I paid $2,000 last year for a hospital emergency department to superglue a cut on my son's head, it took 10 minutes. Next time, I'm going to glue it myself.
I tend to work on the basis that Thais get paid about a fifth that Americans do, and this would have cost you $200 by an American-trained doctor in a world-class hospital in Bangkok. If you’re actually poor, social security would cover it.
That's why the US political system is broken. Companies lobby representatives for incentives and breaks and in the end you get something like this. It's dysfunctional.
The worst part is actually this:
"The hospital received less than half of what it originally billed, based on rates negotiated through his health plan."
If you don't have an insurance the rates are even more of a joke.
Its been said before by some I went to high school with that now has a PhD in public health that America's Healthcare system is first and foremost about paying insurers and everything else is just considered a loss
Hospitals must stabilize anyone who walks through the ER door by law, no matter their ability to pay. They do not receive any funding for that mandate, however, so they have to make up the cost across their patients that do have the ability to pay. The stitches don’t cost $18k, but the ten people who walked in prior with no insurance and a broken leg or heart palpitations do.
Edit: to be clear I’m not defending this awful system.
Highly skeptical of this explanation as this would mean about 90% of the US population is going bankrupt on the regular. No way this is true. Most likely just perverse incentives.
Perverse interaction with insurance companies. Insurance companies have list of prices for operations. If the hospitals rate is higher than their price they have negotiated only to pay their list price. On other hand if the hospital price is lower they only get that much. So logical result is that hospitals maximise their prices to always be above what insurance is willing to pay. And then they can just negotiate lower rate for someone promising to pay in cash, which could be fraction.
That is my understanding from Europe. From outside the logical way would be to mandate single pricing structure and ban any direct discounts.
Unless you are already quite rich, you just are a a bike accident or diagnosis away from bankruptcy, a life of financial stress and misery and even death in the US. It's terrifying.
I'm an American who has been living in Norway for 8.5 years now. I am never moving back, unless there are some serious system changes which will realistically not happen in my lifetime.
Better, is your insurance actually paying, without trying to weasel out of it. Also better, is not being charged almost half the median annual income for stitches.
Living in NY or SF only affects a small subset of Americans. Getting universal health care affects almost 100% of people living in Norway. There are good job opportunities pretty much anywhere when you're in tech, you don't nee to make SV money when you don't live in SV.
> Curious, what’s better?
Parental leaves, more vacations, less working hours per week, better life/work balance, free health and education, &c.
People who never experienced both systems can't understand the impact it has on your life, I'm not talking going in vacation in EU/US, I'm talking working/living for extended period of times. You can't escape the matrix if you don't know you're in the matrix. The US is like Disneyland or Vegas, if you can afford the top level shit you'll have a good time, some would argue even a better time than anywhere else, if you're on a budget be prepared to be treated like cattle.
> if you can afford the top level shit you'll have a good time, some would argue even a better time than anywhere else
This makes working hard/smartly in order to be able to do this incentivizing. Rather than just sitting back and enjoying the life/work balance and less working hours
Yeah ok, but maybe, just maybe, accumulating wealth and gadgets isn't the be-all and end-all of life for everyone. If some people want to be in the rat race until 65 they're free to do so. I personally have better things to do with my limited time on this earth.
> Rather than just sitting back and enjoying the life/work balance and less working hours
What's wrong with enjoying life once your needs are met ? If I'm happy working 35 hours a week why would I work 42 hours a week ? If I don't want to buy the next new shinny toy why would I bust my ass for extra money that I won't need ?
Not sure why you are getting downvoted for what seems like a generally curious question. I'll try and give some answer from the point of view of a Swede who is a serious "USPhile" in many ways (and someone who in his younger days wanted to move there).
- Parental Leave: When I got my first child it's hard to understate how much being able to be off work for 8 months with ~80% of my full pay. I'm now going off for 6 months with my second child in February. And I can save up parental leave for a long time meaning I can take longer vacations to spend summers with them as well.
- Healthcare: Again once you have experienced the true value of universal healthcare you will not want to go back. My second son go a bad infection and had to spend 2 weeks in the hospital with his mother. Cost (excluding what we paid in taxes of course...): 20-30 bucks for buying candy (i.e it could have been 0 ;)).
- Education: All higher education is of course free for all EU citizens. It used to be free for everyone in the world but the unfortunately removed that a few years ago.
There's of course a lot more one could point out (like for example high speed internet access pretty much everywhere, good mobile connection speed pretty much everywhere).
Of course this comes with a cost of paying more in taxes (happy to do it!). I'm not the biggest fan of snow as well.
Similar for me, but in Sweden and I'm only a couple months in.
My ideal societal contract would be something like this: I want to be free to focus my energy on my work, relationship, and interests. I want the state to focus on programs that reduce the need for individuals like me to have to focus their energy on anything else.
In practice, this is stuff like equal access to healthcare, education, childcare, social security, time-off...
In the US, access to these things is not a given, and they often end up as rewards, distributed very unevenly. ...Even worse, this leads to anxiety/worry/focus by individuals like me to try and fix or mitigate those problems.
As you mention, the scale of change in the way the US operates seems unlikely anytime soon; at least for me, removing myself (my skills/labor/knowledge) seems like as good a way as any to try and coerce change.
And I certainly still benefit from such incentives, even in the nordics (private health insurance, time off beyond the 25 days mandated by law, etc are still a thing in a competitive labor market here).
I just see more benefit personally when a basic level of these things is offered to everyone. I don’t need the extra anxiety that my friend, bandmate, barista, or bartender is one crisis away from ruin.
I don't even know what deductibles and copays are!
Edit: Of course I could Google it, and I have a vague idea. But the idea of even having to think about money for things like a kids accident seems completely foreign to me.
Edit: It does rather explain why the founder of the UK NHS called his book "In Place of Fear"
If something happens to you, or your partner, your mom, your children, your friends, on even your neighbors that you don't really care about but don't want them to struggle because it's nice to live in a society with healthy people around you.
I didn't try to pass a moral judgment on the issue and I like the socialized system we have, for the most part.
but confronting cost without taxes is trite and tiresome. I'm going to pay north of 150k eur to subsidize healthcare thorough my life, and being in the upper tax brackets (which start at some ridiculously low point) I also have to copay each service on top of already being paying more taxes for it.
and when I see the "but ambulance rides are almost free here in x european country!" and the likes well no, they aren't, it's people that just didn't factor the actual costs in, because it's sunk in other taxes.
Sure, but taxes are spread across the entire population. Insurance sort of kind of theoretically works like this (maybe substitute "time" for "people" that you're spreading the risk over), but the insurance industry are always going to be experts in making sure that no one is coming out ahead on that system. I'd rather have the entire population subsidize a small amount for everyone's health than randomly make a subset of the population destitute for what's often complete random bad luck.
Secondly, if you take a look at non-insured prices for health care in countries with universal health care (for the most part, the "universal" part is limited to residents and visitors still have to pay), the prices are still significantly lower than they are in the U.S. Having a single payer for insurance and strong regulations over health care enable things like price controls, which makes perfect sense in a health care context since it's never really going to work as a free market (emergency care needs to be treated immediately without the ability to "shop around", the care required isn't always evident at intake, doctors refuse to talk or consider financial aspects, etc.)
You are right that you also have to include taxes, but you also have to account for the fact that taxes are dependent on income and coverage is always guaranteed.
So it is not the same as paying for a service. It is something else.
I think there's a real difference though when the cost is "baked in" via taxes or something else. If a doctor's visit has the potential to cost you hundreds or even thousands of dollars, unless something is really serious, chances are you're going to avoid going.
In a system where costs are paid through taxes, the disincentive to see a doctor is eliminated. That maybe has some negative effects (going to urgent care for relatively minor problems), but I think it has real benefits in terms of preventative care.
In terms of a countries overall finances, it balances out (not entirely - see my previous point), but in terms of affect on behaviour it has a huge effect (in addition to balancing out the burden that I mentioned before).
> The "resolution" says they "only" have to pay 2.000$ in deductibles and copay now.
Well, with what their insurance pays it's still about $10k total.
> Just for comparison: a fully-fledged broken leg operation costs 3.000€ for non-insured people in Germany.
