I injured myself and needed to go to the ER. The injury wasn't life threatening, but I definitely needed to go to the hospital immediately.
I called an Uber.
I don't have the time or expertise to do the months of legalese and calculus it would take me to understand my insurance policy, so I have no idea how much an ambulance ride would have cost me. $0? $400? $15000? None of those numbers would surprise me. As best I can tell, insurance companies throw a dart to decide whether you're covered or not, and then the healthcare provider makes up some insane number if you aren't.
The Uber got me to the hospital faster than an ambulance would have, for less than $10, and I knew it would cost less than $10.
The injury, though extremely gruesome and painful, only warranted an x-ray, some tylenol, and an ace bandage.
I'm insured. They sent me a bill for over $900. For taking a picture, and giving me tylenol and an ace bandage.
I view insurance as a tax my employers pay to the American healthcare system to be compliant. When I have my end-of-life event, whatever that is, I fully expect a choice between death, and living a little longer in bankruptcy. I'll probably get treated outside the US or choose death.
The system works if your net worth is somewhere above $5 million. For everyone else it's just the mechanism that sends everything you earned back to rich people right before you die.
Or maybe I'm wrong! I hope I'm wrong. The stack of papers is 4 inches high so I'll never know, but I sure hope so.
There is pretty much nothing that infuriates me more than the health insurance system. Here is just one example (other than your ambulance example, which is like some trolley-car problem come real):
We use "insurance" for routine medical examinations which are supposedly to be done regardless of health. We use "insurance" for YEARLY checkups.
The absurdity of this is on par with insuring yourself against getting hungry, or buying gasoline insurance to fill up your car.
Gas in $8000/gallon. But pay $900/month and we will cover the cost!
It is absolutely embarrassing that this is the system we have allowed to exist. I consider myself a pretty staunch capitalist in most regards. Health insurance is definitely not one of them.
The health insurance system in the US is about as far away as you can get from capitalism. It's heavily regulated, a cartel, the prices are not transparent, and there is no competition (existing hospitals have to approve new hospitals, etc).
You can't disown capitalism from its problems that easily. It's not hard to see that it is in short-term self interest to form cartels, lobby for regulation, crush competition and treat their (now captive) customers with contempt.
This is a pattern we have seen time and again. Describing this as "about as far away as you can get from capitalism" is the no true Scotsman fallacy. Perhaps it doesn't match how you believe capitalism should work or you have a very different definition of capitalism to the more regular meaning of the term.
really-existing capitalism involves co-opting local power structures (parliaments, legislatures, dictatorships, puppets, etc.) to protect your cartel.
If capitalism is only capitalism when there is no conglomerated power structure then capitalism is impossible.
Often enough today its the left who are defenders of capitalism (ie., of disentangling power structures from coporate control) whereas the right seems possessed by the idea that whatever a company does is by definition captailism.
Capitalism was all about recognizing that business interests are anti-capitalist.
> really-existing capitalism involves co-opting local power structures (parliaments, legislatures, dictatorships, puppets, etc.) to protect your cartel.
I grew up in a communist country and guess what: politicians co-opted local power structures for their personal benefit. They drove the good cars, had the nice houses at the lakes and hard (= Western) currency. This is the case for (AFAIK) every single "socialist" state.
The only difference was that in socialism, corruption was not done for the benefit of a company but for an individual.
Do you really think that once the economic system changes, they (= we) are all suddenly better people?
It's the power itself that is corrupted and it doesn't matter how or by whom or in what system, the end result is the same.
Really-existing communism is bad too. I think worse than really-existing capitalism as it had to pass through a dictatorship stage to be realised, and dictatorships are extremely hard to renounce when formed.
What I was saying was a defence of the fundamental economic model of capitalism, not a criticism of it.
> we are all suddenly better people?
Yes. People are largely ethical products of situations they find themselves in. Reduce the number of opportunities for bad behaviour and you get Good People.
unaccountable systems of power are the recurring situations causing bad-behaviour here.
A healthy democratic capitalism aligns the interests of those power with the people. So that capital owners do not seize control.
"Capital" is not capitalist. It is anti-capitalist, wanting to monopolize and dictate.
To me, this is like saying social engineering isn't a security problem.
It seems pretty obvious that, if your aim is to accumulate capital, regulatory capture is a pretty damn efficient strategy as compared to marketing or product development. It's also efficient for the government official, who gets to sell access to regulation processes (an otherwise difficult-to-sell service!) at market rates.
(Not that libertarian-style "OK, let's get rid of governments!" approaches are a good solution here. In that case, the optimal strategy becomes force, which in effect establishes a government of sorts.)
I believe the distinction should be made between laissez-faire and crony capitalism. The sytsem is as far as you can get from laissez-faire and completely crony
US has a market for regulation: lobbying is legal and elections are funded by donors. So I'd say problems caused by the regulation are pure capitalism: it's just a new, more cost-efficient way of beating the competition.
It's not really new. Lobbying the government, or whatever group has the monopoly on 'enforcement', to benefit private interests goes back to the beginning of civilization. The interesting thing is that this is one of the most ideologically divisive issues when framed as it typically is, yet really I think it's something most people could really agree on. People pursuing a "small government" certainly have little love for corporations, but the idea is that when the power and breadth of government is strictly limited then their role as a corrupting force, which is certainly by far the most efficient way of beating the competition, is minimized.
Going the other direction you can have a big government with extensive powers that tries to force fair play through extensive regulation, as ours does. But this has been tried over and over again, and it invariably trends towards corruption. I think that particularly in a democracy, this outcome is going to be quite difficult to avoid. It seems that these basic facts should be the starting point of discussion, as opposed to the point where people have long since splintered off and polarized themselves towards opposite extremes.
It might be capitalism in that trade and industry are controlled by private entities (that's still debatable because in the US nearly 30% of GDP is controlled by government entities, and most of rest is tightly regulated).
But it ain't "free enterprise" whenever regulation limits consumer choice and market entry by competitive participants.
It absolutely makes sense to insure routine medical examinations. If they’re not covered, people don’t do them. Many routine examinations uncover conditions that are not critical yet and easy to treat before they turn into a costly nightmare. (e.g. routine skin checks uncover potential cancer before it spreads, tooth checks uncover problems before they require expensive replacement) It’s an investment, not only health-wise, but also financially for the health insurance.
But that's the difference between buying insurance, which is an actuarial product you buy to guard against unfortunate events, and buying a service or subscription, which is available for your use when you desire to use it.
Let's ask a simple question to determine which is which in the US: because attending your annual checkups reduces your risk of needing expensive treatment, somebody who attends their annual checkups are cheaper to insure. Are there any American insurance plans that effectively pay patients for attending their checkups? Are there any American insurance plans which say, well, your premiums are $1000/month, but if you go to your annual checkup, not only will your checkup be completely covered with no co-pay, but we'll reduce your next 12 monthly premiums to $950/month each?
After all, if it reduces costs for the insurer, then the insurer is motivated to incentivize patients to go, right?
So, you're claiming that since certain cancer screenings are ineffective it therefore means that managing issues such as hypercholesterolemia, hypertension, and diabetes are also ineffective? That seems like a stretcher to me, and I'm not buying it.
I dont know about the former, but the later two are long term diseases that can be caught when visiting the doctor for other reasons. also, compliance to the drugs and lifestyle is very low.
diabetes usually shows itself, hypertension is a silent killer though.
i'm not arguing against check ups, but I could imagine why they are not as effective as you might think.
i myself do not get checkups, i have insurance, but going to the doctors is a miserable experience.
First is trying to schedule a visit. Usually the earliest they can see me is 3-6 weeks away. when I have free time to see a doctor, thats when I need to do it. I dont know whats going to happen in my schedule a month from now?!
next, if I actually get the appointment, I am punctual and show up 15 - 30 minutes before the appointment. However, I dont get seen for 30-45 minutes after the scheduled appointment. This isn't just one time, this is E[X]. thats 45 minutes waiting with people who are coughing , sneezing, etc. after I see a nurse for 2 minutes and get sent to a room, usually thats another 5-10 minutes waiting in an empty room.
when I finally see a doctor, I am only allowed to talk about one thing. if its multiple things, I have to schedule another appointment. usually the doctor cant help with any of my ailments, I need to schedule an appointment with a specialist. usually another facility. unfortunately, I am not allowed to schedule an appointment with a specialist directly, I have to see my primary care first.
For your last 3 paragraphs, that's absolutely terrible. I'm in the US and none of that mirrors my experience at all.
> diabetes usually shows itself, hypertension is a silent killer though.
Diabetes does not always or often show itself until a major issue has come up.
> i'm not arguing against check ups, but I could imagine why they are not as effective as you might think.
I have this sense that medicine is in some kind of "PTSD" from ...something...? right now. I don't feel like I can mention things to a doctor without them feeling like they absolutely need to do something about it. For instance, there is this one doctor at my child's pediatrician who will prescribe things (for instance she prescribed a nausea medicine when my kid had a stomach bug) that my wife and I are like really; it doesn't help that she doesn't communicate anything about the meds. (Yes, we've mentioned her to the other doctors at the practice.) But that's an extreme case, but little things in the same vein do annoy me.
I don't think yearly checkups are a cure all, but there are chronic diseases that our socity lends itself too. Changing social patterns (e.g. what we eat, how we get around, &c) would probably do more than any amount of medicine could.
One insures for what one cannot covers himself or herself. Regular risk (maintenance) one simply absorbs. That's why the mandatory health insurance especially as defined by ACA is a total garbage - it forces insurance companies to cover regular risk.
I only want to carry catastrophic insurance. If I could, I would have had a policy that kicked in at $50,000 and covered to some absurd amount.
It makes good financial sense for insurers to push the insured to take preventative measures.
An insurer should provide incentive to bring a building up to code to avoid a costly fire.
The option to simply raise prices accounting for the fire leaves out the business of those who cannot afford it: the people leaving in a building that's not up to code.
> "It makes good financial sense for insurers to push the insured to take preventative measures."
This is only true in a well-designed system. In a system in which insurance policies are for a one-year term and can be declined or premium-hiked as necessary after that term is up, encouraging preventive checkups can be counterproductive if the risk of being on the hook for problems discovered in the checkups is higher than the preventive benefit during the duration of the policy.
The point seems to be more that "insurance" as a word betrays the original intention of the service while the current state of affairs demonstrates how much the concept has been bastardized.
Insurance is for those events where you don't expect a gruesome injury and need to insure, or hedge, against those one-offs. Preventative care isn't the same idea because you expect to get older and things to fail slowly. But barring any conditions or disorders, this isn't insurance against external sources of damage but just an action taken against inevitable consequences of having an organic body that tries to keep itself in a delicate and easily-broken balance for 50+ years.
Insurance should be used for what it is — an financial instrument to protect against unforeseen and catastrophic financial loss.
Car insurance doesn’t pay for tires or oil while it could be argued that bad tires increase the risk of accident. However tires and oil are an inextricable requirements to owning a car.
This idea that health care should be paid for by someone else has always puzzled me. It’s the equivalent of food being “free.”
