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


#61

And the collections industry is about as shady as they come, with many of the people who “buy” delinquent debts for pennies on the dollar routinely crossing the line of legality to collect. If you’re shielded by privlages such as financial security and time, you can tell them to go pound sand and hire a lawyer. If you’re, for instance, elderly and disabled, some chicaner who’s probably got a rap sheet for domestic violence screaming threatening messages into your adult children’s voicemail really is the definition of hell.


#62

Yes, but medical school tends to be more expensive. I had a friend (well, former friend) who got a phd in history, came out just over 100,000 in debt (which she might be able to get covered by working for the state or in public education). Another went to medical school and is in debt over $300,000. Now, he does well and will be able to pay it off, but that’s a huge difference in debt load.

I think it’s more than just the medical field that needs reform with regards to costs of going to school.


#63

Are you under the impression that medical care providers control the medical-industrial complex? Because they do not. Corporate boards beholden for their outrageous salaries to shareholders and other investors do. They control the Pharmaceutical industry. They control the insurance industry. And directly through investment groups buying distressed hospitals or indirectly through the levers of private insurance and pharma, they control most hospitals. MDs are there to treat your individual maladies, not cure the broken US healthcare industry.


#64

A couple more Tory governments and I’ll have this to look forward to, I fear…


#65

“People who need it the most”?

Reminder that the Trumpist base is dominated by middle-class white men, not the poor. Poor people are the only economic group in the US that vote majority Democratic.


#66

I believe @Faffenreffer may be referring to senior citizens who, middle class or not, are almost all part of the 99% who can readily be financially wiped out by medical bills yet disproportionately vote against their own best interests.


#67

On my to do list. Right after I start my own interstate highway system, national defense service and do the laundry.


#68

The AMA has been one of the strongest and most consistent opponents of universal health care since FDR was president, and cannot be absolved of responsibility for our uniquely terrible position among civilized countries in access to health care.

Sure, but if you do a deep dive into the budgets of campuses with medical schools, you find that the med schools are supported either through profits in their teaching hospitals if they have them, or through revenues on the rest of campus, which means undergraduate tuition. (I’ve been on my school’s budget committee, and looked at these number not only for my own school, but for many others; the conclusions are pretty consistent across state institutions.)


#69

Based on the current debacle on r/libertarian, I would say this:

  1. libertarian-capitalists say you have freedom to do what you like
  2. socialists sucessfully pool their resources to set up parallel system
  3. cartel that got it’s power from the libertarian-capitalists stomps socialist system out of existence before it becomes a threat to them.

#70

I will probably get blasted for this, but the fact is this is why most hospitals have a virtually incrossable moat between providers and the finance guys. As docs, we do the best we can, but if you ask me what a particular procedure or medication will cost, the fact is I have no idea. I actually do check on the price of things I commonly do, but the billing changes faster than I can keep up, and can you guess how often it changes down? So, I plead ignorance when asked and refer patients to billing, which reminds me very much of Dilbert’s “preventer of information technology” gag. And, yes, most community hospitals are struggling to stay solvent, with more going under every year. Broken system, no help coming, no answers here. Just pointing out that the people you can actually get your hands on are just as irked at the mess as you are.


#71

My tips are not useful? Fine, don’t use them or pass them on. But don’t think for second that I am defending the system. Fucking A. :frowning:


#72

See aoc’s proposal for Medicare for all, which is what I was talking about. She wants zero payment at place of service. I think she should go even further - no copays, deductibles. Including for outpatient drugs. Let the med insurers deal with high drug prices.


#73

I didn’t fuckin’ say or even imply that I think that, so you might wanna check your overblown sense of butthurt there, bro.


#74

Someone walks into my ER, and says “I have abdominal pain, what will it cost?”

There is no answer at that point in the service. As the triage nurse, I first have to figure out if they are going to die in a few minutes. Even if I could accurately predict their entire ER course (which tests will be ordered, which medicines, and the outcome), the hospital provides me no way of knowing what the hospital will bill - let alone the actual cost. It isn’t that I am not allowed to tell you, but that there is no accurate way to predetermine cost for such a vague question. But wait, it gets worse, bc the system just makes such ambiguity even more absurd…

Add in the fact that their insurance plan may be completely obtuse - how much have they paid so far? What is their co-pay? Their deductible? Their max out of pocket? Is the hospital in network? Is the Doctor? (just bc the hospital is, doesn’t mean the doctor is).

There’s no way that a consumer can make rational choices in care costs - not even for non-Emergent conditions. Forget visiting the ER, where is it more obvious that costs can’t always be predicted. Hosptials keep their costs a secret, not just from consumers, but from workers, insurance companies, everyone… They don’t want people to know. They don’t want people to shop around based on cost or value. It took Medicare Years to get hospitals to submit and publish quality data, and those are still vague and difficult to access and parse. If everyone’s prices were obvious, hosptials would have to compete and they don’t want competition.