My dad had brain surgery in Germany by pretty much the leading experts for that particular kind of surgery. The surgery itself, the hospital stay, etc. was about 18,000€ in total.
We had to pay about 1,000€... for a hotel and living expenses for my mother and myself since we wanted to stay with him. Insurance covered everything my dad needed.
So you can literally have brain surgery for what it costs to get some stitches in the US.
The American healthcare industry is large and sprawling. Largely due to the fact that much of it is managed at the state level (as opposed to federal... think of this as the difference between Germany’s healthcare vs what the EU provides).
Deductibles are part of some insurance plans but copays are part of all. Deductibles are generally large but capped by an out of pocket maximum. These are generally on plans that provide a high degrees of network freedom, meaning you can self-refer to a specialist. Because you are not a medical expert, there is added risk to the insurer that you are seeking unnecessary procedures and so they ask you to share the risk by paying a deductible. These are typically the PPO (preferred provider organization).
There is another type of organization, an HMO (health maintenance organization) whereby you must get referred by your primary care physician, thus serving as a check on the risk. In HMOs, there is generally no deductible. There are still copays though, but they are generally small. For example, I just broke my finger and needed surgery to set the fracture. It was $20k surgery. My HMO negotiated it down to $8k and I paid a $30 copay. Had it been a PPO, I’d have paid well over $2000.
As for why there are copays... they actually are there to dissuade hypochondriacs and drug seeking (aka moral hazards). This is a delicate market price though that needs to be high enough to prevent the hazard but not high enough to dissuade against necessary procedures.
You can in an emergency, but it's not recommended. There is special medical glue that is non-toxic, more flexible and designed to come of the skin easier.
Partially joking; this was used in wars to stop bleeding before a doctor could arrive - it saved quite a few lives. There are friendlier glues now though.
I'm too European to understand why this makes any sense. I think the problem is not really that the insurance doesn't want to pay the bill, the problem is that $18,933.44 for stitches and anesthesia makes absolutely no sense at all. Therefore, the resolution is not to negotiate with your insurance and tell them exactly what happened so that you can split the bill. The resolution is to negotiate with the hospital about the costs of stitches and anesthesia. In Europe (Netherlands in my case) the insurance usually pays everything (part one of the solution), which forces the insurance to negotiate with the hospital about prices (part two of the solution). Keeping most simple interventions low in costs.
The hospital charge as much as they can, because some patients are unable to pay. This way they make up the difference (or make more).
The idea is that you go to the billing staff and threaten that you will go bankrupt and will not pay anything. Then negotiations begin. Rich pay cuz they don't care, suckers get conned, and poor gets their credit destroyed. Classic USA.
It is another 'american' system akin to tipping only taken to extreme.
That might be possible if healthcare companies were upfront about the cost of their services. But I bet you couldn't find an upfront cost for stitches from 3 hospitals in your area.
Not only that, I tried to look up pricing prior to an emergency visit. I got a massive excel spreadsheet that was every single name for each codified medical procedure they had. On top of that it’s often not possible to anticipate what all treatment you’ll receive. I was expecting to just receive stitches real quick but ended up in surgery overnight.
If that is capitalism then capitalism can go get fucked in my opinion.
Honestly, we're not talking about having a wart removed here. It's basic medical treatment for a child. That should be beyond reproach in any civilised country.
"Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune the cost of which should be shared by the community."
its certainly not free market capitalism. part of the problem is that the government makes it illegal to turn away ER patients. maybe you think thats moral or maybe you dont, but the point is that an ostensibly free market becomes corrupted with outside influences like this. you cant create a system designed for the free market to be the mistake fixer and then make the market not free and not expect bad mistakes.
i think this is the greatest failure mode for america: pretending non-free markets are free. in some cases, its the worst of both worlds by a very large margin.
I sometimes wonder if this argument is an example of the "no true Scotsman" logical fallacy. No matter how little regulation is imposed on a market someone will still find some example to point to and say "if only we weren't subject to such awful regulation the market would be free and everything would work perfectly".
The very concept of such idealized free market is a red herring. It doesn't exist in human societies (the closest is what you have between criminal gangs and during civil wars). There is no market in isolation from politics.
It's kind of like wanting to talk about electric field around a charge while pretending the magnetic field isn't a thing. Much like physicists noticed that electric and magnetic fields form a common entity together, perhaps it's time more people recognized that market and governance are just as much intrinsically intertwined. Either one needs the other to exist in any but most degenerate form. And both actively try to influence each other.
In absolute terms or in terms average quality of coverage for the population? Because in absolute terms, sure. In real “quality of healthcare”. Most likely not.
The fact that life expectancy in the US is lower (and decreasing too) than any other developed nation is pretty much all you should need to know.
"While the United States spends more on health care than any other country, we are not achieving comparable performance. We have poor health outcomes, including low life expectancy and high suicide rates, compared to our peer nations. A relatively higher chronic disease burden and incidence of obesity contribute to the problem, but the U.S. health care system is also not doing its part. Our analysis shows that the U.S. has the highest rates of avoidable mortality because of people not receiving timely, high-quality care..."
"First, greater attention should be placed on reducing health care costs. The U.S. could look to approaches taken by other industrialized nations to contain costs, including budgeting practices and using value-based pricing of new medical technologies. Approaches that aim to lower health care prices are likely to have the greatest impact, since previous research has indicated that higher prices are the primary reason why the U.S. spends more on health care than any other country..."
The states are riddled with obesity, depression and overworking - still I think health care should be evaluated on the actual structures and services available, not on aggregates statistics that depend on a lot more.
My wife on NHS (UK) gave birth on a sofa with pretty much no equipment - and they conveniently missed the time when epidural could be administered.
Waiting times are bonkers.
And NHS was touted as a best system in the world in 2018.
Who touted the NHS as the best in the world? UK's own politicians? The same guys who under-fund the NHS year on year? The same guys who are trying sabotaging it so they can privatise it?
The NHS is a great institution but the UK government seem hell bent on destroying it while passifying their voters with misleading soundbites about their investment in it.
Seems slightly surprising to me - I would have assumed it would be France or one of the other EU countries.
Edit: I'm a supporter of the NHS but it has been chronically underfunded and had too many management consultants trying to "improve" it over the years.
That sounds like an awful experience and I’m sorry your wife had to go through that.
I just wanted to add that when my wife gave birth in the UK on the NHS last year she had an amazing experience and the level of support before during and after was incredible.
In general all my experiences with the nhs have been positive. In comparison the only other country I have experience with is Hong Kong where I had a dr laugh in my face when I enquired about a genetic condition I may have inherited.
The nhs is far from perfect and could use improvement. I think it’s just that most other countries are even worse.
You cannot. We're talking about anesthesia and stitches for a child. Even if it were legal to do these procedures without a medical licence, which it absolutely isn't, it would still be a terrible idea, even if you could get your hands on the right supplies.
> try to find a cheaper hospital
We're talking about emergency medical treatment for a child. You think there's time to search around for the best price?
> Isn't the US the #1 medical care quality country?
> We're talking about emergency medical treatment for a child. You think there's time to search around for the best price?
Exactly, this child got the emergency treatment. His dad wasn't asked to pay 19k upfront.
I write all this because I was born in a country where all medical treatment is free for everyone.
Guess what? It's super low quality. Doctors got paid less than in McDonald's. If you have a serious problems you literally have to search for a right doctor. It might be someone not even in your large town. And, you pay upfront! So, I'd rather live broke than die because no one even treats me.
It's not a just matter of finding a 'golden mean' on the spectrum of nationalisation/privatisation, there's another dimension: competence of execution.
I'm sorry to read that but just because that system sucked it doesn't mean the US system doesn't also suck. Other countries have better healthcare systems both in terms of cost and actual quality of service. America should be modelling themselves after the best in the world rather than comparing themselves against the worst and saying "at least we're not that bad"
I'm sorry the quality was so poor in the country you were born in, but that doesn't necessarily mean that it's (only) because the service was free (there could be other reasons), or that poor quality is a necessary consequence of healthcare being paid entirely or mostly with public funding.