For the legitimately poor, there is definitely a role for government just as governments don’t let people starve to death, but for everyone else — its just wacky that the government ought to be involved at all beyond safety regulation. We went wrong when some groups started claiming health care as a right — nobody has a “right” to the labor of other people. In other words — I don’t have a right to make you produce something for me.
Health care costs have spiraled out of control because of the detachment of who is paying from who is receiving the service — much like higher education.
> Health care costs have spiraled out of control because of the detachment of who is paying from who is receiving the service — much like higher education.
No, they have spiralled out of control because health care is something where no real market can exists, so you need good regulation (which the USA doesn't have). If you have an urgent and life-threatening health problem you can't shop around for a cheaper hospital or decide to go to none at all if the alternative is death. So they can charge whatever they want if there is no regulation.
You also can't live without food but there is a market for that. Even when you don't have time to cook and need food on short notice, there are plenty of fast food and delivery options available.
There is nothing impossible about a situation where a hospital has a reputation for being cheap but having long wait times while another hospital is more expensive but has shorter wait times. Then in an urgency you wouldn't need to shop around, you would decide based on each hospital's reputation.
Unfortunately hospitals don't publish their median wait times, patient outcomes or even their prices. If they were forced to publish those things, maybe a market would emerge.
You can live on Doritos and donuts for weeks or years. You can be an ill-informed and lazy consumer and survive. I have learned when I can substitute oil for butter without problems and when it'll cause disaster.
How many people on HN have done the reading to know when a fecal occult blood test can and can't be substituted for a colonoscopy? And those are generally tests that don't have urgency. When you're in the hospital because you've been vomiting for 6 hours and are passing out, are you going to say yes to the abdominal CT? This recently came up with a friend, who called me for advice. I was with a doctor in the moment, who said that he didn't see why it was indicated (for a host of reasons). The doc got on the phone with friend who handed the phone to the physician's assistant who was going to bring him to the CT, and argued the guy out of the CT. This took knowledge, effort, and persuasion. Who here is going to be able to self-diagnose and say, "Skip the CT -- I'll have it if X has not improved in 24 hours and Y continues to decline."
For many reasons, in the US there is a lot of "defensive medicine" practiced. The doc would rather order the CT than defend against a lawsuit, and for him/her it takes less time to order the CT when the patient rolls in than wait 24 hours while observing the patient in the hospital. But it's not actually in the patient's best interest. Our incentives are not aligned, and patients do not have the time or baseline knowledge to evaluate individual treatments.
You can live for weeks without food, it can be stored easily (unlike services which aren't stored at all), and the barrier to entry is low... Many people even have their own food gardens. It's also very amenable to nearly complete automation. Therefore food is super cheap.
>I understand that healthcare is more expensive than food for all those reasons. What I don't understand is why there can't be a market for it. Expensive services can have markets too.
At the moment the only thing I can think of that are expensive services are also luxury services. Most people consider health care to be a basic service that should be open to those who need it, regardless of wealth.
Back to the food analogy, people who can't afford the food they need to live are given food stamps. Even so, there is still a market for food. People know ahead of time what the exact price of the thing they are buying with their food stamps. Nutritional information is available on the packaging.
Why exactly can't I know ahead of time how much will each hospital in my area charge if I have a heart attack and have to go to their ER? Why can't I know which hospital has better survival rates, or the shortest wait times?
That information is all that is needed to have a healthcare market. It should not be impossible.
I understand that healthcare is more expensive than food for all those reasons. What I don't understand is why there can't be a market for it. Expensive services can have markets too.
They are all medical procedures that are not covered by insurance. As the number of providers increases and the technology advances, prices drop and quality increases.
Those are not required procedures, so obviously there is much more of a chance for a real market there. But you can't just compare that with e.g. ER or cancer treatment.
Because the idea that cancer treatment as well as other exotic treatments needing to be covered by insurance is a pile of horse manure - i'm saying it as someone whose grandmother died from cancer and someone who has a few friends that successful beat down cancer.
Lets engage in an intellectual exercise. 10MM USD (today) and for 1 person cancer is gone. Should we include coverage for cancer into all policies?
Your lifetime odds for cancer are like 50%. If insurance doesn't cover life threatening illnesses and life-saving treatments, what's the point in paying for insurance?
I agree it should cover them (in theory). I would even agree that healthcare should be a human right. But even under a zero profit model, for the cases where the treatment is so expensive, what would the financials look like for all the insurance payers? Is it actually even possible?
This is naive voice of someone who has never needed an effective healthcare system or faced many of the challenges that many do, such as chronic problems, unemployment etc.
What happens if it was your brother or sister dying? Not paying for them! Nice chap.
Healthcare costs are high because of lack of regulation and the ability for private enterprises to set costs. Profitability is not ethical when it comes to doing no harm. I’m sorry I can’t treat you, you can’t afford that option.
It’s simply not true. In the 4 countries I have lived in, the US was the only one with very expensive heathcare, and in the other 3, which all have what Anericans call socialized medicine, healthcare was even more detached, but much cheaper.
what do you mean by that in the UK I got treatment based on my NI contributions which in the US is unavailable unless you can prove you can personally pay $1500 a month for the rest of your life, to pay for the anti rejection drugs post operation.
I'm puzzled when Americans say this, because their government spends far more on healthcare than other governments, and also doesn't provide universal healthcare.
The US is the worst situation: expensive government provision, that doesn't prevent the harm caused by lack of access, but which also causes harm with too much access for the wealthy.
To be fair, a lot of stuff work that way. Take an HVAC maintenance plan for example. For some fee (based on the model and age of your HVAC and the condition it's in), you get routine maintenance covered. They do what they can to prevent major hiccups, but if it breaks down, they'll repair it (after trying to weasel their way out of it).
It's pretty darn common across a lot of industries.
Warranties are different because though they also depend on non-utilization, the defects they cover are generally likely to occur at some point (the guarantor is just hoping it will be after your warranty expires), and consequently higher utilization rates are expected.
Insurance is based on the assumption that only an extremely small number of insured persons will ever make [significant] claims against the policy; insurance is for expensive potentialities that are very unlikely. The entire industry and regulatory framework is structured around that assumption because that is what the word "insurance" means in all contexts outside of health care.
The problem is that pretty much everyone is going to need significant medical care at some point in their life, certainly as they age into their senior years if not earlier.
Would you buy a "health maintenance plan" under the stipulations of health insurance policies, which are basically "Pay us a lot of money, and we'll make some farcically big numbers look smaller for you, but you'll still probably owe a lot of money; we won't know how much until you already owe it"? Of course not.
The racket we call the American health system can only exist by masquerading as "insurance".
There's a pretty important difference between humans and HVACs, which is the reason the two systems end up being very different.
You can always rip out the HVAC and put in a new, off the shelf unit with roughly the same specs (often better, because progress) at a fixed, known cost, and the customer will even often be happier if they end up doing that instead of repairs. If health care providers could trivially decide to euthanize and replace patients with expensive diseases, health care insurance would be as trivial as HVAC maintenance plans.
What you say is totally true, but completely irrelevant to the point I was making.
All i was saying is that it's pretty common/normal/etc for insurance (in any industry. Literal insurance or things that are insurance in practice but not literally) to offer routine exam/tests/maintenance/checks if it can prevent the worse case scenario $$$ from happening.
Similar story; dislocated my shoulder, and needed to visit the ER. Came to the same conclusion at the time, that Uber would be the cheaper/easier option. The driver got me safely to the ER, likely faster than an ambulance would have. The driver was even courteous enough to help me with the door. I don't remember the exact price, but it was reasonable, I'm sure it probably saved me hundreds relative to an ambulance ride.
It was probably the more socially responsible option all things considered. I didn't require urgent medical care, so taking Uber helped ensure those resources where free to those whom might have (though this thought didn't cross my mind at the time).
My wife was in a car accident, and surprisingly, the ambulance bill (perhaps 5 miles, "night" surcharge (7pm), private ambulance in the bay area) was "only" ~$3400. I seem to recall an ambulance ride when I was a kid (20 years ago) costing something like $5k plus when I crashed my bicycle.
Funny thing, though, the ambulance bill was the only thing NOT covered 100% initially. The hospital and surgeons bill your insurance, and we didn't pay a dime (other than a comical $200k+ explanation of benefits telling us our claim was denied when they initially submitted to the wrong insurance). The ambulance company billed us, and I spent ~6 months working it out, and I think it's finally sorted. The upshot is because it was a "car accident", the health insurance doesn't want to pay it; car insurance is primary. In theory the car insurance is the primary on her entire hospital stay, but because the medical payments on our car insurance is only $10k it's basically pointless to involve them. They don't even know there was a hospital visit. So I had to go back and forth a bunch of times to even (re-)open the car insurance claim, get it submitted, send more and more documents, fend off the ambulance company always threatening to send us to collections because I had better things to do than deal with their crap, and so on.
Current status is I've paid maybe $600 on a payment plan, my insurance says they paid in full, the payment wasn't yet reflected on the ambulance co billing site, but in theory once that payment posts they issue me a refund on my payments to date.
We're so incredibly lucky to have insurance; actually she was double-covered at the time of the accident (hence the billing confusion initially), we have money, we have family in the area to help with doctor visits, and there was really only one provider. I can only imagine what a nightmare sorting the bills would have been if we had to manually submit to insurance from multiple providers and stay on top of many many claims. It would be a full time job for sure.
Some credit cards come with automatic travel insurance, but regardless it is well worth researching before you travel. Hospital stays abroad sometimes need to be paid out-of-pocket until you are reimbursed later on.
It all depends on the circumstances, your country of origin and any extra insurance you might have taken out.
I ended up in hospital for a fairly routine operation about a decade ago and had to pay out of pocket, luckily it was in a place where they just charge you for actual cost rather than to try to balance their budget by bankrupting you so it ended up being $1500. The same thing in the US would have been a large multiple.
My aunt broke her shoulder while travelling in the US and had to fly back to Ireland to get it properly treated after an initial x-ray. She would have been ruined financially otherwise.
Is that particularly different from how you'd be treated in any other foreign country?
I mean, I have no idea what would happen if I broke my arm while overseas either. I have insurance (in the US), and assume it would get sorted out somehow, eventually, but I have no idea what my share would be. I just don't anticipate being turned away at the hospital door though.
You most definitely get some huge bill. Depends what covers that bill. Travel insurance, your home healthcare or some extra insurance you buy for the US specifically.
3.4k and 5k. I would expect the keys to ambulance after the ride for that price. How can that cost be justified, did you get any treatment in the ambulance other than oxygen and maybe some morphine?
It's not just a ride in a vehicle is it? Ambulances carry paramedics and sometimes doctors, tens of thousands of dollars worth of drugs and equipment. Even if you don't use all of that, they can't do anything else during the time that they're on your call, they need to be heavily insured, and they also need to stand by all day waiting for calls.
The numbers still seem extremely high, even if an ambulance only does 3 trips a day on a bad day, that's over 10k USD. A private ambulance ride in Thailand (Im not talking rescue org ambualances) for example is $80-$120. Now I understand the service standard might not be as high, and wages are lower, and so on, but is it really 40x as expensive in USA to cover costs?
Actually a better example, might be HKG, where service probably exceeds US, an ambulance ride is HKD990 (~USD127) apparently. It is mentioned elsewhere in this topic that its $82 in Canada for an ambulance.
