[isostatic]

Wasn't a joke.

I went to the US on business - our corporate insurance means there's a $1000 excess that we pay up front.

Went to a hospital for a minor issue. At no point was there any price list shown, at the end I was asked for $390 before been given my prescription. That was the end of it I thought, sickeningly high charge for 2 minutes with a doctor, a 10p tablet, and hours of waiting around. I asked for an itemised bill, but they couldn't give me one.

A few weeks later I get another bill through the post for another $390 (slightly different amount), complete with the entire bill. The whole bill was about $2k. The 10p tablet? $250. In fact they originally gave me a 50mg one for $9, then took it off the bill, then gave me 2x25mg ones for $250. I then had a $1100 "uninsured discount" which brought the total price down to just before $800.

The bulk of the bill was a single line that was fairly incomprehensible but seemed to cover pointless taking my blood pressure 3 times and the 2 minute consultation with a Doctor who barely spoke to me, and renting the chair for a few hours I guess.

edit: see http://imgur.com/ERjjQBil.png

The U.S. is seriously broken.

[mercutio2]

In the US, patients should go to urgent care for minor health issues that are unlikely to require a fully outfitted trauma and surgical unit. Conveniently, they’re also much easier to get to in urban areas.

Urgent care would have had something closer to a $100 markup than $2,000, because you’re only paying for a few nurses and doctors to be on call, not for having used the resources that are meant for trauma and acute crises.

That hospitals are required make up fictitious itemized explanations for their very real costs is indeed broken, but it’s a very small part of the overall issue.

If you called the hospital billing department and offered 20% of the overall bill, they would likely have immediately accepted; uninsured hospital billing has expected value on the order of 10% of outstanding balances, so if you give them more than they can get from sending you to collections, they’re usually happy to compromise much more steeply than the 60% “discount” they offered you.

[amluto]

You mean how the Bay Area, which is fairly urban, has precious few urgent care clinics open until 10 pm and, I believe, literally none open after 10pm? I went to one of these urgent care clinics once and got charged $650 for about 5 minutes of doctor time and a single DermaBond stick. The latter costs something like $20.

Oh yeah, I asked how much I would be charged before the doc saw me and they refused to answer.

$100 markup my arse.

[uberduber]

In LA, Hispanic neighborhoods have 24 hour urgent cares but the doctor quality is all over the place though usually bad.

Urgent cares used to be pretty upfront. I went to an urgent care a couple of years ago, $99 advertised in the window. I go in, fill out all the paperwork and they tell me it's going to be $150. When I point to the window, she says it's expired. I start to walk out and she tells me to come back and gives me price. This is not the only time I've had to walk out over various health things, it's ridiculous. They think you won't do it because you're ill and act that getting angry over this is some sort of insane response. So now I just pretend not to have the extra money.

Anyway, I use Heal now. So happy that the VCs are funding this, hope it lasts.

[stuff4ben]

You went to the doctor for a bandaid? Seriously? Could you not apply said bandaid yourself? Why would you waste a doctors time and your money for that?

[jacquesm]

I don't like the tone of your comment at all. It's very well possible for a person to end up in the hospital where the right treatment is to 'stick a bandaid on' on one end of the treatment spectrum and a much more invasive or complex procedure on the other when going in with roughly the same symptoms.

For instance, if you work a lot with tools and dirt then there is a fine line between blood poisoning and a mere scratch, they will both start out the same but you won't be able to tell what's in your bloodstream until it is too late if you're going by symptoms alone. By the time the choice is amputation above or below the knee or you've gone into septic shock you've lost the window where you might have been ok. More people die from this stuff than from heart attacks or strokes.

So in some cases, when the exact contaminant is not known it can be a good decision to go to the hospital to have something looked at, and it shouldn't cost an arm and a leg (pun unfortunately not intended) to do so.

Nobody goes to the hospital for fun except for a very few individuals that have something wrong with their heads rather than with their bodies, and that's before we get into things like people with compromised immune systems.

[amluto]

DermaBond is not a bandaid. I personally did not have a container of sterile saline, a pack of sterile gauze, a DermaBond cartridge, and the expertise to evaluate exactly what was needed.

And yes, I have bandaids.

[borkt]

Agreed and the real costs support major bloat. A friend of a friend who's previous job was a phone salesperson for a small, local sign shop got a job in the sales department for hospital software. Within months she was being flown across the country to the companies headquarters monthly and traveling around selling a product she clearly had no understanding of but was following the pitch which was taught to her. Not that she isn't a great person, but I cannot think of another industry where I've seen so many resources going to an entry level, zero experience position that could be handled locally or even remotely rather than sending this person out and paying for nicer hotel rooms than my friend who is a major airline captain stays in.

[heavyset_go]

Outside of large cities, urgent care facilities operate on the standard 9-5 and are very selective when it comes to which insurance plans they take.

It's entirely possible that you're insured, but no facility within an hour's drive will take your plan, and if your kid becomes ill outside of business hours, tough luck. For liability reasons, they'll refer you to the ER anyway if you have symptoms beyond a sore throat.

