A detailed analysis of American ER bills reveals rampant, impossible-to-avoid price-gouging

Originally published at: https://boingboing.net/2019/03/14/grifters-in-gowns.html


Gouging. Gouging everywhere.

A recent CT scan experience showed my local facility was charging 3x as much as one 20 mins away. While I could and did avoid this particular incident of remorseless overcharging it sucks that the only means necessary to get people to hospitals in times of emergencies is subject to the same shady pricing practices.


This does not excuse the gouging but if you are going to the er under your own power for something that isn’t life threatening, try to find an urgent care facility instead. It will usually be cheaper and often faster.


Why do you hate capitalism and freedom, Cory? Why, on this very site over the years I’ve seen people claiming to be the kind of calm and cool businesspeople who negotiate the price of everything in their lives (presumably including when they’re in extreme pain or under anaesthetic). And insurance? Ha! Some of them pay cash. If they can avoid high ER bills by taking personal responsibility, why can’t everyone?


As an Er nurse I find this pretty embarrassing but please: if you want a good price on Tylenol, take it at home. It’s effectively a wholesale price. $2.50 for a Tylenol is pretty reasonable when delivered by a nurse making $40 an hour, rxd by a doctor with $300k in student loans, in a place where when you walk in the door we don’t know if you have fingernail fungus or something that’s going to kill you immediately. $2.50 is pretty cheap in that scenario.

Otherwise though, yeah this is awful. You wouldn’t believe how hard they work us too.


Thank you for taking on a job that crazy. My wife used to be an EMT so I have an inkling through stories of how crazy that work is.

How many patients would you say you see during an average hour on a shift? I know there’s really no such thing in the ER but I’m interested how your time gets divided.

I agree that comparing a treatment self-administered at home is nothing like having it administered by a team of professionals.

I really wonder how hospitals divide their overhead. It would be amazing if there were concrete numbers to cover how much of the bill goes into staff support, the building, services rendered, medicine and equipment.

It would make billing insanely complex but it kind of is already. It’s just insanely complex and completely opaque.


All of this is terrible, but none of this is new.

I assume this was incurred during a trolley-fight in a hot air balloon…


Got into this with a free market fundamentalist small business owner and they were actually willing to take the position that they’d do some online price comparisons for which ER or doctor to go to if they were having chest pains, shortness of breath, and tingly arm numbness (signs of a potential heart attack). When I pressed them on what parameters they’d use to evaluate which doctor to go to, naturally they shifted the goal posts and argued that people wouldn’t get bankrupted by healthcare if they’d just put more work into shopping around.

Is there some microchip or drug I can get to make me enjoy defending shitty status quos as much as these guys? I’ll take it if it gets me good preventative healthcare.


I recently had the same blood tests run 6 months apart. The set that was done at Quest cost me $40 out of pocket, the exact same set of tests done at the local hospital later in the year was $505 out of pocket.

They even coded the analysis as an “in-patient” procedure despite the fact that a nurse took the blood at my usual doctors and sent it to them and I have never set foot in their hospital. I was able to get a 10% discount for paying in full, but now I have to remember to specify where my blood tests are sent after they are taken. Absurd.


Where I live, virtually everything mentioned here is free to everyone who gets taken to hospital, no matter what the circumstances. Prescriptions may need to be paid for, but children and those over a certain age also pay nothing. I have osteoarthritis, my prescription for Zapain, basically codein/paracetamol is free, the physio and X-ray I had we’re free.
Of course, such a concept brings many ‘Mercans out in a dose of hives, which is likely to cost thousands of dollars by a price-gouging health ‘care’ system.


I’d be a lot more willing to roll the cost of the docs, nurses and facility overhead into the cost of the aspirin if those were not also billed out independently and the 2.50 aspirins weren’t sometimes billed without being provided.


I heard her yesterday on Fresh Air… I was wondering if she was sort of ignoring (to some extent) the role of insurance companies in how the pricing works out? Not that the hospitals aren’t part of the problem, but as @Paul_McEvoy notes, an ER (especially at a public hosptial) has overhead to deal with - some of which likely includes having to deal with insurance companies and their arcane process of reimbursing the hospital. So, yeah, I think gouging is part of the problem, but there are other structural problems as well that contribute to this issue, that are kind of glossed over a bit, at least from what I heard from her in her interview.


Yeah, he’s a real jerk for pointing out how rough a job working in an ER is… clearly an entitled baby… /s



I couldn’t really formulate an argument on that one. There are a lot of assholes in the ER but the laziest person works harder than pretty much anyone else in any profession. It’s pretty brutal. I’m on my 8th year which makes me a bit of an old Hans. Most people wash out and go to NP school by year 4 so I mostly work with 24 year old girls (who can be amazing but definitely there are few older very experienced nurses around). The money is getting worse and worse every year.

The only way I tolerate it is taking contracts which allow me to take off a few months at a go to do something interesting.

It’s darkened me quite a bit.


My only point earlier is that it’s ridiculous to point to the price of Tylenol specifically. You don’t go to a restaurant and say the scrambled eggs should count $.50 because that’s how much an egg from a box is.

Now it would be totally ridiculous to go out for breakfast at a diner and not have any idea what it was going to cost at all, and have the bill for breakfast be $40 for the truck drier special. And that’s where we are at right now. I just really hate the Tylenol argument. It weakens what is otherwise a very strong point.


If the restaurant charged you a several-thousand dollar “facility fee” to walk through the door, your tune might be different.

I can understand the premise of charging $40 for a cheap medication, if that price is intended to bundle the logistics, storage, facilities, and staffing costs associated with acquiring and administering it. The problem is that ERs (and hospitals generally to a lesser extent) charge that way, and then go ahead and charge all the other things separately too.

And regarding negative things health care workers say about patients, I don’t actually use the phrases mentioned above and generally find them reprehensible, but we do come up against a particularly awful segment of humanity. We are exposed to extremely high levels of workplace violence, up to and including murder. It’s very common to have police take someone in for some bs medical reason in handcuffs, take the cuffs off and leave us to care for the person. So…while I think being as kind as possible to patients universally is the best scenario, and while there are plenty of shitty people working in the ER, suggesting that it’s not a brutally difficult job is pretty ridiculous.

The terrible thing about it for us is that we have to negotiate the same healthcare system as everyone else. Because I choose to work contract often, my health insurance is oftentimes inconsistent. I dread dealing with healthcare in any way and have exactly the same fears about billing everyone else has. I say oftentimes that I wish everyone in healthcare had a couple get out of jail free cards you could use to get out of an illness but it doesn’t work like that. My mom had a stroke while having some unnessaary brain surgery two years ago. It’s radically changed my family.

So I’m as disgusted by price gouging as anyone else but it’s definitely not my fault. I may end up bagging out of it entirely, hopefully will be going to part time sometime soon. It’s been overall a difficult experience.


I guess you don’t see that I’m generally agreeing with you.

1 Like

I think we do agree in general, I just don’t agree that the Tylenol argument fails on its merits, since the (otherwise perfectly reasonable) counterargument falls apart under scrutiny when you consider all the other billing issues.

1 Like