Ok, let's say 3 people with reasonable salaries, $10k a month. Equipment and a car even though is costly is used for long period, let's say $500k over 5 years, that's $8.3k a month. Medications are expendable, because the more load an ambulance has (and medication usage) the more revenue it brings, but ok, let's add $10k a month for resupplying medications, plus other small expenses it's total $50k a month. In the situation described by rconti (5 miles) it probably took them less than an hour for revenue of $3400, let's say an hour, and let's say they have average load of 3 such calls a day (not really a heavy load). It's more than $300k a month in revenue. So, what's the reason for $250k difference?
I'm not defending the cost! Just saying you can't look at it and say 'that's more than the cost of the vehicle' because it's not about the cost of the vehicle.
Yes, I understand. That's why I wanted to take a look at components of the long term cost, not just one ride. And I'm really curious what's the cause for the difference.
I think ultimately the system is fcked across the board, private interests and greed combined with legal corruption (lobbying) to get their way and government guided by the people that line their own pockets. Weather it is pre-Obama, Obama or whatever Donald is planning all the pricing is insane compared against <take-your-pick> of any other developed country. None of the justification holds much weight, even "cross-subsidization" I don't see affecting it to this extent unless only 1 in 20+ actually ever pay anything.
Yeah, never moving to America. Never. I value my life more than that. In Estonia (and I'd imagine most of Europe), the ambulance ride is free (unless you prank call them, then you get a fine). The healthcare is free (paid by your employer), doesn't matter how badly you're injured. The only thing that's not free is dental care, but you can insure that, so you pay a monthly fee and they cover the actual cost if something happens. And no, it's not a made-up number.
As far as I know most people are just curious (I saw my first black person when I was 11 years old, so yeah, mostly white country). There is racism, sure, especially in less-developed parts of the country, but most people just keep to themselves and don't ever express their racism. I also don't know of anyone below 30 to be racist. It's mostly old people from the soviet times (where there were virtually no people other than of colour white around).
As far as is it a good place to live, well, it's cold (but very tech-advanced). Check out https://e-estonia.com/
You'll be hard-pressed to find the sort of systematic racism found in the US (especially by institutions) anywhere in Europe. Sure, you might get the occasional glance if you are black especially in Eastern Europe and it's mostly because out of curiosity since there are not many African immigrants in ex-Communist countries as there are in, say, France. But other than that you'll be fine.
I should say though that Eastern European countries do have issues with Islamophobia in general, so if you are muslim I would not recommend those countries.
> I know that this does not prove everything but it's one way to measure institutional racism which is kinda hard to measure in an objective way.
It's a lot harder to collect data when you expunge all references to race from the law, and also prohibit public institutions from collecting data on race and ethnicity, as five European countries have already done. Heck, you'll be hard-pressed to find reliable statistics for how many black people even live in (e.g.) France. That doesn't mean racism doesn't exist there; it just means it's impossible to separate out the effects of racism in analyses. The racism has become fully integrated.
This is exactly what institutionalization of racism looks like - racism becoming part and parcel of the society, so tightly integrated that it's actually hard to disentangle the racism from the rest of society.
> Avoiding the culture of dividing and collecting data based on race makes a society racist?
It certainly doesn't eliminate racism from society, no. It just makes it impossible to measure the effects of racism independently. Hence, the racism becomes integrated into the rest of the society.
That's mostly football ultras[0] though. They are usually the lowest common denominator, it's like saying the US has issues with education because there are people who believe that the earth is flat. Besides, I did not say there's no racism in Europe, I said it's not institutionalized.
I should also add that discrimination in European countries is based more along ethnic and nationalistic lines, not race or color the way it's in the US. While in the US people are categorized by their "race" (black, white, asian, middle eastern, etc), in Europe they are categorized by their country or geographical area of origin (Polish, Italian, French, English, Eastern European, Western European, etc). A black English guy is not primarily "black", he is primarily English.
It's also quite interesting how US-centric this website is and how patriotic most of you are.
I totally agree that discrimination is done by geographical area of origin instead of colour of skin. Lots of Estonians have an axe to grind with Russians (due to history), but I don't know of any other people that we tend to dislike. Perhaps British guys that come here to get drunk and yell and piss all over the streets, but I'm sure that's a problem most everywhere.
Well, not if you need treatment. If you're poor, yes you won't pay anything because the hospital won't bother to bill anyone. But if you need surgery and have no insurance or medicade, there are cases of doctors sending you home, waiting for sepsis and then amputating, because it's cheaper and takes less resources.
Extremely poor people may not pay for care, but be assured that in America, they get no where near the same level of care.
And if you're poor and have cancer? Most other western countries will give you a chance.
There is a much deeper problem relating directly to this topic. Transportation. Access to real transpiration is THE BIGGEST FACTOR in escaping poverty.
Uber isn't public transportation. A train is about $2 ~ $3 in most cities. In an Uber that would be a $10 ~ $20 ride. Multiply that by 7 days a week to and from work, and there simply is no comparison. Many cities have discounted fare cards for the poor as well. The structure of American cities hurts the poor.
> And if you're poor and have cancer? Most other western countries will give you a chance
Cancer is probably the worst example you could pick to prove your point. It turns out that the US system is highly-optimized for specialized care (which happens to include cancer), as opposed to routine care. That's one of the reasons it ends up being more expensive.
In fact, even when including poor and uninsured people in the mix, the US has dramatically better outcomes when it comes to cancer treatment than the UK, Canada, Denmark, France, the Netherlands, etc.
> How do you get an improved outcome for cancer if you can't afford treatment?
You're missing the point, which is that the number of people who die from cancer that would otherwise have been treatable except for their ability to afford it is actually quite low. And the US does much, much better at treating cancer overall. Which is why the overall cancer survival rates in the US are drastically higher, even though a small number of people may not be able to afford treatment..
(You're also assuming that people are able to receive cancer treatment in countries like the UK, which is actually not a foregone conclusion. Assuming it's even diagnosed properly - the UK in particular is really notorious for cancer misdiagnoses - they may actually not be eligible for having their treatment covered under the NHS, even though their cancer may otherwise medically be treatable, either in other countries or if they can self-fund it in the UK).
Can confirm it works fairly well for the poor. I have been registered for Medicaid the past three years of school and have not had to used it until this year. Every single time I use my insurance (CareSource) I am absolutely blown away by how painless it is. Other than presenting proof of coverage twice in a series of multiple hospital and doctor's visits I have not had to worry about insurance for a single moment. At one point my physician was ordering lab work and kept asking if I wanted any additional lab work of my choosing and this just seemed absurd because on private insurance I would never consider lab work to be discretionary.
> At one point my physician was ordering lab work and kept asking if I wanted any additional lab work of my choosing and this just seemed absurd because on private insurance I would never consider lab work to be discretionary.
From your perspective that's great, but it's still another sign of the system being broken. As soon as you involve cash flowing between multiple entities, it just becomes a massive cash grab. The physician seemingly knew they could take advantage of your cover in that instance. That in itself seems problematic.
Note: I'm not from the US, so there's probably an aspect of Medicaid that I don't understand. We have a more sane healthcare system :)
Medical is a horrible situation when I've had to use it. The places that take it you pay nothing, but many places won't take it, and many GPs at places that do take it won't take new patients on it.
The dental care was also terrible: 2 places only in my city that accept it. Neither would give an appointment for a cleaning and a checkup at the same time, and I never was admitted less than 20 minutes after my appointment time.
> It really seems like the middle class gets the raw end of the deal.
My hairdresser figured she has to spend $5,000 before she can get any benefit from "health insurance". She & her husband decided it'd be better to pay the penalties, spend that first $5000 on herself, and "hope" that she won't need more.
This to me is the biggest issue with health insurance in the US right now---it's effectively trying to cover two issues at once: 1) non-payment to health care providers 2) unexpected ailments to health care consumers. We have insurance companies as the middlemen, trying to make money from both ends. It's like having the same lawyer as prosecutor and defense attorney; no matter how much you trust any individual to do a good job, you're asking for trouble in the long run.
I feel like the best solution would be to change the arrangement from consumer<-->insurance<-->provider to insurance<-->consumer<-->provider<-->insurance. Have providers charge consumers directly (so prices are more transparent), consumers buy actual "health insurance", and providers buy non-payment insurance. If the government needs to subsidize non-payment insurance rates for certain providers, it can do so without as much risk for inflating prices and screwing over people who can pay the bills.
Crazy. Very recently I saw a guy get knocked out cold on his rollerblades and we called an ambulance. The question of cost never crossed my mind and I'm not sure I would ever want to make the utilitarian calculus: Am I helping this man or am I bankrupting him?
IIRC it's $82 or something like that in Vancouver BC Canada.
The unintended consequence of allowing that to happen would be that people would be hesitant to call for an ambulance for someone else. It will cost lives. I would expect any sane legal system to have strong legal protections for good Samaritans.
In the same sense that it would protect unconscious people from incurring enforceable debts?
A sane system would look at the incentives structure to devise cartel rules to encourage the individual behaviors that lead to the best group outcome.
The injured party desires swift and effective treatment for their injury. They also desire such treatment to be affordable, preferably at no additional out-of-pocket cost.
Onlookers may wish to help in the moment, but they do not want to incur any future obligations by doing so.
Medical providers want the customer brought to their facility, first to assist with the injury, and then also to be rewarded for producing better outcomes due to their care and expertise.
The move that makes sense is for injured parties and onlookers (they cannot know in advance who would be the unlucky one to get injured) to cartelize, and each pay an amount in advance so that the statistically predictable annual number of ambulance rides are all (theoretically) already paid for. And since it could damage the patient to delay care by attempting to verify cartel participation, it really has to include everyone, or ignore free riders. So the cartel becomes a branch of government, and it pays for ambulance rides with some form of tax. Then to prevent gaming the system by private ambulance companies, the cartel can either announce limits on what it will pay for during one ambulance ride, or it can run its own ambulance service.
And to further control costs, if they haven't already determined that it is an emergency with major traumatic injuries, the dispatcher can even just ask the caller if an ambulance is not needed. Most people can at least recognize if someone else does not need an ambulance, and maybe just needs an ordinary ride to the hospital without all the equipment and paramedics. The dispatcher can summon a cab, or Lyft, or Uber, or a bicycle rickshaw, or church bus, or shuttle van, or any other type of local transportation service, and pay their prevailing rate for a prompt, on-demand ride to some form of medical care facility. Since the patient would have to be conscious in order to get a not-ambulance ride, they could either wave it off, or tell the driver to go to their pick of clinic or hospital and have the ride paid for by their ambulance tax.
Other moves create perverse incentives to ignore injuries or hinder the care of an injured person.
Similar analysis indicates that hospital treatment for life-threatening injuries and other health emergencies should also be paid for out of taxes. The rest of the medical system could possibly operate under a different model, but I think most people would rather not be forced to choose between death and bankruptcy--for themselves or anyone else--when there's a dearth of time to think about it.