The last time I had to go to an urgent care clinic in a state where no one took my insurance plan, I had to pay $700 out of pocket to talk with a doctor for 10 minutes and get prescribed a z-pack. I then paid $90 for 6 pills at the pharmacy.

[nytesky]

In theory urgent care would be useful, but for anything non-obvious you have to go to ER. Abdominal pain? ER. Head injury? Dislocation requiring pain management? ER.

Urgent care can get you antibiotics and test for strep, and I think x-ray and set simple fractures, and stitches of course. What else is within their scope, I find it fairly limited.

[isostatic]

> In the US, patients should go to urgent care for minor health issues that are unlikely to require a fully outfitted trauma and surgical unit

Just looked up the one near to my hotel. Closes 6PM. Not much use at 2330.

[mercutio2]

If your symptoms are acute enough that you really can’t wait until the morning, then yes, you’re going to pay for access to round the clock in person medical professionals in the US.

[rpiguy]

Irrational yes. Broken, no just optimized differently than other systems. The system is optimized to serve those who can afford it and those who are very poor and get it for free, but not those in between. It is optimized to generate profit, but also new treatments. Rich people from all over the world come here for surgery and treatment.

The pricing system is intentionally designed to be opaque so that everyone except the consumer benefits. It is not uncommon for a top surgeon to make 500-750K per year, nurses are paid well above the median and can make over 100K with overtime, hospital administrators, insurance companies... the way pricing and billing is handled protects all those interests.

Sounds like something you would want to fix, right? Well that too is complicated. Healthcare is one of the only sectors that is growing middle class jobs. A hospital is one of the only places someone with an associates degree and a certification can make 60K per year.

Furthermore, it is one of the only growing industries that provides many opportunities for women. Not many women want to move to Montana to frack shale oil.

Start socializing medicine and all that job growth and opportunity disappears.

It is a tough problem to solve. The utter irrationality of it used to drive me nuts and still does sometimes, but I prefer it to the alternatives.

[VHRanger]

> Start socializing medicine and all that job growth and opportunity disappears.

Pegging growth to systemic inefficiency is monumentally stupid.

This is only a few steps of abstraction away from simply paying those nurses to dig holes then fill them back up, macroeconomically.

[rpiguy]

Growth occurs organically in a market system. It does not in a socialized system. I was not associating growth with inefficiency - I was associating high pay with it.

[jugg1es]

The premise of your argument falls apart if you really think about it for a minute. Switching to a single-payer model doesn't mean healthcare jobs disappear. It would kill off the insurance companies, but it would not reduce the demand for skilled healthcare workers. It seems like you are arguing that 'socializing' medicine requires that we get rid of hospitals entirely. We could still have for-profit hospitals if we drastically reduced the size of the private insurance market.

I feel like you are making a lot of assumptions about how we would fix our health care system that are unfounded.

[rpiguy]

No socialized system pays what our system pays.

[eptcyka]

Just because the industry is good at generating revenue doesn't necessarily mean that the quality of service is any better. Do you have some data to back up your claim that medical services in the United States are world leading? Are they better than what one would receive in Europe or Japan or South Korea?

Personally, I think it's unethical to keep a process inefficient even if the inefficiencies are profitable. And healthcare in the states is anything but cost-efficient.

[jjoonathan]

About 5 years ago I took a health care policy class and we looked into this. In terms of outcomes, the U.S. was thoroughly mediocre, except for breast cancer and diabetes, where we were at the head of the pack (in terms of treatment) but not, say, better by a multiple.

The fact that the US has many leading medical research institutions is often abused to argue that we have the best care, but it's largely irrelevant for the overwhelming majority of delivered care and even more irrelevant for outcomes.

[rpiguy]

As I said it’s optimized differently.

[MrBuddyCasino]

> Furthermore, it is one of the only growing industries that provides many opportunities for women. Not many women want to move to Montana to frack shale oil.

Is this supposed to be a good argument to drive desperate people into bankruptcy?

[jjoonathan]

It's not a good argument, but if you want to defend the indefensible, your options are limited.

[rpiguy]

Did I ever argue against improving the system or imply these bankruptcies should happen? I just said I’d take this system over alternatives not that it couldn’t be improved.

[52-6F-62]

> originally gave me a 50mg one for $9, then took it off the bill, then gave me 2x25mg ones for $250.

That sounds like straight up fraud. What the hell.

[noitsnot]

I get the point, but that's a joke. She didn't wake up and see a bill. You don't get the full blown, by the way, the anesthesiologist actually charges $20k+ for less than an hour of care bill, until a few weeks later.

[jotm]

Wow, that's a huge discount! Great deal! /s

[jacquesm]

One of the reasons why I don't go to the USA anymore. Past 50 the chances of something medical popping up are higher than they were in the past and I just can't afford worrying about this. The total list of why I don't go there anymore is much longer but this is definitely one item on the list. This sucks because I have more friends in the USA than I do anywhere else and I miss them.

[drak0n1c]

That shouldn't stop you. Comprehensive travel insurance can be had for short and long trips for $50 - $150. Prices for US travel insurance are around the same as insurance for visiting other developed countries such as Japan or Switzerland. All the terms are clearly spelled out.

https://www.lonelyplanet.com/travel-insurance