Ha-ha, only serious: McSweeney's on price-gouging in the emergency room

Originally published at: https://boingboing.net/2018/12/08/sticker-shock-heart-attack.html


But … but how are all those no-value-added middlemen going to make a living if we change the health insurance system to a not-for-profit one?

For those who want further reading about American hospital billing practises, this is also a must [ETA: it’s a Steven Brill article, so it’s very long]:


Yeah, a month ago my 8 year old started showing signs of appendicitis. We ended up in the ER 3 separate times, with tons of specialists and doctors examining him.

In the end he didn’t have appendicitis, he had a rare form of pneumonia and we ended up spending an additional 4 nights in the pediatric ward. They gave us a room big enough with spare beds that allowed us to stay with the kid overnight. He received all the care he needed and we had as good an experience as you can expect when your kid almost dies.

I guess we’d have had to take out a huge loan or sell the house or something if we lived in the sold-out dystopia a few miles south of here. But this is BC, so I took particular pleasure in paying our family’s $75 monthly fee for the health care here. I also had to pay a few bucks for the take-home antibiotics, so there is that (another $40 or so).

Your system is appalling, I am continually astonished that it is somehow allowed to continue.


Stuff like this makes me so damn thankful I live in a civilized country with proper socialized medicine.


This requires that everybody should be asked their occupation at every restaurant (or anywhere else where the bill comes after the consumption) when entering or just before the bill is presented. Hospital Financial Administrator you say? Here’s the (unpriced) menu, feel free to order whatever you like. At the end: that’ll be $17,000 please.

Seriously, is there any other ‘consumer’ (hate using that word in medical context) domain where prices are not available before consumption?


Lots of industries rely on information asymmetry to one degree or another – real estate is famous for it. American hospitals and for-profit ensurers are a particularly egregious example, especially since patients doing non-elective procedures have no choice but to enter into the transaction.


Yeah, lots of industries rely on information asymmetry. (Nearly all of them, probably, to some extent and in some respects) Even if hospitals published price lists there’d still be asymmetry. But does any other direct consumer-serving sector get away with refusing to quote prices? Or even give a quote in advance? And why A&E (ER)? If I go for any elective surgery, I get a quote in advance if I am paying directly (did once have to go private while without private medical insurance in UK, and that is exactly how it worked).

ETA - dumb question from me, obviously. Why A&E (ER)? Because you are over a barrel at that point with almost no ‘shopping around’ options. But even so, just publish the tariffs!!


$5000 for an icepack is because hospitals play a game with medical insurers. They charge ridiculous rates to pad their bills, because their working arrangement with insurers means that they happily accept pennies on the dollar as proper compensation.

However, if you look at your bill, you will see the $5000 cost for that icepack has been “paid” by your insurance. Except, no - it has not been paid. They paid maybe 20% of the total charges, and the hospital credits them will full payment. So, what the patient sees is a fraudulent accounting.

And nobody would care except for one thing: those inflated prices can wind up being charged to patients. If you have insurance, you have deductions, copays, uncovered services, charges above “usual and customary” etc - you pay your insurance company or the hospital or the doctor’s office the full inflated price, even though medical insurers ONLY pay discounted prices to providers.

If you have zero insurance, you will get stuck with the whole inflated bill. And some people DO pay that bill - and are financially ruined because of it.

Never pay the full bill - negotiate it down by 80%, just like the insurance company does. Or threaten to go public. Let’s hope we get Medicare for all. But if we don’t, we need to demand that medical providers pay for all our medical bills - no cost shifting with deductibles, copays, partial payments.


You really expect sick people to do this? Especially people who are working class?

Okay then. I’m sure they’ll enjoy that cake you recommended, too.



Hospitals have people on the payroll who work in accounts receivable and who do this all the time for patients. Yes - they will settle your bill for pennies on the dollar. Many hospitals also have all sorts of financial aid programs for folks without insurance or who have low incomes. But they don’t exactly shout it from the rooftops. You have to ask about them.

I recently got put on a new medicine that would have cost me $400.00 per month. I told the pharmacist not to fill it, I would do without because I couldn’t afford it. They quietly took me aside and with lowered voices gave me a phone number to call for their prescription assistance program which, btw, had very generous income limits. I now pay zero for all my prescriptions at the Rx, which is part of the hospital system.