Maybe, but he suffered a concussion and reasonably wasn't in full awareness of the situation. Leaving him to suffer on the street until he made that decision on his own shouldn't be the morally correct decision. I stand by my behaviour and would do it again irrespective of the chance I might have to pay for it: there are some moral decisions I would rather not have to think about and instead just do the right thing. I lose enough sleep over more trivial things.
How much is an ambulance in Australia? Last time I was there, I saw a protest against the Abbot government (yea it was that long ago) because he wanted to put in a co-pay (yes, Australians don't have co-pays).
In the US, with insurance, they're typically like $300.
Ambulances are not a nationalised service in Australia. In some States it is State run, in others it is a private company.
I live in Western Australia and it's all done by St John's Ambulance. My partner has needed two non-urgent ambulance call-outs (transfer to a public hospital), which were both charged at ~$500. She's on my private 'extras'* insurance policy, and my insurer fully covers an unlimited amount of ambulance transfers ($50 co-pay for non-urgent). I believe this to be a common thing for this type of insurance policy - I'm not on any fancy tier of coverage.
HOWEVER:
A couple of years ago my significant other had an accident in a public area where she unable to move or call an ambulance. A nearby resident heard her yelling and called the police / ambulance. The paramedics seemingly had the authority to take her away from the police officers who were questioning her. She was taken to the nearest public hospital and was discharged from the ED shortly thereafter. She never received a bill. She's only young and the accident (very apparently) occurred as a result of drug use, so I think that the paramedics operating the ambulance are allowed discretion when deciding whether or not somebody should be charged.
* Physio, psychology, dental.etc. (all non-emergency). These services are not (fully) covered by our public health system, so many people opt for private cover. These policies work heavily on annual limits, so it's a bit unfair to call them insurance.
Just to give you some context, I'm a West-Australian, living in Austria.
I've had to take an ambulance to hospital a number of times. Cost to me: eu0.
I've also had to stay in hospital a couple of times, had a couple operations. Cost to me: eu0.
Of course, I pay regularly into the Austrian health system with portions of my pay check every month. But there is no suffering beyond that, if I have to have any medical procedures or take the ambulance for an accident.
I don’t know if it’s the same for everyone, but about 8 years ago I got gastro and thought I was dying because I was in so much pain. I was a Kiwi living in Australia l, called myself an ambulance and I don’t have Medicare so figured I had to pay the bill.
After being discharged I gave them my passport and the hospital bill was $0 while the ambulance bill was around $950 Aud.
When I moved to singapore to live I got appendicitis. I called a taxi and paid $9 to go to the hospital. Too scared to get ambulance now even if it’s covered by insurance.
So Aussies and Kiwis can live/work in the other country without visas (instant residence) but whoever drafted that agreement really fucked up. Aussies get instant ACC in NZ but Kiwis don't get Medicare in Australia. I remember there were discussions about it on Radio NZ a few years back.
There is a big private health care industry in Australia (for better or worse) that's not employer based (you see adverts on TV), so I'm guessing a lot of Kiwis just get private care in the AU.
But I'm wondering how much it costs an actual Australian resident/citizen with medicare. I know as a non-resident, a doctor cost around $70 ~ $80 (went once in Melbourne and once in Sydney) and I saw a real doctor. That's a far cry from America where you pay $200+ to see a Nurse Practitioner (yes, pretty advanced, but still not an MD).
Oh I could get Medicare, but because I was never in the country for 6 consecutive months at a time over the 5 years I lived there (traveling for short holidays) they wouldn't grant for me.
Doctor + Prescription in Australia is expensive! Would cost me like ~200 give or take.
In Singapore, consultation is like $15 and the medicine is prescribed by the clinic so no need to go to a pharmacy, total is like $50.
So I don't even bother seeing my insurance doctor where it costs me like ~$5 total, I just go see my normal doctor cos I trust him. (been to same doctor for 6 years)
> I'm wondering how much it costs an actual Australian resident/citizen with medicare.
Here's the costs for St John's Ambulance. It's $949 for a life-threatening or urgent call, $510 for non urgent. It mentions that Medicare doesn't cover the cost, and that the costs will always be incurred by the patient. (I actually thought it was covered by my private health insurance, but apparently not.)
Some doctors in Australia bulk-bill, so it's free for me to go to see a doctor whenever I want. Though for a short period when the government changed the billing rules, he started charging $25 per visit, but he's gone back to bulk-billing again.
Actually that is not true in BC, Canada. According to BC Emergency Health Services [1], It charges a fee of $50 if transportation is not required. $80 if transportation is required.
Wow! It is almost $400 here in Alberta [1]. But we don't have MSP premiums, so I guess it is not much different from BC when you consider all the factors.
If it's not life-threatening, don't go to the ER. Go to urgent care. They'll charge you $100-$200 for the visit, plus cost of materials. $27 X-Ray kind of cost of materials in my experience.
Better yet, get direct primary care. It's ideal for tylenol and ace bandage situations.
I am completely convinced that even if you have insurance, you are much better off acting as a self-pay patient. Your options are better, and you have a much better idea of how much things cost. People say you can't shop for a hospital in an emergency, and that's true -- but I already know how much the hospitals around here cost and how good they are because I have to for routine medical care.
Many places don't have urgent care facilities. And you'd still need to use an ambulance (or Uber) to get there otherwise if you aren't well enough to drive.
Many places don't have them, but many people who do have access to them are unaware and don't understand the advantage. OP sounded like someone who thought the only option available was going to a hospital and rolling the dice on insurance. I'm trying to encourage people to learn about urgent care. It can handle a lot of common problems and the price is super predictable. Usually it's listed on the web site. (Come see us with a UTI? $125). It's worth learning about as an option. Google urgent care near you! It doesn't solve everyone's problem, but it solves a lot of people's -- and I want the industry to thrive and expand and hence bring down the cost of urgent medical care for everyone.
Absolutely you still need to get there. Absolutely Uber is a good option when you shouldn't be driving.
Don't take an ambulence unless getting medical care ontheway could be lifesaving. Don't go to an ER unless getting medical care in the next couple hours could be lifesaving.
This is all coming from a hardcore capitalist, so know that going in:
Health Insurance, as a concept, is disgusting.
You "Insure" property. You "Insure" specifically against loss of that property, and the cost of insurance is determined (forgetting an awful lot of math, but the basics are) by: The value of the property in question, the amount of payout required to replace said property in the case of full loss, put up against the security of said property and the odds of loss occurring.
For cars, this presents as the value of the car, factoring in where you live and work (the two places the car is most likely to be), the costs to repair or replace the car, the security devices the cars have, and obviously your driving record.
To insure a life, you need to first establish the value of a human life, specifically your life. Your life (probably) is infinitely valuable to you. The cost to repair you in our current system could also be infinite, given the numerous and terrible things that can happen to a person with literally no fault of their own. By the same token, the odds of you needing that payout are also damn near incalculable; every place you go, every activity you engage in from skydiving to eating turtle soup in Mexico all have a probability of killing you. By the same token you can trip and crack your skull open in Harlem, NY or in the center of the Pentagon, it makes no difference.
Therefore, you have an asset with incalculable worth, incalculable cost to repair or replace, that is exposed to hundreds of things per day that could result in a full-policy payout, with barely a hint of predictability.
Even if the industry behind it weren't legendarily corrupt and full of fraud and nonsense from every player in it, this would be completely insane to attempt. The solution (the first part anyway) is to outlaw health insurance, completely, full stop. Then hospitals must be instructed to destroy their chargemasters and go back to charging for services at reasonable rates. After that, everything else should more or less be solved.
The reason you must get car insurance isn't to cover the cost of the car, it's to cover the very high variance in potential payouts to third parties should you cause an accident.
Health insurance in principle works on a similar basis: it's a cost smoothing mechanism for unexpected large costs that not everyone is expected to incur.
It breaks down if everyone incurs the big costs (old age) or not everyone insures (only at risk people insure, which increases costs, which pushes out people who aren't as risky, which pushes up the price further, in a cycle.) It also doesn't make much sense for regular care that doesn't directly prevent major payouts.
So it seems to me that health insurance is only workable if it is mandatory, old age spending is rationed, and checkups that find things that can become very expensive are covered, but other bits and bobs aren't. Obviously gold plated coverage could cover more, but that's all the mandatory insurance should cover.
It's all far too politically charged for any kind of rationality to prevail though. I think single payer state care can work, but it has high overhead and suits high tax countries better, not the US, where there is less acceptance of the social contract of taxation.
GP was referring to the car insurance, not the driver insurance.
Those are separable concepts. If your rear-view mirror is broken off by a punk with a baseball bat while parked on a Chicago street, that is property damage to your car that would be covered by your car insurance. If you t-bone another car, the damage to their vehicle is covered by your driver insurance, while the damage to your own vehicle might be covered by your car insurance, if that possibility is listed in the policy. Generally speaking, if your car insurance doesn't pay for damages incurred by the owner while driving, you-as-car-owner can't file a claim against you-as-car-driver under the driver insurance policy, and end up getting any money out of it.
When the policies are offered by the same insurance company, the actuaries for each can share information, such that the risk of owner-caused damages can be assessed for the car policy, and can therefore be rolled into its premiums. This is why those policies are often combined.
Where states mandate insurance, the mandate is always for driver insurance. So the car insurance then becomes an upsell option for those who already have to buy something from an insurance company.
With health insurance, there is the one big problem that you just can't get around. Everybody dies, eventually. You can sort of predict when and how in a large enough population, but everyone has a very high, statistically predictable likelihood of needing medical care at some time during their lifespan. There is also another big problem. Most people incur their highest medical costs in the year before their death. Obviously, after you die, you can't work off your medical debts.
That's not a good looking model for healthcare providers, and a tough one for healthcare insurance actuaries to squeeze profitable premiums out of. There is a perverse incentive to drop a client or raise their premiums right after a claim is paid, on the presumption that any uptick in medical payments might be a harbinger of greater future medical expenses. There is also perverse incentive to drop customers immediately after the first payment related to chronic disease is made. We paid for an office visit to an oncology specialist and for biopsy lab tests, so our model says that we should drop you right now before your lab results come back. We hope you don't have cancer, so you can prove it before coming back to us as a customer, but otherwise, good luck with your treatment bills....
Health insurance is like driver insurance, not car insurance.
Health costs are borne by the community in A&E if people don't pay for it themselves. That's why a mandate is fair from a social contract perspective. Some people might prefer a state that leaves poor people to die on the side of the road after an accident, but not the majority.
(FWIW, in the UK, driver insurance is attached to the car (or possibly multiple cars) and is described as car insurance colloquially. Car insurance may or may not include property insurance, at two levels: damage you're not responsible for (fire and theft), or damage that you are (an accident you caused).)
I completely agree, but I don't think it's a winnable fight. I think it's so big and so entangled with everything that the only thing that could ever pry it loose is some kind of fundamentally transformative event that results in the complete dissolution of our entire economy and/or nation.
Trying to make any progress through typical political avenues is hopeless. You're casting your vote into an ocean of voters that don't even see health insurance as a financial product, they see it as healthcare itself.
I think this is something where individual US states need to blaze a trail. California passed a (light-on-details) single-payer healthcare bill through the state Senate, though unfortunately the matter has been tabled for now by the Assembly, and funding it would require creative use of Medicare dollars that a) would require federal approval, and b) may not even exist much longer if the GOP gets its way.
