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
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.