Public healthcare isn't entirely free where I live, but the fraction of the cost paid directly by the patient is small enough that it qualifies as mostly free to most people. Complaining about public healthcare almost seems like it's a national sport, and it's true that you can get shorter queues and faster response in non-emergency cases if you go private, but the quality of public healthcare as a whole still doesn't suck, and especially emergency care and treatment for serious conditions is still pretty good.
Doctors get paid less than e.g. in the U.S., but they're still among the most well-paid professions.
What I think leads to disaster is if funding to public healthcare is poor and the quality is low, which leads to people not appreciating the service and thus towards further devaluation of the public system, which becomes a vicious cycle.
It may also make sense to not have healthcare entirely free so that people don't start going to see a doctor too easily for reasons not requiring a doctor, but I think a system where it's potentially way too expensive does at least as much damage.
I don't claim to know what happened in your country of birth, but there could be factors other than just free healthcare.
It’s likely a local anasthetic and simple stitching. Both of these can be found in normal first aid kits, so I would bet that you can legally use it at home.
Even in the hospital, this work was probably done by a nurse with a 2 year degree. You can go to any clinic and have it done. If the kid were at summer camp, they would have probably had the staff nurse do it.
Emergency rooms are both overkill for this, and happily overcharge as well.
We are all talking as if the hospitals performed a dangerous complex procedure and saved the kids life. If so, then isn’t 19,000 a small price to pay? If not (and it’s a simple task as I believe) then why did they charge so much?
> Both of these can be found in normal first aid kits
Neither are found in a normal first aid kit.
> I would bet that you can legally use it at home
No, suturing is a surgical procedure.
> this work was probably done by a nurse with a 2 year degree
I'm not a medic, but from what I can gather online, suturing is considered an advanced specialised skill for nurses.
> If the kid were at summer camp, they would have probably had the staff nurse do it.
I doubt it, even with a qualified nurse on site. No summer camp wants a reputation for being reluctant to take injured children to the emergency room, neither do they want liability.
> Emergency rooms are both overkill for this
Does any first-world country agree with you on this? As far as I'm aware suturing is always treated this way, it's not just for-profit medicine and artificial gatekeeping.
> We are all talking as if the hospitals performed a dangerous complex procedure and saved the kids life
> If not (and it’s a simple task as I believe) then why did they charge so much?
Because they could. There's a deep power imbalance at play. You can't go price-shopping when your child needs emergency treatment. You might know going in that medical expenses are the top cause of personal bankruptcies in the USA, but you can't haggle. You won't even know what you owe until after the fact.
Brits like myself are generally horrified at the way American medicine is run. This kind of thing simply doesn't happen in the UK. (That's not to say our healthcare system is perfect, of course.)
I don’t really know what to say except that your experience doesn’t match mine.
I could look up research articles on best practices but I often find that those things just pay lip service to what we are “supposed” to do and not what actually happens.
Also I take exception to this notion that unless your country has economic power in the top 20 of the world, then whatever practices you have has no value.
Extreme specialization is a byproduct of rich economies but that shouldn’t be confused with it being a good practice in all cases.
The idea that this is a free market system is patently false The cost is not $19k , it is whatever the billing department decides to surprise the patient with.
The medical care quality isn't relevant to the point, but it is dependent on how you want to measure it. If getting basic care to your citizens at an affordable cost is any important metric , then the US fails miserably.
I never goto the ER even if I need to anymore. I'm too busy paying off my $30k bill for a single EKG.
> The idea that this is a free market system is patently false The cost is not $19k , it is whatever the billing department decides to surprise the patient with.
Totally agree. And even if the billing department could tell you the price, which they can’t, is the dad supposed to call around for quotes while the kid bleeds?
Free market and competition relies on the consumer being able to make an informed choice. How can they if there are no published prices, and then no way for these entities to compete?
It is designed this way like a cartel, inflate prices, nothing free market about it.
This is not capitalism but government meddling and third party payer inflating prices.
Sure, the USA is one of the best medical care systems in the world (and it's definitely better quality than any public service you will find in Europe) but it doesn't cover cheaper services.
Under an unregulated market, with pure capitalism, you would see cheaper, smaller hospitals pay-as-you-go or via cheap insurances.
How do you propose to find a cheaper hospital when is nearly impossible to get a hospital to tell you how much a procedure will cost before they do it?
Nevermind doing that while your kid is bleeding on the pavement.
> $19k is the cost for the US stitches and anesthesia.
No it's not. $19k is what that hospital arbitrarily chose to charge for stitches and anaesthesia. What it actually cost the hospital was significantly less. Several orders of magnitude less I'd wager.
The fact that the insurer was able to negotiate a payment of ~36% (less than half the original price) and the hospital still had enough margin to be profitable should be telling.
> I'm not a fan of this system but it works. Isn't the US the #1 medical care quality country?
No. Not even remotely. It's 36th in the world as ranked by WHO. It is, however, ranked #1 in the world for the most expensive healthcare system. And by some margin too. I don't consider that a placement to be proud about either.
The whole point is that $19k is not even close to the cost of doing stitches for a kid. It's a simple procedure that takes half an hour of doctor's work and the same from some assistant; if you need a million-dollar-per-year specialist for that, even then their work costs less than a $1000; double it for overhead/facilities and youŗe at $2k (instead of $19k) for a very conservative estimate (private nonsubsidised facilities in high cost of life parts of Europe would offer to do for much less for uninsured foreign patients and still make a healthy profit on that).
$19k represents a ridiculously inflated markup that's not even in the ballpark of what the costs are, even in USA. Things like liability insurance etc add some extra costs, but not nearly enough so that tenfold increase would make any sense.
This isn't a free markets issue, this is a prime example of crony capitalism.
To paraphrase Marc Andreessen, with free markets and competition, you now can buy an amazing giant 65" 4K LCD TV with all of the latest greatest features for barely $500. Stuff gets better, cheaper, and more convenient for the consumer, while the companies duke it out to get ahead.
But when things get overly regulated, subsidized, or effective cartels are formed, you end up with situations like monotonically rising US healthcare costs, monotonically rising US housing costs and monotonically rising US college costs.
This isn't an issue of too much free market competition.
That's not capitalism, that's libertarianism. The two are not really related, just confused by some biased media. Much the the American concept of 'socialism'.
But it isn't capitalism, at least not a free market. While you may have a limited choice on what hospital you can go to, good luck with getting a price beforehand.
This problem occurs because of the parasitcle nature of health insurance and the hospitals, and that you are pretty much required to have health insurance. Once the government mandates it, you are losing the capitalism. And there is a lot of corruption and Negligence between insurance and hospitals
No it just means that it’s beyond comprehension. As a Canadian, I feel the same way.
Everything about the American healthcare system feels like a nightmare to me. From the cost, to the fact that it’s usually tied to your employer (!!) and that even if you have good insurance, you have to make sure to get care from “in network” healthcare professionals.
It seems to require a tremendous amount of energy for very little benefit for average citizens.
You can understand or not understand something -- it has 0 to do with your nationality. "As a Canadian" is just nonsense. It doesn't bring much to the table.
"As a Canadian doctor" is authority. You often find this with appeals from "As a mother" -- it's just a fallacy.
I don't think this is a very charitable reading. "As a European", "As a Canadian", etc. isn't a statement of authority or a value judgement that makes someone better, it's just stating that they come from a cultural context where this isn't the norm, so it seems bizarre.
Including the cultural context you're viewing things from can be useful so that people can understand where you're coming from.
A reference to feudalism is a bit strange there, but I'll weigh in with the observation that in Australia it's comparably challenging to understand.
I think in almost any western country (and many non-western) 'free' (or close to) healthcare is a basic right of citizenship, so it's extremely difficult to try to comprehend how 20-40% of the average person's salary could be consumed by treating a child's minor accident.
That's usually what happens. The uninsured tend to be poorer, less stably employed, and the hospitals look to extract marginal revenue from these people. Paying for all of the bill collectors, legal review, etc. to get the original bill amount just isn't worth it in most cases, or so I hear from insiders. I suspect in this case because there is insurance that the family will try and succeed somewhat to get partial responsibility from the insurance company. This was emergency medicine for a dependent child - not a commonly excluded category.
The last time my daughter required stitches, the hospital did it for free. They didn't even ask for my name. I didn't even had to fill any paperwork (which would have been a chore since I didn't have the EU health card with me and I speak very little of the local language). Happened at French alps during last year ski season.