I agree that major health care reform at a US national level is pretty unlikely at this point, even if Democrats manage to gain a supermajority in both houses of Congress and win back the presidency. I'm not even sure trying out something novel at a national level is a good idea, since it carries a lot of risk. I think doing something new at the state level, if they can get around federal interference, has a decent chance of getting somewhere.
Eliminating, no, but definitely slashing funding. The proposal in CA would have required federal Medicare funding to make it viable, and less of that would probably kill it.
The thing that pisses me off is that the GOP wants to slash funding for a ton of public services, but not materially lower taxes for people. So if states want to bring back those public services, they need to raise taxes, which overall causes a person's tax rate to be higher.
I'd be fine with the federal gov't even entirely killing Medicare if that would cause my effective federal tax rate to drop by several percentage points, points that I'd be happy to turn around and give to CA for them to implement something like single-payer.
(The downside, of course, is that residents of less progressive states get screwed, which is why I'd rather the federal gov't leave things alone, but give states like CA more latitude in how they use those dollars.)
No, as usual the GOP doesn't remove anything, they just make it as difficult as possible for anything to receive the funding it needs, and then go on TV and moan about how nothing the Government runs works properly.
Insurance does not replace value, insurance is fundamentally and always a value transfer vehicle. Although in some implementations insurance can act as a value replacement mechanism this is the result of the implementation and not a fundamental property of insurance. You seem to base your understanding of insurance on some common implementations that do replace value but these are not the rule for all insurance.
I've always had this same objection. I prefer to think of it as a "health plan" rather than "insurance". You can't "insure" someone's health (well, ok, you can, but it's a case of "I don't think this word means what you think it means"). You can merely create a structure where people pool their money on a large enough scale such that it's affordable to fix a person when they break in most (if not all) of the myriad ways they can break.
That's similar to insurance in some ways, but isn't in one crucial way: you generally don't know the "repair" cost up-front; the repair is done, and then you get the bill. If you insure your car against damage up to $50k, you get an estimate when it gets damaged, and ask the insurance company for approval for that amount before the work is done. If the insurance company disagrees on cost, you can find another auto shop that agrees with the insurance company's cost, choose to bear the difference in cost yourself, or decide to forego the repair entirely. You can't do any of that when it comes to healthcare.
> The cost to repair you in our current system could also be infinite, given the numerous and terrible things that can happen to a person with literally no fault of their own. By the same token, the odds of you needing that payout are also damn near incalculable; every place you go, every activity you engage in from skydiving to eating turtle soup in Mexico all have a probability of killing you.
This isn't entirely true though, or, rather, it doesn't matter. Health "insurance" companies have a ton of data that allows them to predict pretty well how much it will cost to fix people when they break, in the ways that they usually break. They collect premiums based on that data and are doing a pretty decent job of not going bankrupt while actually fixing people, even outliers who fall outside of the "usually break" range. (Yes, I know, that's certainly debatable; they're dicks and deny coverage for things they should absolutely cover, and that helps with their bottom line; in principle, however they can afford to cover everything that medical science can perform and still stay afloat.)
> Then hospitals must be instructed to destroy their chargemasters and go back to charging for services at reasonable rates. After that, everything else should more or less be solved.
The problem here is that "reasonable" means different things to different people, and for some procedures, even if the price were dropped down to "at cost" (if that's even a calculable thing), you'd still have people who couldn't afford it. Health care itself isn't free. It costs money to develop medicines. It costs money to train doctors. Those doctors, once trained, need to make a living. It costs money to run hospitals and private practices. Someone needs to bear this cost.
So you still have the same problem of inherently deciding that the life of a rich person is worth more than the life of a poor person; in some cases the rich person can afford to get healed, while the poor person can't and dies (or lives, but goes into crippling debt or bankruptcy to do so). I agree that healthcare costs in the US are out of control, but even if you fix that problem, you still need some system in place to ensure everyone gets the care they need, regardless of their financial situation. (That is, of course, if you believe health care should be a basic right. If you don't, then we're not going to have a productive discussion.)
I think the concept of a pooled health plan is fine; just payments into it need to be dependent on means, and payments of $0 don't disqualify you from coverage. The person who can't afford to pay into it gets the same treatment that everyone else gets. I don't care how we achieve that, whether it's government-single-payer, or something similar to what we have now, just with price controls and government subsidies/credits for those who are unable to pay.
Absolutely agree that the current corrupt health "insurance" industry needs to go, though.
It adds one crucial feature every healthy, functioning market needs: honest feedback.
Right now nobody, and I mean literally nobody, makes rational economic decisions for medicine in the US.
Neither the hospital, doctor, administrator, insurance company, or patient really has any real idea 1) the cost of the health care being provided 2) the amounts being charged or 3) the dollar amount of benefit gained by the patient. The actors above who do have some pieces of the data largely aren't the ones making the decisions.
If you abolish insurance and state prices up front, at least you force hospitals to charge something closer to the true cost for services, and you force patients to evaluate whether they would rather have care or dollars in their pockets. Over time, they would figure out what's good value for their health and what isn't.
Of course one could argue that the government should be making all these decisions because it has access to more information, and that's probably true; but that's not what's happening in our Frankenstein ('s monster) of a system.
The root cause tho is that the consumer of the product (patient) is generally different from the payer (employer). Insurance isn’t the real problem. The invaluable argument could be applied to your house too.
Currently though, even if the patient is paying for insurance out of their own pocket, the real decisionmaker is generally still bureaucrats (in the literal sense) at the insurance company + hospital.
Speculation to follow: Health care as an industry is significantly more profitable than the proactive/preventative healh programs. Eliminating insurance removes a volatility dimension. Preventing problems (if possible) saves infinite suffering but costs someone profit.
Here in Germany the copayment for an ambulance is 10 €, everything else is covered by the health-insurance.
So the choice is easy: If it's urgent call an ambulance, if it's not urgent and/or there are other ways too get to the hospital quickly and easily use those instead.
“I'm insured. They sent me a bill for over $900. For taking a picture, and giving me tylenol and an ace bandage.”
What also happened: You received care at an ER. The time of professionals was used on you and not other patients at that time. You also received a diagnosis and verification that the injury was easily treatable and didnt require much else. What if they came to a different conclusion?
$900 is expensive but you are grossly mischaracterizinf the services you received.
> The system works if your net worth is somewhere above $5 million. For everyone else it's just the mechanism that sends everything you earned back to rich people right before you die.
Must be above my net worth! Sure I can afford to pay out of pocket for everyday medical expenses, but cancer or a heart attack would probably destroy my finances.
They sent me a bill for over $900. For taking a picture, and giving me tylenol and an ace bandage.
That is awful :(
Imagine someone making minimum wage. 900$ is huge for most people.
Honest question - outside of politics, is there anything a person on the road do to help make this situation better (other than not falling sick)? Any company/org working on solutions?
Generally speaking, most of the people "working on the problem" are actually working out ways to profit enough from the existing mess that it doesn't affect them personally.
If you intend to visit the US, you absolutely need to buy traveler's insurance, with medical coverage, before you enter. If you can't afford the premium, cancel your trip, and go spend money in a country with a better paradigm for emergency medicine.
If you have something life threatening and you know it in advance, please have a look at Indian healthcare system. It will not be that costly and there are a few mind blowing hospitals who are really very damn good.
The point is sound though - x-ray is a very good example of a procedure that is absurdly expensive compared to its actual cost - and compared to any other country on earth.
I'm currently on holiday in New Zealand and had to take my infant daughter to the urgent care. The total cost was $21 USD (including the prescription).
Back in the US it's $330 for a 15 minute appointment with her GP.
There is no way it costs $1,300/hour to run a GP clinic. Between my employer and I, the cost of family insurance is > $20,000/year and we pay the first $6,000 in expenses. That's similar to the TOTAL income tax of a median household in New Zealand - how are they providing all of the functions of government plus universal health care for the cost of just health insurance?!?
It really makes me wonder about the ROI on taxes in America.
These are sticker prices, used for anchoring expectations during negotiations with insurance companies. i.e. if your initial offer to the insurance company was $330, you'd get an actual rate of $25; whereas if your initial offer to the insurance company was $25, you'd get $20.
The problem is that if you don't have insurance, you are charged these total fantasy prices - which is part of why being uninsured in the US is about so much more than just being on the hook for catastrophic costs.
The insurance policy for you and your family costs $20,000PA? I don't know about you, but to me that is madness. My private health cover with Bupa costs me less than $1200PA.
Healthcare in the US is so bogged down by regulation, standards, certification, etc, that there's really no room for competition. You have to buy the X-ray machine that's 40x overpriced. You have to use the software that's 200x overpriced. You have to hire the guy with 8 years of schooling.
American healthcare could be a lot better if we just allowed more breathing room for competition
If you don't get bogged down in details of the service, I see this as generally net good. For many, ambulance rides are prohibitively expensive, and while I certainly wouldn't be cost-conscious taking an ambulance in the event of a seizure or heart attack, for something like a broken arm, or non-life-threatening ailment, an Uber/Lyft/Cab is a good alternative to trying to drive myself.
Beyond that, I'd like to see statistics on whether people ride-sharing to emergency rooms / urgent care facilities was freeing up ambulances or causing them to sit idle. I suspect it's the former, which would mean ambulances could be more available for more people with more serious conditions, but I could be wrong.
Six years ago I had something similar to a stoke. I had a relative drive me from work to the ER in outer suburbs because:
a) I would literally rather die than pay for an ambulance. I put my money where my mouth was on that.
b) I knew from previous experience their ER was far cheaper, cleaner and quicker than the one in the cities.
Maybe I am just particularly frugal but I had the presence of mind to consider costs while I could not feel one side of my face.
Another time, I needed surgery and called around to get quotes. The place I ended up was something like a quarter the place my doctor wanted to send me.
I am glad you are safe. I obviously have no clue into your actual diagnosis, but just some thoughts.
This works if and only if you are in control of the situation. That being said, have you considered if when the worst case happened to you, the kind of stress your relative could experience afterward? Perhaps guilts? What about if you are permanently disabled? You probably won’t be able to keep your current job, and then have to re-adjust to a different life style and re-learning whatever physical skills you have lost. Meanwhile, others would have to take up responsibilities for you, and more money draining down the road. Next thing you know, you regret your decision.
I do share you views in general - I would prefer going to a hospital I know that can provide better service per dollar value, but when it is life threatening situation, I won’t choose money over my life. If it was a minor stroke that probably okay, but still, so much uncertainty. Yes, if ambulance is late, you probably should consider going there on your own (keep 911 operator on the phone - never hang up until an officer has arrived). I am too really frustrated with my ambulance bill, and I wish someone can help me understand why the heck an aumblance can cost $1000.
I am sure you know the risks, but I do want to give my two cents.
If I'm having a stroke, I'm not going to care about anything except getting to the nearest emergency room as fast as possible. Minutes matter in a stroke. The faster you can get basic drugs and a CT scan, the better your chances for preventing serious damage.
I'm still in my 30s and young. Maybe when my body is older and falling apart I'd have a different opinion, but your statement feels really ludicrous and dangerous advice to me.
