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


#21

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.


#22

minus the other issues, $2.50 for a Tylenol seems entirely reasonable. Adding in the other issues, it’s pretty much irrelevant.

For the record in reading this stuff I’ve seen charges for Tylenol much more than $2.50.

I stand by the idea that it weakens the argument. A $2500 ER visit for something minor is obscene (even for something major). Pointing out that Tylenol costs $2.50 is pointless.


#23

Some of you know I had a stay in the hospital back in November. I was extremely fortunate that things turned out as well as they did (medically speaking); I am also fortunate that my employer-provided health insurance paid for most of the bill, which altogether came to about half a million dollars. ($12000 of that was for a helicopter ride, and another $1200 was for an ambulance to take me about half a mile from the hospital to the fire department, where the helipad is.) Or not – I can’t believe that anyone ever would, or be expected to, pay $500K out-of-pocket (I realize this is what causes some to go into bankruptcy).

I ended up being on the hook for about $3000 and I also consider myself fortunate that I was able to (eventually) manage that (with difficulty, but it’s done). The ER visit itself was only $150 of that – the insurance sets that as the co-pay.

Like I said everything ended up being OK but to put it mildly and gently, the ER did not handle my case as well as they could’ve. I presented with a strong headache & vomiting (after I’d fainted) – at the time I thought I’d “merely” had a concussion, but I’d have thought that the ER might’ve prioritized that a bit differently than sending me back out into the waiting room for a couple more hours with a bag to puke into. But I digress…

ETA: The “point” here, I guess, is that no one should have to pay more than what I did, and hopefully less. I’m guessing that with single-payer (or something resembling what the rest of countries with developed economies have), for one thing the bullshit of billing the patient (or patient’s insurance) half a million dollars (that they’d never collect even if they tried) goes away.

My wife’s an RN, though not in an ER. But her department is stressful enough that she was selected to attend a moral resilience program. One of its components is mindfulness meditation, and the hospital set up a room for the nurses to use for this purpose. Part of me thought, “hey, that’s really great” while another, more cynical part thought “sure, like nurses have time for that.”


#24

I think it’s a “murder, arson, and jaywalking” thing.


#25

Sorry for your ER experience.

I thought you might appreciate this video:


#26

Thanks and I hope I didn’t come off as implying that this is typical of ERs. My wife was more upset about it than I was; I tried to look at it that if they had done anything differently (better or worse) then I might not be here to type about it.


#27

Agreed on main premise of headline, the idea that these are the magical free markets that neo cons love to parrot endlessly is laughable at best.

I have always been confused as hell by health-care because it’s the only thing I end up having to pay for that I never know upfront how much I’m going to be asked to pay.

Can you think of any other industry that gets to charge you retroactively whatever the fuck they want? And it changes constantly seemingly at whim?

When your life depends on being able to pay bills the idea of getting sick and bankrupting you is utterly frightening. The idea that somehow any of us get to negotiate this shit it’s crazy to anyone who’s ever even been to a doctor no matter how much money they have.

We need a law passed by Congress that says prices for all medical procedures and treatments must be publicly available and the prices people actually end up paying


#28

The thing is it is sort of typical of ERs. People come in by ambulance all the time and get put in the waiting room and people walk in the door and sometimes get immediately put in a bed with a full court press. And sometimes the wrong person gets the wrong disposition.

I always feel like there’s an assumption with medicine that we ultimately should be able to understand every possibility for every patient, and that’s sort of the goal, but even the highest functioning doctors I’ve worked with screw things up on occasion. They are just generally really good a large percent of the time.

My analogy is like it’s going to a mechanic but the mechanic can’t open the hood or plug in the computer. All he can do is tap on various parts of the car and scan it to see if the parts are in the right place. It’s really kinda crude. Even things like CT scans and MRIs are pretty crude in their own way (and also amazing too).

Regardless I’m glad you did ok. Not trying to justify any sort of crappy treatment you might have got. Just trying to shed some light on the ER process as I understand it.


