intopieces
Yes, this is accurate. There is no expectation, from anyone, that a person
with a $1.1m medical bill will pay that. There's a specific group of people
called Medical Bill Advocates that help people navigate the medical billing
system.

As well, people don't really go bankrupt from medical costs that often.
Hospitalizations cause about 4% of bankruptcies among nonelderly adults. Among
uninsured, this rate is about 6%. They mostly go bankrupt because they lose
their jobs and income [0].

[0][https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5865642/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5865642/)

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seesawtron
Reminds of this story. Perhaps not relevant here or is it?

Henry Ford once balked at paying $10,000 to General Electric for work done
troubleshooting a generator, and asked for an itemized bill. The engineer who
performed the work, Charles Steinmetz, sent this: "Making chalk mark on
generator, $1. Knowing where to make mark, $9,999." Ford paid the bill.

[0] [https://www.smithsonianmag.com/history/charles-proteus-
stein...](https://www.smithsonianmag.com/history/charles-proteus-steinmetz-
the-wizard-of-schenectady-51912022/)