No, thank you, but it's a very sweet offer. As an Australian I already qualify for free healthcare, and I don't require any medical attention at the moment.
Referring back to the (G)GP - when trying to put geo-political context around such comments, it's useful to mention the geo-political context of your comment.
Same happened in Italy to a friend from latin-america, traveling as tourist.
She left the hospital with a smile, impressed how easy and friendly people were. Nothing serious so nothing to pay. She was very worried and they even managed to make her smile.
This was in Verona, Italy some years ago, in the ER of Borgo Roma. It was late night and just a short queue to wait. It has been a great human experience and we will be always grateful to the doctors there.
I remember a podcast, it had an account of a guy. He woke up in the middle of the night with chest pain and in sweat. He though 'I think I might a heart-attack coming'. He drove his car as he might not be able to afford ambulance.
This was my first time i learnt of US health system.
Imagine waking up in the middle of night, realize you might have heart-attack and the next thing you think of is if you can afford an ambulance.
> the problem is that $18,933.44 for stitches and anesthesia makes absolutely no sense at all.
It does make sense if you have a law that limits the profit rate for a particular enterprise so it has no other way of increasing the profit than pushing up the price to a level where 20% of that price is the desired outcome.
Netherlands has a really nice system that would probably work for the US as well if there were any political interest to fix the healthcare system. Right now both parties are heavily in the pockets of insurance companies so the only things you can see is failed half-assed, broken solutions like Obamacare that cost billions even to operate a website.
I don't think 20% of that number seems normal, either. It's still ~$4K, for what sounds like stitches and local anesthesia (unsure, as the link does not seem to open the article for me, only gives a list of other NPR articles). That's over one month of pre-tax salary (edit: for the median US worker), which does not equate with the length, complexity or risk of the treatment.
So, what I am saying is that I fail to see what attempts at limiting the price has to do with the price being too high in the first place.
>The ACA requires health insurers in the individual and small group market to spend 80 percent of their premiums (after subtracting taxes and regulatory fees) on medical costs.
Means their profits are capped at 20%. Only way to grow profits is to inflate costs by colluding with private health providers.
Ah, I see. What the parent poster and myself seem to be getting at is that in terms of international pricing, perhaps 1000$ of service happened here (and I'm being generous - in many places, that would be considered outrageously high). A 20% profit margin would put it at 1200$. How it got to 19K is mind boggling.
I'm from the UK, where it's difficult to find price lists, since the patient never sees a bill.
This paper [1] covers "the NHS, child and family costs of falls, poisonings and scalds".
> In total, 344 parents completed resource use questionnaires, with > 95% of children recovering within 2 weeks of injury and almost 99% recovering within 1 month. Mean NHS costs ranged from £2588 to £2989 across injury mechanisms for children admitted for ≥ 2 days, from £719 to £1011 for those admitted for 0–1 days and from £97 to £178 for those attending an ED but not admitted.
All this boy's treatments were on the same day, and he only fell off his bike -- these British figures include accidents like scalding -- so in the UK, he would have been at the lower end, i.e. under £1000.
All in the name of stopping socialism. Meanwhile, the people keep lowering taxes for the rich until you have a civil war with all those people who have plenty of guns, but nothing to loose.
Are insurance and healthcare companies trying to milk the system dry for the last few years before inevitable reform?
Because that's what these sort of prices look like - you see it in tech when a service is clearly on the way out, but still has a handful of enterprise customers left who are unable to migrate away quick enough.
If you are charging someone 19k USD for a simple cut wound something is seriously rotten in the system. For comparison,in India, one could get this all done for less than 50$ including the medicine, this is without the insurance. People don't even use medical insurance for such trivial things.
Heck, you could get this done for free if you have a Govt hospital nearby.
Outrageous billing aside, the problem here is that the insurer can foist expenses on its policyholders rather than pursuing third parties themselves. We'd see abuses like this evaporate if insurers were compelled to do their own recovery. Think a third party is responsible? Ok, sue them.
Imagine going in to a police station and reporting a robbery. The officer is sitting at cash register and rings up your account and quotes you $8,000 to investigate the crime.
This is how absurd it feels for a British person to see $ values assigned to medical treatments like this.
The problem with the USA is not that medicine is not socialised, it's that the price is inflated because of government / insurances plays.
Imagine all the money savednot paying for public officials!
I've lost money as the metropolitan police was completely useless.
They had information, proof, arrested the guy, and then let him go.
He ran away to Dubai and came back operating the same scheme under his second name. Reported it again to the same detective with location of the office and info from newly scammed people I contacted.
They dismissed the case.
I lost only 2k, but other victims (landlords being scammed by a fake agent) lost tens of thousands.
Tried going to court but there is not a physical person with asset in the UK to persecute so I will likely won't get anything. Wasted 500£ more with this.
The government doesn't have any incentive stopping crime, it just relies on the good will of policemen and their limited resources.
If people complain because there is too much crime, they just have one more reason to increase taxes and do nothing.
> The government doesn't have any incentive stopping crime, it just relies on the good will of policemen and their limited resources. If people complain because there is too much crime, they just have one more reason to increase taxes and do nothing.
This made me laugh out loud, so I guess you managed your objective (I'm referring to your nick)
The problem with communism is that for (what communists call) real communism you need individual to give up private ownership and share everything, including their labor.
In practice, the chance of every individual complying is extremely low, which forces a strong central government to actually enforce "communism".
You end up with the mass massacres and poor living conditions of last century.
We never attempted a pure libertarian system in which all services (including health care, personal protection, justice, lawmaking) are provided by companies you can choose to buy from or not, voluntarily. Until we make that experiment is hard to speculate on what's going to happen.
I don't think it would be much different from what we have today, we just would have less bureaucracy, we won't have a central government taking a fee for everything that happens, people would be free to live how they want and we would have a dynamic consumer based set of laws.
That said, even moving the current system in the libertarian or communist direction cause the system to perform better and worse.
Look at China and how they used capitalism to drastically improve their economy and improve living conditions for people (albeit I doubt they were aiming for that).
That's seen by some as a naïve view. Those with money would get services; the masses could get little or nothing. No interstate highway system. No commercial code. No free commerce between states. Police paid for by the rich (and crooked in many cases). And on and on.
Enjoy eating asbestos burgers and lead laced cola.
Insider trading and whole hull house of exploits that are now barely held back by regulations.
You must be blind to not see how current system is currently exploiting democracy and technology information era, I dread what would happen if they were to run free and unchecked.
Imagine for a second scenario, you got jumped on the street and stabbed you are bleeding and need help fast. You call ambulance, street cameras see you are bleeding... Yes sir we can be there in 3min it will be $50,000 for ambulance, without it you will die. You call another ambulance company, they say same thing. Of course they are in the syndicate fixing prices its not illegal. Tell me how in a pure libertarian society this wouldn't end up being the case.
Once the promise of defending the people is done (presumably in part to justify the existence of the government in the first place) the government doesn't have an incentive to stop or persecute crime which has already happened.
Deterring potential criminals with random patrols and showing up when called is enough.
A twitch streamer (SweetAnita) recently had problems with a stalker caught going to her house with a knife.
Despite the police looking for him to question him for an unrelated assault he committed in public, and despite finding him with a knife a few minutes from Anita's house, the police released him.
Could it be because of bureaucracy or occupancy issues in jails? Maybe!
My point still stand, I'd prefer a private insurance firm defending me.
When we lived in the US my daughter tripped and opened up her chin on the kerb. My wife having no idea what to do (go to Urgent care) went to the ER...
She had 5 stitches and was in and out in about 90 minutes. A plastic surgeon did the stitches and at one point there were 8 folks in the room.
She has no scar and the experience was very good.
We had full insurance, and when the bill came, it was ~$4500 of which we had to pay roughly $990 ourselves.
Still not sure how to feel about it - that's a high price for a few stitches, but if I had a choice of going to a UK hospital for free, or paying a grand to know my daughter will be perfectly cared for, assuming I had that grand, I'd rather pay.
Not everyone has that option though and that's the problem.
> if I had a choice of going to a UK hospital for free, or paying a grand to know my daughter will be perfectly cared for, assuming I had that grand, I'd rather pay.