> I would literally rather die than pay for an ambulance.
I wish more people realized this was an option. You can't even imagine how common it is to see the claim "medical care is a special market, because if someone is dying, they will pay ANY AMOUNT for care no matter how high".
Sure, if that person is dying and rates their own health infinitely higher than the welfare of their family, maybe. That's not many people.
Incidentally, the same stupid argument also proves that scamming a life insurance policy by committing suicide is impossible. Life insurance companies, in general, do not agree.
> Sure, if that person is dying and rates their own health infinitely higher than the welfare of their family, maybe. That's not many people.
I don't think that's true. I think that's actually the vast majority of people. Nearly all of them, even. The human survival instinct overrides so much of a human's rational thought processes or even their higher-order emotional processes. You may be one of the rare few for which that's not the case, but, well... you're of a vanishingly rare breed.
And it's not even exactly that. When you're in a life-threatening situation, it's likely that you're either a) unconscious, or b) completely unable to have even a remote grasp of what the cost will be to "fix" you. As in, not even a ballpark figure. Given the potential urgency, you may not have the time to get a second opinion or shop around for a cheaper fix. Just the cost of stabilizing you to the point where you can sit back and make an informed decision could bankrupt you.
Also, just a side note on:
> ... the welfare of their family
There's also a cost to their welfare if you die, too. It's hard to put a number on that while you're healthy, let alone in the midst of an emergency or life-threatening illness.
well people deciding between an ambulance or an uber aren't really qualified to make that decision so it wouldn't surprise me if a bunch of people who needs an ALS unit decide to take an uber.
> Beyond that, I'd like to see statistics on whether people ride-sharing to emergency rooms / urgent care facilities was freeing up ambulances or causing them to sit idle. I suspect it's the former, which would mean ambulances could be more available for more people with more serious conditions, but I could be wrong.
I'd also like to see whether ride-sharing increases the number of people who attend ED.
"I can't justify getting an ambo, so I won't attend" vs "I'm not wasting an ambo, so it's okay if I attend".
Coming from a country where ambulance usage is free for citizens, it would be interesting to see the stats in Uber cities. The only reason not to call an ambulance here is if you feel it would be unethical (e.g. if you broke your arm and your partner could drive you).
EDIT: That is, I imagine you might be able to see whether Uber provides a better alternative than the local cabs. This still holds in US cities though, why is Uber specifically good? Why don't people consider calling their local cab company, which will still be much cheaper than a $250 ride.
In most places in the US, the local cab companies are terrible. They might answer the phone, they might show up, and they might try to scam you.
Imagine you call a taxicab for a medical emergency, and they never show up, or only after an hour.
Uber and Lyft are extremely popular because the apps always tell you if a driver will come, the drivers almost always arrive very quickly, and the price is set in advance.
I'd bet that most people younger than 25 years have never used a traditional taxi, and they never will. They don't even see them as an option.
Not to mention that there are consequences if an Uber/Lyft driver blows off a confirmed ride, and even if they do, you can request another one immediately.
In the case of taxi dispatch, a car may never show up, and you won't know until you get tired of waiting, and there are no consequences for the taxi company or driver if they do this. Pre-Uber, in SF, the normal quoted wait from a taxi dispatcher was on the order of 20 minutes, which if anything was usually understated. If you're in a lot of pain you probably don't want to wait that long.
I would probably still call an ambulance for something I thought might be life-threatening, but for anything else I'd take a Lyft.
> In the case of taxi dispatch, a car may never show up, and you won't know until you get tired of waiting, and there are no consequences for the taxi company or driver if they do this.
depends on the country and the taxi company. England has a reasonably effective regulatory regime for taxis and cabs.
Sure, but both the article and my comment are both about the US, where there are no consequences for no-shows. I'm not sure our government(s) here are the best places to regulate that sort of thing. Uber/Lyft-style accountability seems to be working really well, though, and the mode of operation eliminates the possibility that a driver will cancel on you and you won't know about it.
I also come from a country where ambulance usage is free but I can tell you from experience that getting one of these ambulances isn't as simple as one might think.
I imagine, maybe, there are keywords or phrases that result in instant dispatch but the default behaviour seems to be to frustrate you as much as possible to the point where you just hang up and drive yourself to the nearest hospital accident and emergency department.
This is, I suppose, a result of the service being costed and allocated to different departments who are all under pressure to manage their own budgets?
Accident and emergency departments obviously get the brunt of all this because they don't have anyone to pass the buck to.
So, yeah, maybe utilising a service such as Uber is actually going to be a way around this problem?
Free ambulances are always going to come with the problem of abuse, followed by a reluctance to send an ambulance.
Resulting in news stories of how some people call of help and don't get any. But these stories are rare, it's seem better than letting poor people die.
This said, we probably should add a tiny ambulance fee ($50), and apply a fine for inappropriate use.
'This said, we probably should add a tiny ambulance fee ($50), and apply a fine for inappropriate use.'
I agree although reclaiming this fee from those who abuse the system is likely to prove difficult?
I can remember a time in the UK when ambulance and, IIRC, fire service would bill you after the event for attendance.
Not sure if this was every case or just where they deemed it appropriate? But, I do remember, it was common knowledge there was no penalty or follow-up if you didn't pay.
> I agree although reclaiming this fee from those who abuse the system is likely to prove difficult?
You assume everybody that abuses free services are broke. We need data to tell whether that's the case. I would assume that a significant portion of the abusers mostly just lack manners.
Anyways, the point isn't to kick the ones who are down (poor). It's only to limit abuse... But first maybe it should be assessed of abuse is a problem.
And maybe, having a deal with taxi company is a better solution...
Also UK, and the problem is basically that there aren't enough ambulances, so they're triaged. It's the same as when you go to A&E and you have to wait hours if they don't think you're an urgent case. Unless you're going to die if they don't get you to the hospital now, they'll put you down the queue (which is fair enough).
As you point out above, the decision to dispatch an ambulance is ultimately the emergency operator's. Typically you tell them what's wrong, and they send out what they think is necessary (which might also be police and fire).
Strange, my family has had need of 3 ambulances in the past 3 years. Never had any issues, other than them taking around 30 mins to arrive, and 2 of the 3 were on Saturday nights.
> The only reason not to call an ambulance here is if you feel it would be unethical
I dunno, maybe you just want to avoid the psychological feeling of urgency and gravity that comes with an ambulance. I think there's something to be said for staying calm and keeping self-control and dignity when facing an emergency situation.
If you're bleeding profusely or are in-and-out of consciousness or have a deadly virus, obviously that's different. But what about a broken bone? Or a laceration or burn for which you've already successfully applied first aid?
Might you not prefer to stay out of an ambulance in those situations, even if it's free?
There’s also the question of control. No matter how badly injured, if I’m driving myself or taking a cab, I am still “the boss.” But as soon as EMTs and doctors become involved, that control is lost.
In an increasingly authoritarian country/world, where we are expected to give up all rights upon first interaction with persons in a position of power or authority, be it the policeman that graduated yesterday but has the full might of “the boys in blue,” the TSA agent at the check in line, the EMT responding to the call, or the nurse checking you in, it is easy to understand why some people have an aversion to willfully surrendering themselves and their free will so long as an alternative is present.
I prefer to not cede what little control I have until I have to. If I want the driver to take the highway and not the local roads, it’s my call. If I want to text while I’m being driven through traffic, it’s my call. If I change my mind and want to go back home to die, well, it’s my call.
I've done nursing work, and my brother is an EMT in paramedic training. From the discussions we've had, you can always leave nursing/hospital care if physically able to express that desire and mentally stable, and the only EMT care you can't decline is if you tell them you're going to kill yourself or are physically unable to decline.
>Might you not prefer to stay out of an ambulance in those situations, even if it's free?
Ambulance ride here in Finland has a symbolic fee (10 eur if it's deemed necessary), but still, for a non life threatening issue it feels much more sensible to get a taxi. Since the situation is not life threatening you'd be put in a pretty low priority for the ambulance and have to wait for an hour or so. Taking a taxi is even incentivized - taxi to the hospital is going to cost the same 10 euros even if it's from further away, but even without that system I'd probably still use a taxi for broken bones etc.
I’d be more interested to see the reduction in medicab or medivan usage.
My father had the misfortune of having a stroke, and transporting him via van is outrageous — you’re talking >$250 for a 15 mile drive, in what amounts to a cargo van with zero service beyond driving.
It’s one of those weird markets where the pricing is driven by the Medicaid reimbursement, which is a price floor.
Same situation for me, and I've seen the same with regards to price.
That said, I also suspect the med transport niche is heavily regulated (a la taxi service). Special training for drivers, insurance, etc. I don't think that covers the full $250; just saying they're not identical to a Uber.
Right. If the Uber driver fails to get you to the hospital in time to save your life for any reason, they have no liability or consequences whatsoever, because they're not intended to be a life-saving or emergency service.
If the ambulance driver screws up in some way, they're in for a world of trouble and legal liability.
Here in the UK, there has been a major campaign to try and reduce the usage of ambulances and emergency departments. Many of our ambulances literally have "this is not a taxi" written on them.
Because it's free to use, a lot of people call ambulances when they really don't need them. Women in the early stages of an uncomplicated labour. Young people with minor injuries. Elderly people who want a repeat prescription. Discouraging these people from abusing the service without putting off people who are genuinely in need of an ambulance is a complex and delicate task.
The US healthcare system is clearly an unmitigated disaster, but our single-payer utopia has a different set of problems.
Your example is the result of years of government failure to provide adequate funding and support to the health system, not some kind of fantastical moocher, using ambulances for no reason.
Not sure why you got downvoted, what you say is true.
People sat similar things as GP about A&E - "the problem is all the people who use it who shouldn't". No. Those people are easily triaged and sent away. The problems with A&E are all the people who need a hospital bed who spend hours on a trolley in a corridor.
> Women in the early stages of an uncomplicated labour.
That's taking a bit of a shortcut there. You don't know if a labor is uncomplicated until it is done and it can go from 'uncomplicated' to 'life threatening' in the space of a heartbeat.
London Ambulance Service policy states that ambulances should not to be dispatched to women in the early stages of labour unless there are known risk factors. It's a massive waste of resources to send two trained personnel and a fully equipped ambulance to act as a taxi, just in case something goes wrong en route.
I've been wondering about this for a while but, is there a reason why Uber or an alternative cannot/should not get into the Ambulance space, if it were able to get qualified staff.
I feel like Ambulances/Hospitals charge way too much and using the app/tech at a basic level to connect the ambulances with patients addresses may be a good start for everyone and also the increase in supply may reduce costs.
When people criticize 'Silicon-Valley-Types' for only being able to think of technical solutions to social problems, it's exactly this kind of thing they have in mind.
Just read this thread - the way medical care is paid for in the US is batshit-insane, injured people not wanting to call an ambulance incase they lose their house - and reads like a history book about european medieval history. The solution is not more apps, it's a proper healthcare system like almost every other developed country.
We fix the largest problems that we are permitted to touch.
We cannot propose a solution to the ultimate cause, because that would require the representative democracy to elect more scientists, technicians, engineers, and mathematicians to the legislature in lieu of the usual professional politicians, lawyers, corporations managers, and educators.