#29

And PS this is all tangent to the article. I absolutely agree about the gouging. Its just a part of a totally screwed up healthcare system that makes zero sense whatsoever.


#30

Or a Super Hans? You after a particularly grueling shift…

peep-show-superhans-how-doing

But my original point to the guy who decided the people who do an incredibly hard job are assholes was more that you guys do an incredibly hard job, more that you’re not responsible for being stressed and sometimes touchy in the situation that you regularly work in… and my original point was about how I felt that the analysis focused on the weird and opaque way that hospitals bill, which left out the role of insurance companies overall.

Anyone who doesn’t says that they don’t understand that is lying, especially when it comes to a level one trauma center.

Which to me, indicates that the problem is less with hospitals and care providers, and more with the system we have in place to PAY for such things.

Anyway, I’m just sorry that some posters here can’t see the value in what you do and assume that you’re at fault for the shitshow that is the American health car system. I think for profit hospitals are part of the problem, but the system that funnels so much towards insurance cos bear much of the blame for what we have to deal with.


#31

NO CAPES!


#32

re: “…the health care system’s woes”, this is not a system but lots and lots of separate ones. It should be one system with at least a single payer negotiating the prices (and preferably paying the bills). We have to keep pushing on the lawmakers until we get there.


#33

That sounds nice but…I recently had a terrible episode of vertigo and vomiting so: 1. Called my regular PCP but there were no same day appointments available. 2. Called the on call nurse who directed me to the urgent care. 3. My wife drove me to urgent care where they didn’t do anything for me but tell me to go to the ER (the urgent Care waiting room was empty.) 4. Went to the ER where I waited four hours to be seen. I was given an EKG and a blood test to see if I was having a heart attack (though I had no heart symptoms to speak of). 5. Finally given a meclizine (about $9 for a bottle) and a shrug. When I left at 9PM the ER waiting room was even more full than when I got there. Final cost about $2000 with the out of network doctor bill.


#34

Except that there is now a giant, immensely-profitable industry with decades of experience in sucking money out of sick people, and that isn’t going to go away. Yes, single-payer will give the buyer — the government rather than the patient — more clout when it comes to negotiating prices. But the same businesses that are now selling generic Tylenol for $2.50 a pop aren’t going to meekly roll over when they see their gravy train drying up. Rather, assuming they can’t just lobby to block it entirely, they will try to turn government-backed healthcare into a rent-seeking opportunity, ensuring that they stay profitable, and that US healthcare expenditure remains many times more costly than in other developed countries. And as the costs of providing Medicare-for-all consume an ever larger slice of the budget (and taxes rise accordingly) voices calling for a return to “the way it used to be” will get louder and louder.

If this seems far-fetched or unduly pessimistic, just look at defense procurement, or the state of US infrastructure. Infrastructure building in the US is also vastly more expensive than in other developed countries, in part because everyone wants a piece of that sweet, government-funded pie.

I love the idea of socialized medicine along the lines of one of the many successful models used elsewhere in the world (I used to live in France, where I enjoyed first-rate, personalized care at very affordable prices, and if you said the words “medical bankruptcy” people would just stare at you uncomprehendingly). But let’s not kid ourselves that all it would take is for someone to wave a magic wand and say “Medicare for all!” There are some fundamental problems — as described in this post — that will need to be dealt with first.


#35

ERs are also not permitted by law to refuse care, so they get lots of uninsured, penniless folks, in which case they have to eat the cost. This results in significant cost shifting. There is also a case for just flat out money grubbing, but it is not all inexcusable. This is one of the places where universal coverage would make a huge difference, but just look at the number of smaller rural ERs that shut down after the ACA, when their states refused to expand Medicaid.


#36

I agree whole heartedly! The fact that public, level 1 trauma centers especially cater to all drives up costs, since these are people without any sort of means of paying much if anything for their care. If they could, at least some of them would get more preventative care and not end u in the ER in the first place.

I found what I heard from her on the radio the other day pretty wanting, from that aspect, as well as the lack of discussion on the role of insurance companies in driving up costs.


closed #37

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