Is the implication that UK hospitals provide lesser care than their (costly) american counterparts?
I would assume that while a broken chin would get reasonably fixed in UK, it would not involve "at one point there were 8 folks in the room.". I'm not a doctor so I can't be certain, but it seems plausible that in UK they would get adequate care but in USA they would eagerly "overprovide" services that are nice but carry a hefty extra cost.
In the UK you would never have a top surgon and 8 doctors and nurses dropping by to makes sure everything was OK for something as trivial as stitches. You'd have one person who would get you in and out as quickly and efficiently as they could. Whether that qualifies as 'lesser' is up for debate.
No - the only implication is that the UK wouldn't use so many (costly) resources for something as minor as a few stitches on a 3 year old.
But as a parent, it is YOUR 3 year old so you want the absolute best for them. The end result, I believe, would have been exactly the same had it happened here or in the US. Just I had a lot more confidence (at the time) seeing just how much was being done to ensure there was no scarring.
>>but if I had a choice of going to a UK hospital for free, or paying a grand to know my daughter will be perfectly cared for
I just don't understand why it's a binary choice, either free care of good care. My own experience with the NHS has been stellar, the standard of care I have received(and still receive) is incredible. Everyone is very friendly and I get all my meds and treatment for free. My father has fought cancer for 9 years, during that time he had multiple operations and years of Glivec supplied to him free of charge, the only complaint he's ever had was that they would only reimburse him for 2nd class train ticket when going to the hospital for an operation, even though driving was more expensive.
But the thing is - if I or him ever wanted to(for some reason) to go private, that's still an option. Private insurance with private doctors and hospitals is also available. In US you don't really have any option other than going private.
In my time in the UK I never had any contact with the NHS - how do you imagine her experience in a British hospital?
Coming from Germany and now living in Denmark, I have full confidence in the systems here to handle it equally well (maybe with less than 8 people in a room though).
And that is one of the many reasons why US healthcare is so expensive. I live in Sweden now, and many of the 'minor' things a doctor would handle in US is handled by nurses here. Personally I've never felt this to be a problem at all, but I know many people in the US feel very uncomfortable about that idea.
My only personal experience in a British hospital was fine. They saw me promptly, the treatment was fine, the free meal was typically British.
I've been twice to Danish hospitals, and I think the experience is very comparable. The staff in Copenhagen seemed kinder (a bit more time to reassure the patient etc) but otherwise there wasn't much difference.
I trust both countries in 2015, and Denmark in 2020. I don't know what's happened in Britain since 2015. My family aren't complaining (at least, no more than the usual British amount), but the British people keep voting against their interests.
It would have been fine in the UK, the difference would have been waiting time (we'd definitely not be in and out in 90 minutes here). Also we'd have had a junior doctor or nurse do the stitches.
End result would be roughly the same.
In some parts of the country it may be a longer wait than others. The NHS generally though are very good when you visit with very young children.
> but if I had a choice of going to a UK hospital for free, or paying a grand to know my daughter will be perfectly cared for, assuming I had that grand, I'd rather pay.
Lol. It’s not like the doctors are dumber or do poorer quality work when it’s socialized. I doubt having $1k skimmed by some middleman got you better care than we’d get in Canada.
Yeah, honestly, even $2,000 is absolutely outrageous for a procedure like this. This pretty clearly to me would have a pretty disastrous effect on preventative medicine - if each doctor's visit has the potential to cost you thousands, of course you're going to reserve it for emergencies only.
This was a $2000 deductible/copay, which is capped annually. So it's not $2000 per treatment, more like $2000 per year where you need services beyond the basics. And meanwhile, having that high deductible keeps the monthly premium expense low
Interesting point, although income taxes including health insurance where I live can be as low as 12%.
If you mean more than $2000 than that's correct, of course, although I am not sure weather it is relevant.
I imagine it varies depending on state and profession, but what's the average in the US? do you reckon it offsets the possibility that slicing yourself up while riding a bike could put you in serious money trouble?
important to notice this is not the medical bills they showing, but the claim rejection, and the claim rejection is "we require additional information"
we don't know what information was on the claim, but judging but the long list of "professional services" it's indeed too vague to be itemized against their policy if that was the description provided.
or in short this piece is presenting a very biased view by withholding a lot of information required to come to an understanding.
It ended up being $1.8k. Would have been much less if they didn’t call the fire dept (did he call 911?!) over a bike wreck. That’s the part a lot of comments are leaving out. A stretcher trip. Ambulance? Helicopter parenting.
In my country, you call 112 and they inform you on how to proceed. They decide whether an ambulance is necessary. The decision is made by a trained professional, not a panicked parent.
You can call 112 when your cat is stuck on a tree.
Why shouldn't you call 911 for an accident? You aren't trained to triage these sorts of situations, the people answering the 911 call are. If you call, explain the situation, and they respond by sending an ambulance, then surly that indicates that an ambulance was necessary.
I had a very similar accident while on vacation in Portugal in 2018 (i did go to the hospital in a rental car, however). I first went to a small local clinic. They stopped the bleeding and bandaged me for free and sent me to a larger hospital. There i got stitches. The hospital bill (which they handed me) was 50€ ($60), which my insurance paid.
Just a comparison, because we were in the exact situation in Germany and this is how it went down here:
- my son broke his hand falling on the playground, we drove to the nearest hospital that handles kids (which happened to be a private-owned hospital).
- he received the necessary medical attention and his cast, based on his insurance card - we are insured in the public system, but the insurer is a private, for-profit entity
- we did not pay anything. There are co-payments, but not for children. However co-payments are like 5 EUR for a prescription or 10 EUR for a day of hospitalization.
- a year later, we received a letter asking us to detail the exact circumstances of the accident, because they want to see if they can defer the payment to another insurer. For example, if he fell from a faulty piece of equipment in the park or if somebody pushed him. On the letter I had a link on which I could fill the form in online. Did it, explaining that the equipment was in order and we were even the only ones in the park and it was simply and unfortunate accident.
- that was that
edit: alongside with our employers, we are paying ~1300 EUROs per month (2 people, child is co-insured autoamtically) for health and care insurance to the insurer. What was nice was that when my wife wasn't working, she was also automatically co-insured on my contract for free.
Sounds pretty similar to the linked story, except they got a trained staff of firefighters and EMTs show up on scene and a ride in an ambulance. He also didn't pay anything at time of service. Yes, he had to pay $2000 copay/deductible eventually, but we don't know what his monthly premiums are. I pay close to $0 month, but have a high deductible, for example.
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[ 2.7 ms ] story [ 241 ms ] threadI know it's said every time these stories pop up, but I'm sure glad I live in Sweden and not in the US.
For Europeans, this is shocking, I wonder if people in Asia or Africa have similar financial troubles if they ever need medical assistance.
If you don't have an insurance the rates are even more of a joke.
It's possible you might see more non-profit vs. for-profit hospitals, but is that such a bad thing?
Edit: to be clear I’m not defending this awful system.
That is my understanding from Europe. From outside the logical way would be to mandate single pricing structure and ban any direct discounts.
I'm an American who has been living in Norway for 8.5 years now. I am never moving back, unless there are some serious system changes which will realistically not happen in my lifetime.
Also do you have similar levels of job opportunities as NY or SF?
> Curious, what’s better?
Parental leaves, more vacations, less working hours per week, better life/work balance, free health and education, &c.
People who never experienced both systems can't understand the impact it has on your life, I'm not talking going in vacation in EU/US, I'm talking working/living for extended period of times. You can't escape the matrix if you don't know you're in the matrix. The US is like Disneyland or Vegas, if you can afford the top level shit you'll have a good time, some would argue even a better time than anywhere else, if you're on a budget be prepared to be treated like cattle.
This makes working hard/smartly in order to be able to do this incentivizing. Rather than just sitting back and enjoying the life/work balance and less working hours
> Rather than just sitting back and enjoying the life/work balance and less working hours
What's wrong with enjoying life once your needs are met ? If I'm happy working 35 hours a week why would I work 42 hours a week ? If I don't want to buy the next new shinny toy why would I bust my ass for extra money that I won't need ?