So we work on what we can reach.
We cannot create a proper healthcare system from the top down, but we can issue bugfix patches and hope they get adopted upstream. That keeps the system limping along, but never getting quite bad enough for anyone to demand the complete overhaul that it needs.
It only looks crazy because the biggest problem any motivated individual can solve is limited either by the amount of investment capital they can attract with their solution, or by the amount of campaign funding they can attract with their solution. So any proposals that threaten profit margins cannot be considered.
An alternative ambulance service wouldn't be just an 'app', but an actual entrerprise with various logistical, legal and medical operations and probably hundreds of employees.
The US would be a better place with that hypothetical startup.
If Obama couldn't successfully reform healthcare long-term (as Trump will repeal it sooner or later), what can regular people do?
Not really. There are plenty of private ambulance services in the US. They generally deal with things like transporting a medically frail person to see a doctor in a different city, things like that. Non emergency, mostly.
I didn't realize there were public ambulance services in the US. When I was hit by a car I was definitely taken to hospital by a private ambulance as an emergency patient.
There are a lot of private ambulance services in the US, they're anything but unregulated though as you'd expect with anything in the US medical field (one of the most regulated industries on earth).
There's no theoretical reason why Uber couldn't get into the driving side of the business, with human drivers. Their future is in autonomous however, which will never be the ambulance business (it will never be autonomous, ambulance drivers frequently have to break standard driving laws in emergencies, drive at high speeds, drive around vehicles, etc).
> It will never be autonomous, ambulance drivers frequently have to break standard driving laws in emergencies, drive at high speeds, drive around vehicles, etc).
And because they have to perform emergency medical treatment, right?!
Are we talking about different things - a mini hospital on wheels staffed by highly trained paramedics, and glorified taxis for the elderly/non-critical?
Some ambulances are just glorified taxis, others are staffed with EMTs who can do more.
If it weren't for the need to drive in a "non-standard" manner, you could likely save on costs by having an autonomous vehicle staffed by an EMT. The EMT can't also drive the vehicle, after all.
> Their future is in autonomous however, which will never be the ambulance business (it will never be autonomous, ambulance drivers frequently have to break standard driving laws in emergencies, drive at high speeds, drive around vehicles, etc).
None of these are reasons for ambulances to not be autonomous. If you accept that most other vehicles will be fully autonomous, ambulances do not require anything further extraordinary to also be autonomous. The vehicles on the road would likely be networked, at least within a nexus of proximity, and move out of the way of the ambulance so it could speed past them.
NB: I’m not saying ambulances will be autonomous. I’m just saying that if everything else is, the ambulances have no significant (technical) obstacle for also being autonomous either. A significant theoretical advantage of fully autonomous vehicles is not simply that the modal vehicle is safer than a human, but that a networked and autonomous fleet is hyper-efficient and hyper-aware as a hive mind.
It is very problematic, e.g. how would you develop such a system? No city is going to allow you to break traffic laws to train an autonomous ambulance. At best you could make one for rural areas. I think the problem is probably AI-complete and would require human-like abilities of abstraction to train.
Once autonomous cars become common enough, and we have a common protocol for communicating between them, I'm pretty sure the cities will be ok with it. The autonomous cars could be instructed to move out of the way for an ambulance to come through and/or stop at intersections, which would actually make things much safer for the ambulance.
Shoot, it'd be safer even if the ambulances weren't autonomous - because the cars would be reacting in a predictable manner.
Once automation gets good enough it'll probably be better at it then human drivers (imagine weaving through traffic, that sort of thing. It would also be able to do things like reroute in real time to avoid congestion.
You'll still need warm bodies in the back for life support, but I see no reason that the human in the front seat can't be replaced by sufficiently advanced technology.
Hell, in this ideal future where most or all of the rest of traffic is also autonomous, you don't even need to avoid congestion -- you just "phone ahead" along the route to tell any cars in the way to, well, get out of the way. As long as you don't have standstill traffic (which might actually be something you can eliminate as a general rule with a fully-autonomous, networked fleet), you're fine.
I think the bigger market would be Uber meets "full assisted transportation."
ATM if my father (who had a stroke in early Oct) has to go to the doc there aren't many options - that I've been made aware of - other than me. My mother can't help him enough (without endangering both of them), and anything more traditional would just pull up and wait at the curb.
Long to short, the country - and 1st World - is getting old. It's a big market. The issue is how well technology is a fit, at least for the next couple generations.
p.s. I should know this but does Uber or Lyft deliver groceries? For less than the market?
Healthcare in the US sounds nightmarish. I'm a UK citizen and broke my leg badly in France; ambulance etc. Whole thing was <75 GBP. That was for the cost of crutches and medicine in France, X-ray+ER visit was free. Then after I got my train back to the UK I had complex reconstructive surgery for free on the NHS.
A relevant personal anecdote - I hit my head earlier this year and gave myself a concussion, but did not realize it at the time. The next day, I began experiencing severe headaches, sensitivity to noise, sensitivity to light, etc. and decided to go to a hospital. I called an Uber.
I'm not sure what I would have done without Uber. I guess I could call a cab, but I don't know that I would have wanted my ride to the hospital to be 30 minutes late, to refuse to turn the music down, and to tell me the credit card reader is broken when I get to my destination and then insist on taking me to an ATM. So I might well have called an ambulance.
> my ride to the hospital to be 30 minutes late, to refuse to turn the music down, and to tell me the credit card reader is broken
As much as I'd like to stick it to taxis because of their decades of price gouging due to being granted a monopoly, I have not had many bad experiences riding a taxi. If I had to put a number on it, I'd say that less than 5% of my taxi rides were in any way unpleasant other than for the cost. What city or country are you in if I might ask? Are taxi experiences really that bad for most people?
This really depends on where you live. Harassing and other similar situations are very common in Taxis where I live, while Uber drivers seem to be well-behaved.
None of my female friends dare get into a Taxi due to, well, harassment, (some have stories of groping, attempted rapes, etc.). Generally, they'd only take a taxi in groups, or walk.
Uber seems to be working well in that regard (at least for now).
In my country, Uber service is far better than taxis by a mile... many taxi drivers are poorly-paid employees which don't care much, and they're basically immune to any kind of incentive or threat.
On the other hand, Uber drivers with a bad score are usually suspended or banned from the app, keeping out the bad apples, and they're usually the car owners themselves, thus having an incentive to drive better and take more rides.
I believe than something similar to Uber scores for taxis with similar effects (removing bad drivers from the service) would create a huge improvement.
Another unfortunate side effect is that there's some segmentation - poorer and older people still take taxis, while more affluent people take Ubers.
In Binghamton NY, they all tell you the credit card readers are broken at all times of day and insist on driving you to an ATM so they can get paid in cash. In Washington DC, if they think you're drunk, they overcharge you / don't start the meter and the dispatchers always tell you 15 minutes, but then the cabbies just grab other people and you end up needing to call the dispatcher repeatedly to actually get a cab and it usually takes closer to 45 minutes or an hour. And in Ithaca NY, they tell you the credit card reader doesn't work until you say you don't have any cash, and then it's suddenly working.
NYC cabs are waaaay better now that ridesharing is dominating. They used to almost universally keep their doors locked and quiz you on the destination, then drive away if it was Brooklyn or somewhere they did not feel like going. They are actually happy to get a fare now, so they do not treat the customer like crap anymore.
Taxis in cities with decent taxi systems, in a neighborhood with decent taxi coverage, hailed by waving your hand on the side of the road are fine, and getting better by way of competition. I have no qualms with taxis in, ie NYC or DC. Taxi dispatchers, though? Especially in smaller cities? I lost count of the number of times I had a cab no-show when I lived in Pittsburgh.
In SF, pre-Uber, taxi dispatchers would universally quote "20 minutes" for expected arrival, when the reality was usually 40 minutes to never (where "never" was equally likely as a finite number). I called to complain about this (and other things) so often that one of the cab companies blacklisted me and stopped answering my calls.
Right, but 5% is quite terrible when you're sitting around wondering if the car will ever show up, and if they quoted 20 mins, should you call again after 15 or 20 or 25 or 60?
Well yeah. I had a kidney stone earlier this year. Pain so bad I couldn't move or think. Went to the hospital in an ambulance and ended up paying nearly $3k for the ride. First round they thought it was muscle spasms, so when I inevitably had to go back again I got an uber. The only reason I wouldn't take that option again is if I was bleeding / puking / doing something that would make a mess in the car.
Various insurance companies had contracts with the taxi company I drove for. Part of our usual fares were taking people to and from emergency rooms. If a person with Medicaid had a problem they'd call their insurance company, whose representative decided whether to send an ambulance or a taxi.
The hospitals also had contracts to send their patients home. One pre-obamacare passenger comes to mind: she didn't have a problem that wasn't related to being poor/homeless/childhood abuse, but the E.R. couldn't address her actual problems, and gave her a prescription for "something". She waved the prescription and said, "I can't afford these pills..." The hospital sent her to her sister's apartment. I called twice to check up. She was doing okay the first time. The second time the passenger's sister said she was at the State's psychiatric hospital.
A non-insurance passenger with a non-life-threatening injury asked to go to an emergency room. I suggested going to the full-service emergency room at the heart hospital. They got in & out in a fraction of the time that people usually spent at the big hospitals.
I knew of that emergency room because the Fire Department had a contract with the taxi company too. They sent people who didn't need an ambulance via taxi to the nearest emergency room. That guy was homeless, iirc.
I'm currently a student in the Bay Area. One of the first thing that my seniors told me here was if you are ever injured or in an accident do not call 911 unless its life threatening as the ambulance bill can bankrupt you. We do have insurance but the system is too complicated and the consequences are the too scary if we don't get reimbursed.
Are you from the Bay Area? Is there anything in particular that would cause it to be extra expensive?
During undergrad in the Midwest, I heard a freshman who was way too drunk fall off his lofted bed around 4 in the morning during the last couple days of the year. I heard his roommates discussing whether or not to call the ambulance because last time this guy got super wasted and hit his head drunk, the ambulance ride was a couple thousand dollars.
It was so messed up to hear them talking. He could have a brain bleed going on and they were discussing how handle the situation. Ultimately they did call 911 and he was fine the next morning.
I'm happy that in Lithuania (northern Europe) you can call ambulance even if you have fever and it's free (paid by you with taxes). Of course it's not perfect, medical personal don't earn much, and yes, it could take longer than Uber (except might be rush hours when ambulances can skip the congestions).
I've personally found this to work great, the only exception being the moment of surprise and confusion when I asked the driver to pull around to the emergency entrance.
Yeah, most people don't tell the stories about how they go to luxuriously built hospitals that make most corporate offices and hotels seem cheap by comparison, with parking lots full of BMW's, Mercedes, and other 6-figure foreign cars, and are treated by teams of highly paid people using millions of dollars of the best equipment in the world ...
"As long as you have money the US is great" even if you have money you will still have to go to the local hospital for emergency and will have to wait for specialist appointment some stupid amount of time unless you actively spend time and money donating to the hospital some serious $ so you have direct numbers of people in charge etc.