There is not a single sign or brochure in the pharmacy advertising this program. And I can tell you the hospital also has an identical program that covers ALL hospital expenses. But you gotta know about it. Somehow.


Be very thankful.

I once had an ER charge me $900 for two pills of Vicodin; years later, that hospital was sued in a huge class action suit, for price gouging customers.


I’ve dealt with hospital billing issues, for myself and one of my parents. it’s a convoluted, complicated process that isn’t easy to navigate for someone like me (who has a graduate degree). The insurance companies are just as responsible, if not MORE so for the current state of affairs, as hospitals, who are generally speaking trying to stay solvent so they can continue to serve the public.

So, people need to be mind readers as well, apparently.

how about we have a system that isn’t based on lining the pockets of insurance companies, that pays for needed treatment and focuses on wellness and treatment, rather than on creating an entire layer of bureaucratic nonsense between patients and doctors.


Stop; you’re making way too much sense.



Same as it ever was…


A few years ago my partner and I were in the north shore in MA for a wedding, and the after party eventually wound up on some strangers’ boat. When the police got around to asking us off said boat (4 am, maybe? It was a good party :sunglasses:) my partner slipped between the boat and the dock as she stepped off the gunwale. Fortunately I caught her before she hit the drink, but I was not fast enough to prevent a roughly 2” gash slicing up aside her shin torn open by an old rusty bolt. I pulled her up to the dock, and with our group headed back towards the hotel (the police, I will note, didn’t even flinch to help when she fell nor did they bother to inquire as to her condition acab.) Along the way she was pleading with me not to go to the hospital, can we please just put a bandage on it, I’ll be fine, etc. obviously though we were going to the hospital.

Anyway, we get a cab to take us to nearby, tiny Beverly Hospital, which was fortunately as dead as an er can be. My partner was triaged, cleaned out, and stitched up in about 45 minutes, and we took the same cab back to the hotel, where we returned to partying, intent on finishing every last drop of alcohol we could find. It was a good party!

The cabby was kind enough to only charge us for the trip to the ER, however a couple months later I would find out just how charitable Beverly Hospital was- a bill in the mail for over $2500! I called them immediately, demanding to know how the hell 45 minutes, local anasethia, 25 stitches from a nurse practitioner, and a handful of antibiotics could possibly cost that much. After receiving a mouthful of hospitalese in response, I’d had enough. I asked if the thread was spun from gold, and kindly informed them that they might as well send the bill off to collections, because they sure as shit weren’t getting a dime from me. Fuck that, and fuck you.


To be honest, it seems like you guys are debating two different issues. @burllamb is advising on the best tactics to navigate a broken system, while @Mindysan is debating the broken-ness of the system.

Maybe I’m being naive, but I tool burllamb’s posts as “hey, here’s some helpful tips”, not “hey’ here’s excuses for why the system is good”…

One huge problem with pharmaceuticals that starts above the hospital level is the drug pricing for exclusive/protected drugs. When my mom was dying of stage 4 cancer, she was put on a relatively new oral chemotherapy drug that ran $100 per fucking pill, of which the dose was 1/day. Yup, roughly $3k/mo. to try to maintain some quality of life and stay alive as long as possible. And this was the f-ing post-insurance price. The company that produced it did have an income based discount program, but the limits were actually pretty high, and Mom didn’t qualify. Luckily we could afford the extortionate cost of the prescription, at least for the limited time it was needed…


My problem is less that he’s advocating for how to negotiate a broken system, and more that he assumes that everyone has the exact same level of time and wherewithal to do so. What is possible when you’re middle class and educated is not what is possible when you’re working class and possibly having only a HS degree. Not everyone has the same resources and opportunities to spend hours on the phone with administrators or your insurance company - and this reality is set up precisely to reap profit out of people least able to afford it, by making it so difficult to navigate when you have little time or education to do so. Pretending like someone has the same resources or time to do this is essentially victim blaming. I’m very lucky that my family has the time and space to work with this broken system. Millions of other families do not have that option and it’s not their fault.


The problem therein is that those ‘tips’ come from a place of relative privilege, and therefore, they are not at all that useful to the underprivileged people being preyed upon by an unfair and opportunistic system.


You said it far more eloquently than I could! Spot on!