- Parental Leave: When I got my first child it's hard to understate how much being able to be off work for 8 months with ~80% of my full pay. I'm now going off for 6 months with my second child in February. And I can save up parental leave for a long time meaning I can take longer vacations to spend summers with them as well.
- Healthcare: Again once you have experienced the true value of universal healthcare you will not want to go back. My second son go a bad infection and had to spend 2 weeks in the hospital with his mother. Cost (excluding what we paid in taxes of course...): 20-30 bucks for buying candy (i.e it could have been 0 ;)).
- Education: All higher education is of course free for all EU citizens. It used to be free for everyone in the world but the unfortunately removed that a few years ago.
- The everymans right: https://en.wikipedia.org/wiki/Freedom_to_roam#Sweden
There's of course a lot more one could point out (like for example high speed internet access pretty much everywhere, good mobile connection speed pretty much everywhere).
Of course this comes with a cost of paying more in taxes (happy to do it!). I'm not the biggest fan of snow as well.
My ideal societal contract would be something like this: I want to be free to focus my energy on my work, relationship, and interests. I want the state to focus on programs that reduce the need for individuals like me to have to focus their energy on anything else.
In practice, this is stuff like equal access to healthcare, education, childcare, social security, time-off...
In the US, access to these things is not a given, and they often end up as rewards, distributed very unevenly. ...Even worse, this leads to anxiety/worry/focus by individuals like me to try and fix or mitigate those problems.
As you mention, the scale of change in the way the US operates seems unlikely anytime soon; at least for me, removing myself (my skills/labor/knowledge) seems like as good a way as any to try and coerce change.
I just see more benefit personally when a basic level of these things is offered to everyone. I don’t need the extra anxiety that my friend, bandmate, barista, or bartender is one crisis away from ruin.
Just for comparison: a fully-fledged broken leg operation costs 3.000€ for non-insured people in Germany.
Isn't insurance supposed to bring things down to 0$ instead of copays that still surpass the actual cost?
Edit: Of course I could Google it, and I have a vague idea. But the idea of even having to think about money for things like a kids accident seems completely foreign to me.
Edit: It does rather explain why the founder of the UK NHS called his book "In Place of Fear"
I suspect your 3000 cost is skimping on a lot of taxes that are subsidizing the actual costs.
but confronting cost without taxes is trite and tiresome. I'm going to pay north of 150k eur to subsidize healthcare thorough my life, and being in the upper tax brackets (which start at some ridiculously low point) I also have to copay each service on top of already being paying more taxes for it.
and when I see the "but ambulance rides are almost free here in x european country!" and the likes well no, they aren't, it's people that just didn't factor the actual costs in, because it's sunk in other taxes.
Secondly, if you take a look at non-insured prices for health care in countries with universal health care (for the most part, the "universal" part is limited to residents and visitors still have to pay), the prices are still significantly lower than they are in the U.S. Having a single payer for insurance and strong regulations over health care enable things like price controls, which makes perfect sense in a health care context since it's never really going to work as a free market (emergency care needs to be treated immediately without the ability to "shop around", the care required isn't always evident at intake, doctors refuse to talk or consider financial aspects, etc.)
In a system where costs are paid through taxes, the disincentive to see a doctor is eliminated. That maybe has some negative effects (going to urgent care for relatively minor problems), but I think it has real benefits in terms of preventative care.
In terms of a countries overall finances, it balances out (not entirely - see my previous point), but in terms of affect on behaviour it has a huge effect (in addition to balancing out the burden that I mentioned before).
Well, with what their insurance pays it's still about $10k total.
> Just for comparison: a fully-fledged broken leg operation costs 3.000€ for non-insured people in Germany.
My dad had brain surgery in Germany by pretty much the leading experts for that particular kind of surgery. The surgery itself, the hospital stay, etc. was about 18,000€ in total.
We had to pay about 1,000€... for a hotel and living expenses for my mother and myself since we wanted to stay with him. Insurance covered everything my dad needed.
So you can literally have brain surgery for what it costs to get some stitches in the US.
Deductibles are part of some insurance plans but copays are part of all. Deductibles are generally large but capped by an out of pocket maximum. These are generally on plans that provide a high degrees of network freedom, meaning you can self-refer to a specialist. Because you are not a medical expert, there is added risk to the insurer that you are seeking unnecessary procedures and so they ask you to share the risk by paying a deductible. These are typically the PPO (preferred provider organization).
There is another type of organization, an HMO (health maintenance organization) whereby you must get referred by your primary care physician, thus serving as a check on the risk. In HMOs, there is generally no deductible. There are still copays though, but they are generally small. For example, I just broke my finger and needed surgery to set the fracture. It was $20k surgery. My HMO negotiated it down to $8k and I paid a $30 copay. Had it been a PPO, I’d have paid well over $2000.
As for why there are copays... they actually are there to dissuade hypochondriacs and drug seeking (aka moral hazards). This is a delicate market price though that needs to be high enough to prevent the hazard but not high enough to dissuade against necessary procedures.
Wait, what ? $1,800 for stitches and local (I suppose) anesthesia ?
The hospital charge as much as they can, because some patients are unable to pay. This way they make up the difference (or make more).
The idea is that you go to the billing staff and threaten that you will go bankrupt and will not pay anything. Then negotiations begin. Rich pay cuz they don't care, suckers get conned, and poor gets their credit destroyed. Classic USA.
It is another 'american' system akin to tipping only taken to extreme.
But otherwise you use bankruptcy as a bargain card. Because nither side wants to go there.
to profit, and profit they do. They deliver record returns on investment year over year.
I know it's more complicated than that but everything has its cost. $19k is the cost for the US stitches and anesthesia.
Edit: I'm not a fan of this system but it works. Isn't the US the #1 medical care quality country?
Honestly, we're not talking about having a wart removed here. It's basic medical treatment for a child. That should be beyond reproach in any civilised country.
https://en.wikipedia.org/wiki/Aneurin_Bevan
NB Of course, it is perfectly possible to disagree with this view, it just happens to be something I personally strongly agree with.
its certainly not free market capitalism. part of the problem is that the government makes it illegal to turn away ER patients. maybe you think thats moral or maybe you dont, but the point is that an ostensibly free market becomes corrupted with outside influences like this. you cant create a system designed for the free market to be the mistake fixer and then make the market not free and not expect bad mistakes.
i think this is the greatest failure mode for america: pretending non-free markets are free. in some cases, its the worst of both worlds by a very large margin.
It's kind of like wanting to talk about electric field around a charge while pretending the magnetic field isn't a thing. Much like physicists noticed that electric and magnetic fields form a common entity together, perhaps it's time more people recognized that market and governance are just as much intrinsically intertwined. Either one needs the other to exist in any but most degenerate form. And both actively try to influence each other.
It depends which indicator you choose ... if you choose life expectancy, the #1 rank turns to #36 :
https://en.wikipedia.org/wiki/List_of_countries_by_life_expe...
The fact that life expectancy in the US is lower (and decreasing too) than any other developed nation is pretty much all you should need to know.
Also. Is it better to have the best medical care (if it's true) for some or a great system for everyone?
"First, greater attention should be placed on reducing health care costs. The U.S. could look to approaches taken by other industrialized nations to contain costs, including budgeting practices and using value-based pricing of new medical technologies. Approaches that aim to lower health care prices are likely to have the greatest impact, since previous research has indicated that higher prices are the primary reason why the U.S. spends more on health care than any other country..."
https://www.commonwealthfund.org/publications/issue-briefs/2...
My wife on NHS (UK) gave birth on a sofa with pretty much no equipment - and they conveniently missed the time when epidural could be administered. Waiting times are bonkers. And NHS was touted as a best system in the world in 2018.
It's just political propaganda if you ask me.
The NHS is a great institution but the UK government seem hell bent on destroying it while passifying their voters with misleading soundbites about their investment in it.
https://www.commonwealthfund.org/
https://www.theguardian.com/society/2017/jul/14/nhs-holds-on...
Seems slightly surprising to me - I would have assumed it would be France or one of the other EU countries.
Edit: I'm a supporter of the NHS but it has been chronically underfunded and had too many management consultants trying to "improve" it over the years.