I think I’m getting too angry at the system to keep typing, and should stop before I start raving!

– Sometimes it is good that I don’t know these answers. When the reason you have abdominal pain is that you have internal bleeding from your car crash yesterday, your blood pressure is 75/40, and you really need to go to the operating room in the next 5 minutes, your health care team should be forming their treatment plan by what will save your life, not by what your insurance company will pay us. There are times when we SHOULD be decoupled from the costs and profits.

edited to fix parenthetical problem. Thanks, Melizmatic!


#75

Er…

I humbly suggest not using triple parenthesis like that for emphasis, or whatever; it’s a known “code” of bigots in reference to hate speech about Jewish folks.


#76

but how? if you never signed a contract or even verbally agreed to a price?


#77

So just to share another perspective here…hospitals are also a victim in this whole mess known as the American health care system.

My uncle is a hospital administrator for a fairly large regional care system. He manages all the labs for over a dozen facilities and handles operations for a 600+ bed hospital in a mid-sized Southwest US city. We talk often about the state of the US system and why it’s so f*cked up.

From his viewpoint, hospitals are the last line of defense between life and death. They cannot, by law, turn away a patient. If somebody (either thru insurance or directly) doesn’t pay the bill, the hospital is forced to eat the cost. And spiraling out of control costs are what’s destroying everything.

A well run hospital makes less than 2% margin (profit) in total while most hospitals run in the negative year after year after year. As a business (and yes, a hospital is a business - we can debate if it should be elsewhere)…name any other business that can stay running with years (decades even) of negative profits.

It’s also impossible for the hospital to know what a procedure costs as their are dozens of factors in play. What tests will be ordered? Which doctors are involved? How much facilities are required (room stays, operating rooms, lab equipment, MRI machines, etc, etc). Every patient and every procedure is unique. There are guidelines for sure but that’s all they are. A simple appendix removal can turn into a month long stay if something goes wrong. It’s not always black and white and the hospital is required to perform no matter what.

Here’s a real world example of the kind of costs involved…once my uncle was in charge of ordering some supplies. A medical supply catalog had a simple cutting board, just like the one you have on your counter. Price? $800. He found the exact same one at Walmart for $6. Same manufacturer, same brand. But he’s required by law to purchase the one from the catalog. That’s just one out a million different examples that balloon the costs of our health care.

Look, make no mistake…I’m in no way defending this. It’s untenable and something has to change. My uncle echos this too. He’s not a capitalist monster looking to gouge poor unsuspecting patients. He got into health care to help people and he truly cares about the quality of services his hospital provides. But he also has to stay in business in order to keep helping people. This means he has to work within the f’d up system we all have to deal with.

It’s important to remember there are dozens of complex reasons why we’re in this mess and hundreds of factors to consider for why things are the way they are. I’m for single payer as well but unfortunately, none of the solutions being talked about deal with the cost side of the equation. Until we get costs under control all we’re doing is shifting things around.


#78

idris-elba-talking

YES! The market can’t fix EVERYTHING. Thanks for your insights into how this stuff functions in the real world…


#79

I’ve seen this locally, with our intown public hospital, Grady. They do fantastic work, are a level one trauma center, etc. They nearly went bankrupt a couple of years ago, but there still there. Meanwhile, many of the rural hospitals in GA have been going out of business. It’s easier for ATL to fund Grady, because we have a larger tax base here. The rural hospitals are sort of fucked with the current (and incoming) administration which has refused to expand medicaid, which would help both Grady and the rural hospitals that are still hanging on by a thread.


#80

But even Medicare and Medicaid don’t address the cost side directly. What they do is impose limits on what they will reimburse for. And those limits are going lower and lower while costs keep going up. This forces hospitals to take deeper and deeper losses.

Let’s look at an example. For the sake of argument let’s say A straightforward knee replacement requires an X-ray, an MRI scan, a battery of basic blood tests, and a 2 night hospital stay. Let’s say the static cost to the hospital is $5000 (totally made up number. Doesn’t include doctors, physical therapy, etc.). This is the bottom line hardwired costs to the hospital for everything involved - bed, food, facilities, land, payroll, etc.

Now let’s say Medicare will only reimburse up to $3000 total. Not a penny more. Who pays for the difference? Nobody. The hospital writes it off and takes the loss.

Now let’s say next year the cost to the hospital goes up 15% while Medicare reduces reimbursement 10%. That hole just got deeper and who pays for it? Again, it gets written off as a loss. This is not sustainable.

Controlling cost is everything