It depends on where you live. The US tends to be highly segregated by income/wealth. In the high income places they have ERs advertising to get more business because they are underutilized.
"Best equipment in the world"? This is capitalism. They're going to use the cheapest "good enough" equipment they can get away with. And considering the domain experience a patient would need to tell a new MRI from an eight year old one... I'm sure they get away with lots.
I guarantee the hospital administration isn't going to pay the upcharges for the fanciest new MRI if they can spend it on themselves.
Health Care is not capitalistic or free market in the least and cutting costs is not how profits are maximized.
Doctors, Hospitals, Insurance companies and everyone else are working with what are essentially cost-plus contracts, so the more expensive everything is the more they make.
I imagine most of the cases involving people opting for an Uber instead of an ambulance aren't in obvious risk of dying if they don't make it to the hospital in time. The first things that come to mind are broken bones, lacerations, and severed digits. Then again, there are plenty of things that can be fatal without being readily apparent, especially if the only person making that judgment call is the patient.
> Researchers often cite costly transportation as a significant barrier to receiving quality healthcare. A study by Samina T. Syed and Lisa K. Sharp, doctors at the Kalamazoo College, suggests that cost-efficient access to a vehicle is consistently associated with increased access to health care.
Uber is using venture capital to subsidize rides. Drivers are often providing the services by going underpaid and putting up their own capital without getting the appropriate rent.
This is not a sustainable model. If there is a real need that is currently not met it has to be provided through other means in the long run.
Never ever have I thought this would be a side effect of not having any proper health care. I've never had to take an ambulance, but it's a second nature where I live in Europe to just call the equivalent of 911 and they'll send out the best unit depending on the injury. It can be a plain ambulance or a faster car with doctors that definitely is very expensive if you weren't covered.
Had a bad bicycle accident about five years ago. No taxi would stop for me as it probably looked like I'd been in a drunken brawl. Uber or Lyft would have been nice, as I could have probably texted the driver not to be alarmed but that I needed a lift to the ER (at that point I still had not gotten a smartphone). I ended up walking 2.5 miles to the nearest hospital.
Drivers don't have issues with an uninvited dog passenger? As a dog owner, I find this surprising. But if drivers are OK with it it would be a great option for me because I don't own a car.
It depends on the city, culturally, and it's a good idea to call and ask first.
Obviously if it's a service dog they're required to transport it, but from knowing people with service dogs, it's still worth calling because some drivers are allergic and would rather you call another
Most drivers are okay if it seems like you have your pet neat. I take my cats in carriers all the time, but would never take my parents super sheddy dog.
We can view this as either a positive for how Uber works or a negative for how taxi cabs work. If the pervasive means of transportation other than ambulances are unresponsive or expensive compared to ambulances, then obviously ambulances are the choice. One might also drive oneself, get a ride from a friend or family member, or hope that a city bus will be fast enough. An Uber ride could be faster than a ride from friend or family and safer than driving oneself.
I took a taxi to an urgent care clinic when I broke my ankle in a bike accident. Would've taken an Uber or Lyft if taxis hadn't been around, but there were a lot of them. Whatever was fastest. I really wasn't worried about saving a few bucks on a ride at that point.
Good, former EMT and Paramedic for busy metropolitan city here. Your exorbitant costs are subsidizing the homeless, system abusers, and illegals who can't be billed. 90% of the calls we were dispatched to were not acute emergencies. And 90% of those calls were people of the lower socioeconomic demographic systematically abusing medicaid.
> Many potential emergency room patients are too sick to drive themselves to a hospital. But an ambulance can cost hundreds or thousands of dollars without insurance. This is where a popular ride-sharing app can step in, while also freeing up the ambulances for those who need them most.
Cities with Taxis have lower rates of ambulance usage too.
In fact, any kind of public transportation will result in lower ambulance usage. Because when there are alternatives some %age of ambulance rides will be replaced by some %age of public transportation rides.
Would be nice to have a service like Uber where you have a virtual doctor's visit by phone in the car on the way to the pharmacy or to the hospital if it turns out to be more serious.
What are you going to do if it turns more serious during the ride? The Uber driver (probably) has no medical training and certainly has no advanced medical equipment, the best he can do is pull over and hope that a real ambulance can meet you at his car before you die.
If you have a condition that is so serious that you feel you have to keep in contact with a doctor while you're transported to the hospital in case it gets worse, call an ambulance since they can actually treat you in-route.
If Uber says 5 minutes, it might be 7, or even possibly 15 if things go very, very wrong. Heck, if it's gonna be 15 you know this ahead of time because you can see the driver making wrong turns.
If you call a taxi service, and they say "15 minutes," it could be 30, 45, or 60. Maybe they're mussing with the truth, maybe they're outright lying. You don't know, and without the map showing the driver, you have no way of knowing.
A lot of modern taxi services have apps (often written by just a few big shops and contracted/branded out, but still). So you can start to get some of the same assurances from Taxis that you could get from Uber.
Also even before Uber/apps, I never had a problem with calling a Taxi and it not showing up within a few min, and I've lived a lot of places.
The first time was in 2012 because Microsoft was paying for it. It was from downtown Bellevue (so not an obscure place). I called them, they estimated 15 minutes, and it took them 40 minutes to show up. I'd never called a taxi before so I didn't realize this was normal; I called them back a few times to ask what was wrong, and they just said "soon!"
The second time was in 2015 in a country that didn't have Uber. They had an app. The app didn't work. They also didn't answer the phone. I tried multiple times, including an hour later after eating lunch. I gave up and spent 50 minutes walking home in ridiculous heat.
The third time was in 2016 because it was in a small town in the US that didn't have Uber. They did have an app. Their "app" displayed a phone number and told me to call it. That was the entire app. I called it, they estimated 30 minutes and showed up in 45 minutes, and they charged me $40 for a ten minute ride. Small town so I can understand the wait, but the price was definitely because they knew I had no other choice.
Meanwhile, I get annoyed when Ubers take longer than 5 minutes to show up because they take wrong turns.
I think it's definitely a matter of luck and location. Some places have horrible taxi services, some places have okay taxi services. Some places only have okay taxi services now because of competition from Uber. Ubers are still nearly always a huge margin better.
I guess you never tried to get a taxi in SF, then. Pre-Uber, attempting to hail one could leave you standing in the street for several tens of minutes, and calling a dispatcher would get you the universal estimate of 20 minutes, which in reality would be 40 minutes or more, assuming they actually showed up, which was a tossup.
Can't you pay directly for private insurance in the US?
I pay directly to the insurance company. It costs me about 145 usd/month and includes health insurance (with urgent care), long term care insurance, life insurance (about 500k usd) and some more.
I could have done it through my employer, but when I leave for another place I'll have to renegotiate the price with the insurance company, and also this option has less good of coverage IMO. It is cheaper by 70% tough.
The title of the NPR article would be more accurate as "Cities See a Reduction in Ambulance Usage After Uber is Introduced".
The paper looks at 700 different cities, each with a different Uber market entry time over a two year period. The researchers also control for some seasonality effects.
Perhaps more covariates could have been considered, but this seems like a pretty decent design to measure a before/after causal effect.
I'm curious, this article spins the whole "lower rates of ambulance usage" as a positive thing, but is there enough evidence to say that?
From the article:
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With demand for ambulances decreased by available Uber drivers, emergency personnel have been able reach critical patients faster while also applying necessary treatment on the way to the hospital, according to a new economic study from the University of Kansas:
"Given that even a reduction of a few minutes can drastically improve survival rates for serious conditions, this could be associated with a substantial welfare improvement."
The study investigated ambulance rates in 766 U.S. cities from 43 different states. Taking into account the timelines of when Uber entered each city, the researchers found that the app reduced per capita ambulance usage rates by around 7 percent.
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Okay they claim the study says "emergency personnel have been able reach critical patients faster" but decreased usage does not necessarily equal faster response time. It would have been much more solid if they actually looked at the ambulance response time, not just how many are being used. (My skeptical side leads me to think this is because that data-set didn't match their narrative.)
There is also the question of: Is this actually a good thing? Are those 7% less people using ambulances all not having serious health issues? Especially when something is wrong, you are often not a good judge of your own health.
How many people having chest pain thought it wasn't too bad so they called an Uber instead of an ambulance and died on the way to the hospital? Might not have turned out that way if they just called an ambulance in the first place..
Need more data to decide if this is an Uber propaganda piece.
I agree. 7% is a really low number, and people shouldn't be afraid to call an ambulance just to save money. That's fucked up. Especially with comments talking about strokes and heart attacks. In most western countries, this isn't even an issue.
I honestly question of the numbers are even statically significant, but even if they are, this is seriously fucked up and not something Americans should be proud of at all!
>Need more data to decide if this is an Uber propaganda piece.
Well, they could ask Uber for all the rides they made to the ER and see if - roughly - the numbers match with the claimed 7% reduction of ambulance calls.
I mean, a lot of people may have - coincidentally in the same period Uber came to the cities - become aware of the high cost of ambulance, or lost their insurance or whatever other reason and used taxis or some other means.
After all the study takes into account what happened over very roughly 3 years 2012-2015, how many people read (say):
If there was a "penetration rate" (which is not the same thing as "establishing the service") and a direct correlation with roughly the same number of UberX rides to the ER and of less ambulance calls then it would IMHO sound much more credible.
Here in the UK ambulances are paid for by the NHS, to which Uber steadfastly evades contributing to. Now that their drivers have been legally classified as employees, there’s a shed load of back NI they owe us.
It may be an overall improvement in efficiency, but it's not going to help patients long term. Whoever pays for the ambulances is going to eventually reduce their funding because they're being under used and revert them to the same state they were in before. If that wasn't the case, then they would have already been paying for more ambulances before Uber came along.
This is simplistic and probably wrong. Part of the reason ambulances are expensive is not because of the intrinsic /cost/ of the service but because the consumers have no choice but to choose the ambulance. They are, in effect, a monopoly and therefore can charge monopoly rents. And Uber (or whatever) is helping to break that monopoly.
(It doesn't have to be that way. Other countries have managed to keep ambulance services affordable.)
I called an Uber.
I don't have the time or expertise to do the months of legalese and calculus it would take me to understand my insurance policy, so I have no idea how much an ambulance ride would have cost me. $0? $400? $15000? None of those numbers would surprise me. As best I can tell, insurance companies throw a dart to decide whether you're covered or not, and then the healthcare provider makes up some insane number if you aren't.
The Uber got me to the hospital faster than an ambulance would have, for less than $10, and I knew it would cost less than $10.
The injury, though extremely gruesome and painful, only warranted an x-ray, some tylenol, and an ace bandage.
I'm insured. They sent me a bill for over $900. For taking a picture, and giving me tylenol and an ace bandage.
I view insurance as a tax my employers pay to the American healthcare system to be compliant. When I have my end-of-life event, whatever that is, I fully expect a choice between death, and living a little longer in bankruptcy. I'll probably get treated outside the US or choose death.
The system works if your net worth is somewhere above $5 million. For everyone else it's just the mechanism that sends everything you earned back to rich people right before you die.
Or maybe I'm wrong! I hope I'm wrong. The stack of papers is 4 inches high so I'll never know, but I sure hope so.