I just wanted to add that when my wife gave birth in the UK on the NHS last year she had an amazing experience and the level of support before during and after was incredible.
In general all my experiences with the nhs have been positive. In comparison the only other country I have experience with is Hong Kong where I had a dr laugh in my face when I enquired about a genetic condition I may have inherited.
The nhs is far from perfect and could use improvement. I think it’s just that most other countries are even worse.
Of course, it depends from the indicators you use... Who tried, came up with this:
https://www.who.int/healthinfo/paper30.pdf (World Health Organization - Measuring Overall Health System Performance for 191 Countries)
At page 18 you will find the results. Spoiler: The US are not n.1... not even top 10.
You cannot. We're talking about anesthesia and stitches for a child. Even if it were legal to do these procedures without a medical licence, which it absolutely isn't, it would still be a terrible idea, even if you could get your hands on the right supplies.
> try to find a cheaper hospital
We're talking about emergency medical treatment for a child. You think there's time to search around for the best price?
> Isn't the US the #1 medical care quality country?
Absolutely not. The WHO ranks the USA as 37th out of 191 countries: (PDF) https://www.who.int/healthinfo/paper30.pdf
Exactly, this child got the emergency treatment. His dad wasn't asked to pay 19k upfront.
I write all this because I was born in a country where all medical treatment is free for everyone.
Guess what? It's super low quality. Doctors got paid less than in McDonald's. If you have a serious problems you literally have to search for a right doctor. It might be someone not even in your large town. And, you pay upfront! So, I'd rather live broke than die because no one even treats me.
Public healthcare isn't entirely free where I live, but the fraction of the cost paid directly by the patient is small enough that it qualifies as mostly free to most people. Complaining about public healthcare almost seems like it's a national sport, and it's true that you can get shorter queues and faster response in non-emergency cases if you go private, but the quality of public healthcare as a whole still doesn't suck, and especially emergency care and treatment for serious conditions is still pretty good.
Doctors get paid less than e.g. in the U.S., but they're still among the most well-paid professions.
What I think leads to disaster is if funding to public healthcare is poor and the quality is low, which leads to people not appreciating the service and thus towards further devaluation of the public system, which becomes a vicious cycle.
It may also make sense to not have healthcare entirely free so that people don't start going to see a doctor too easily for reasons not requiring a doctor, but I think a system where it's potentially way too expensive does at least as much damage.
I don't claim to know what happened in your country of birth, but there could be factors other than just free healthcare.
Even in the hospital, this work was probably done by a nurse with a 2 year degree. You can go to any clinic and have it done. If the kid were at summer camp, they would have probably had the staff nurse do it.
Emergency rooms are both overkill for this, and happily overcharge as well.
We are all talking as if the hospitals performed a dangerous complex procedure and saved the kids life. If so, then isn’t 19,000 a small price to pay? If not (and it’s a simple task as I believe) then why did they charge so much?
Neither are found in a normal first aid kit.
> I would bet that you can legally use it at home
No, suturing is a surgical procedure.
> this work was probably done by a nurse with a 2 year degree
I'm not a medic, but from what I can gather online, suturing is considered an advanced specialised skill for nurses.
> If the kid were at summer camp, they would have probably had the staff nurse do it.
I doubt it, even with a qualified nurse on site. No summer camp wants a reputation for being reluctant to take injured children to the emergency room, neither do they want liability.
> Emergency rooms are both overkill for this
Does any first-world country agree with you on this? As far as I'm aware suturing is always treated this way, it's not just for-profit medicine and artificial gatekeeping.
> We are all talking as if the hospitals performed a dangerous complex procedure and saved the kids life
It's routine emergency medicine. Nothing more, nothing less.
> If so, then isn’t 19,000 a small price to pay?
No, it's absurdly inflated.
> If not (and it’s a simple task as I believe) then why did they charge so much?
Because they could. There's a deep power imbalance at play. You can't go price-shopping when your child needs emergency treatment. You might know going in that medical expenses are the top cause of personal bankruptcies in the USA, but you can't haggle. You won't even know what you owe until after the fact.
Brits like myself are generally horrified at the way American medicine is run. This kind of thing simply doesn't happen in the UK. (That's not to say our healthcare system is perfect, of course.)
I could look up research articles on best practices but I often find that those things just pay lip service to what we are “supposed” to do and not what actually happens.
Also I take exception to this notion that unless your country has economic power in the top 20 of the world, then whatever practices you have has no value.
Extreme specialization is a byproduct of rich economies but that shouldn’t be confused with it being a good practice in all cases.
The medical care quality isn't relevant to the point, but it is dependent on how you want to measure it. If getting basic care to your citizens at an affordable cost is any important metric , then the US fails miserably.
I never goto the ER even if I need to anymore. I'm too busy paying off my $30k bill for a single EKG.
Totally agree. And even if the billing department could tell you the price, which they can’t, is the dad supposed to call around for quotes while the kid bleeds?
It is designed this way like a cartel, inflate prices, nothing free market about it.
This is not capitalism but government meddling and third party payer inflating prices.
Sure, the USA is one of the best medical care systems in the world (and it's definitely better quality than any public service you will find in Europe) but it doesn't cover cheaper services.
Under an unregulated market, with pure capitalism, you would see cheaper, smaller hospitals pay-as-you-go or via cheap insurances.
No it's not. $19k is what that hospital arbitrarily chose to charge for stitches and anaesthesia. What it actually cost the hospital was significantly less. Several orders of magnitude less I'd wager.
The fact that the insurer was able to negotiate a payment of ~36% (less than half the original price) and the hospital still had enough margin to be profitable should be telling.
> I'm not a fan of this system but it works. Isn't the US the #1 medical care quality country?
No. Not even remotely. It's 36th in the world as ranked by WHO. It is, however, ranked #1 in the world for the most expensive healthcare system. And by some margin too. I don't consider that a placement to be proud about either.
$19k represents a ridiculously inflated markup that's not even in the ballpark of what the costs are, even in USA. Things like liability insurance etc add some extra costs, but not nearly enough so that tenfold increase would make any sense.
To paraphrase Marc Andreessen, with free markets and competition, you now can buy an amazing giant 65" 4K LCD TV with all of the latest greatest features for barely $500. Stuff gets better, cheaper, and more convenient for the consumer, while the companies duke it out to get ahead.
But when things get overly regulated, subsidized, or effective cartels are formed, you end up with situations like monotonically rising US healthcare costs, monotonically rising US housing costs and monotonically rising US college costs.
This isn't an issue of too much free market competition.
This really reads as "Is this some peasant joke I'm too rich to understand".
Everything about the American healthcare system feels like a nightmare to me. From the cost, to the fact that it’s usually tied to your employer (!!) and that even if you have good insurance, you have to make sure to get care from “in network” healthcare professionals.
It seems to require a tremendous amount of energy for very little benefit for average citizens.
"As a Canadian doctor" is authority. You often find this with appeals from "As a mother" -- it's just a fallacy.
Including the cultural context you're viewing things from can be useful so that people can understand where you're coming from.
I think in almost any western country (and many non-western) 'free' (or close to) healthcare is a basic right of citizenship, so it's extremely difficult to try to comprehend how 20-40% of the average person's salary could be consumed by treating a child's minor accident.
Referring back to the (G)GP - when trying to put geo-political context around such comments, it's useful to mention the geo-political context of your comment.
Really? How so?
She left the hospital with a smile, impressed how easy and friendly people were. Nothing serious so nothing to pay. She was very worried and they even managed to make her smile.
This was in Verona, Italy some years ago, in the ER of Borgo Roma. It was late night and just a short queue to wait. It has been a great human experience and we will be always grateful to the doctors there.
This was my first time i learnt of US health system.
Imagine waking up in the middle of night, realize you might have heart-attack and the next thing you think of is if you can afford an ambulance.
It does make sense if you have a law that limits the profit rate for a particular enterprise so it has no other way of increasing the profit than pushing up the price to a level where 20% of that price is the desired outcome.
Netherlands has a really nice system that would probably work for the US as well if there were any political interest to fix the healthcare system. Right now both parties are heavily in the pockets of insurance companies so the only things you can see is failed half-assed, broken solutions like Obamacare that cost billions even to operate a website.
https://www.aeaweb.org/research/regulating-health-insurers-a...
https://www.bloomberg.com/news/articles/2014-09-24/obamacare...
