
Emergency room bills: what I learned from reading 1,182 ER bills - flippyhead
https://www.vox.com/health-care/2018/12/18/18134825/emergency-room-bills-health-care-costs-america
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jellicle
> $1 ointment/$76 ointment

When prices can be 76 times higher at one facility than the one next door,
with no notice to the patient until their bill is overdue, there's obviously
no way to price compare at all and market functionality does not exist.

> in-network/out-of-network

Vox doesn't say it, but doctors and hospitals are purposely orchestrating the
"out of network doctor in an in-network hospital" to raise their fees. It's a
deceptive trade practice.

The US medical system is broken. The solution is single-payer (none of these
problems exist in single-payer systems).

~~~
normal_man
Yeah, the idea that "shopping around" is something that people want to do, or
is even possible to do, with health coverage is utterly absurd propaganda
designed to discredit single payer policy.

~~~
rukittenme
What do you mean? I "shop around" for healthcare.

~~~
normal_man
You shop around for health insurance (which is another annoying nightmare
altogether, and most people's only option for that is the provider chosen by
their employer). If you were in an accident and taken by emergency services to
the nearest hospital, you pay whatever they say and you didn't have any
control as a "consumer."

It's a mistake, and frankly barbaric, to think of healthcare as a "market." It
should be a public service to all in the pursuit of a just society.

~~~
rukittenme
> If you were in an accident and taken by emergency services to the nearest
> hospital, you pay whatever they say and you didn't have any control as a
> "consumer."

Which accounts for 4% of healthcare spending. Rare, unforeseen events are
covered by insurance. That's how home insurance works. That's how car
insurance works. That's how health insurance works.

> It's a mistake, and frankly barbaric, to think of healthcare as a "market."

I don't "think of" healthcare as a market. By definition, it _is_ a market.
Whether it functions well enough to any person's satisfaction is a matter of
what that person values.

> It should be a public service to all in the pursuit of a just society.

Is a "just" society your only goal? A healthy society, a wealthy society, a
free society. There are many goals which might conflict with a "just" society.
How do you balance those objectives with social justice?

\---

Edit: I forgot to respond to my main point. Namely, that I do pick and choose
healthcare based on who provides the best price. I shopped around my dentist.
I shopped around for my root canal, I shopped for some eye issue I had, I
shopped around for my general practitioner, I ask for alternatives when the
doctor wants to prescribe medications.

Which is to say. I do not shop around for health insurance (it is provided by
my employer). I shop around for health care specifically.

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erentz
My own experience with hospital billing:

Had to go to ER in November, and I was admitted upstairs for a “rescue dose”
of IVIG for neurological condition (similar to CIDP/GBS). We were told by the
admitting doctor it should probably be covered by insurance but if not in his
experience it should cost around $10,000 for all five infusions necessary,
plus another $2,000 per day for the bed. The doses are infused over five
separate infusions.

Get one dose that night of 30g of IVIG. Next day new doctor comes and tells me
he doesn’t think insurance will cover it, and he’s talked to the pharmacist
and it will cost us $16,000 per infusion. We absolutely can’t afford that so
get discharged.

We now have an outstanding bill for $16,666.30 for 30 grams of IVIG that
insurance didn’t cover.

(Cue dramatic story about having to get rid of all of our stuff and being
driven 3,000 miles across the country to change to a different insurance plan
offered by my company.)

I am now on regular infusions of IVIG, and a 40 gram infusion costs $3,700 at
the contract rate the new insurance pays. That’s $94 per gram vs $555 that the
hospital is trying to charge is. A 6 fold increase to a private individual who
can’t afford it, without being told in advance the actual price or given the
option to not get it.

~~~
flippyhead
TBH it's stories like these that make it hard for me to not regard my doctors
visits as adversarial.