So, what I am saying is that I fail to see what attempts at limiting the price has to do with the price being too high in the first place.
Means their profits are capped at 20%. Only way to grow profits is to inflate costs by colluding with private health providers.
Right now the focus is on the people and freight rail transport system but it's happening.
This paper [1] covers "the NHS, child and family costs of falls, poisonings and scalds".
> In total, 344 parents completed resource use questionnaires, with > 95% of children recovering within 2 weeks of injury and almost 99% recovering within 1 month. Mean NHS costs ranged from £2588 to £2989 across injury mechanisms for children admitted for ≥ 2 days, from £719 to £1011 for those admitted for 0–1 days and from £97 to £178 for those attending an ED but not admitted.
All this boy's treatments were on the same day, and he only fell off his bike -- these British figures include accidents like scalding -- so in the UK, he would have been at the lower end, i.e. under £1000.
[1] https://www.ncbi.nlm.nih.gov/books/NBK447063/
Because that's what these sort of prices look like - you see it in tech when a service is clearly on the way out, but still has a handful of enterprise customers left who are unable to migrate away quick enough.
They still have:
https://www.france24.com/en/20200517-young-cuban-doctor-help...
https://www.theguardian.com/world/2020/nov/25/sicily-asks-cu...
This is how absurd it feels for a British person to see $ values assigned to medical treatments like this.
The problem with the USA is not that medicine is not socialised, it's that the price is inflated because of government / insurances plays.
Imagine all the money savednot paying for public officials! I've lost money as the metropolitan police was completely useless. They had information, proof, arrested the guy, and then let him go. He ran away to Dubai and came back operating the same scheme under his second name. Reported it again to the same detective with location of the office and info from newly scammed people I contacted.
They dismissed the case. I lost only 2k, but other victims (landlords being scammed by a fake agent) lost tens of thousands. Tried going to court but there is not a physical person with asset in the UK to persecute so I will likely won't get anything. Wasted 500£ more with this.
The government doesn't have any incentive stopping crime, it just relies on the good will of policemen and their limited resources. If people complain because there is too much crime, they just have one more reason to increase taxes and do nothing.
This made me laugh out loud, so I guess you managed your objective (I'm referring to your nick)
I swear, the pure communism is more believable as a system that could work than pure libertarian.
Any we all know pure communism works only for ants.
We never attempted a pure libertarian system in which all services (including health care, personal protection, justice, lawmaking) are provided by companies you can choose to buy from or not, voluntarily. Until we make that experiment is hard to speculate on what's going to happen.
I don't think it would be much different from what we have today, we just would have less bureaucracy, we won't have a central government taking a fee for everything that happens, people would be free to live how they want and we would have a dynamic consumer based set of laws.
That said, even moving the current system in the libertarian or communist direction cause the system to perform better and worse. Look at China and how they used capitalism to drastically improve their economy and improve living conditions for people (albeit I doubt they were aiming for that).
Insider trading and whole hull house of exploits that are now barely held back by regulations.
You must be blind to not see how current system is currently exploiting democracy and technology information era, I dread what would happen if they were to run free and unchecked.
Imagine for a second scenario, you got jumped on the street and stabbed you are bleeding and need help fast. You call ambulance, street cameras see you are bleeding... Yes sir we can be there in 3min it will be $50,000 for ambulance, without it you will die. You call another ambulance company, they say same thing. Of course they are in the syndicate fixing prices its not illegal. Tell me how in a pure libertarian society this wouldn't end up being the case.
Once the promise of defending the people is done (presumably in part to justify the existence of the government in the first place) the government doesn't have an incentive to stop or persecute crime which has already happened.
Deterring potential criminals with random patrols and showing up when called is enough.
A twitch streamer (SweetAnita) recently had problems with a stalker caught going to her house with a knife. Despite the police looking for him to question him for an unrelated assault he committed in public, and despite finding him with a knife a few minutes from Anita's house, the police released him.
Could it be because of bureaucracy or occupancy issues in jails? Maybe! My point still stand, I'd prefer a private insurance firm defending me.
She had 5 stitches and was in and out in about 90 minutes. A plastic surgeon did the stitches and at one point there were 8 folks in the room.
She has no scar and the experience was very good.
We had full insurance, and when the bill came, it was ~$4500 of which we had to pay roughly $990 ourselves.
Still not sure how to feel about it - that's a high price for a few stitches, but if I had a choice of going to a UK hospital for free, or paying a grand to know my daughter will be perfectly cared for, assuming I had that grand, I'd rather pay.
Not everyone has that option though and that's the problem.
Is the implication that UK hospitals provide lesser care than their (costly) american counterparts?
But as a parent, it is YOUR 3 year old so you want the absolute best for them. The end result, I believe, would have been exactly the same had it happened here or in the US. Just I had a lot more confidence (at the time) seeing just how much was being done to ensure there was no scarring.
I just don't understand why it's a binary choice, either free care of good care. My own experience with the NHS has been stellar, the standard of care I have received(and still receive) is incredible. Everyone is very friendly and I get all my meds and treatment for free. My father has fought cancer for 9 years, during that time he had multiple operations and years of Glivec supplied to him free of charge, the only complaint he's ever had was that they would only reimburse him for 2nd class train ticket when going to the hospital for an operation, even though driving was more expensive.
But the thing is - if I or him ever wanted to(for some reason) to go private, that's still an option. Private insurance with private doctors and hospitals is also available. In US you don't really have any option other than going private.
Coming from Germany and now living in Denmark, I have full confidence in the systems here to handle it equally well (maybe with less than 8 people in a room though).
And that is one of the many reasons why US healthcare is so expensive. I live in Sweden now, and many of the 'minor' things a doctor would handle in US is handled by nurses here. Personally I've never felt this to be a problem at all, but I know many people in the US feel very uncomfortable about that idea.
I've been twice to Danish hospitals, and I think the experience is very comparable. The staff in Copenhagen seemed kinder (a bit more time to reassure the patient etc) but otherwise there wasn't much difference.
I trust both countries in 2015, and Denmark in 2020. I don't know what's happened in Britain since 2015. My family aren't complaining (at least, no more than the usual British amount), but the British people keep voting against their interests.
End result would be roughly the same.
In some parts of the country it may be a longer wait than others. The NHS generally though are very good when you visit with very young children.
So, it works for some people, but overall it’s a pretty shitty system.
Lol. It’s not like the doctors are dumber or do poorer quality work when it’s socialized. I doubt having $1k skimmed by some middleman got you better care than we’d get in Canada.
I am so glad I am an European.
If you mean more than $2000 than that's correct, of course, although I am not sure weather it is relevant.
I imagine it varies depending on state and profession, but what's the average in the US? do you reckon it offsets the possibility that slicing yourself up while riding a bike could put you in serious money trouble?
I doubt it :)
we don't know what information was on the claim, but judging but the long list of "professional services" it's indeed too vague to be itemized against their policy if that was the description provided.
or in short this piece is presenting a very biased view by withholding a lot of information required to come to an understanding.
You can call 112 when your cat is stuck on a tree.
Look at it this way:
$18,933 is more than Apple would charge! ;-)
- my son broke his hand falling on the playground, we drove to the nearest hospital that handles kids (which happened to be a private-owned hospital).
- he received the necessary medical attention and his cast, based on his insurance card - we are insured in the public system, but the insurer is a private, for-profit entity
- we did not pay anything. There are co-payments, but not for children. However co-payments are like 5 EUR for a prescription or 10 EUR for a day of hospitalization.
- a year later, we received a letter asking us to detail the exact circumstances of the accident, because they want to see if they can defer the payment to another insurer. For example, if he fell from a faulty piece of equipment in the park or if somebody pushed him. On the letter I had a link on which I could fill the form in online. Did it, explaining that the equipment was in order and we were even the only ones in the park and it was simply and unfortunate accident.
- that was that
edit: alongside with our employers, we are paying ~1300 EUROs per month (2 people, child is co-insured autoamtically) for health and care insurance to the insurer. What was nice was that when my wife wasn't working, she was also automatically co-insured on my contract for free.
Let's call this what it is. It's a racket and unethical.