[vonmoltke]

> the distorting lens of the unfortunate US insurance landscape, costs (for whatever "costs" mean in this distorted context)

On the topic of distorted costs, I nearly flipped out last night when I got the statement for my recent polysomnogram. The sticker price, if I walked in uninsured, would have been $8750. My insurance company is paying $616, and I am paying $15. I think it is abhorrent that the facility just ignores 93% of the sticker price just because I have insurance. I saw similar massive write-downs on my arm surgery. I imagine a C-section is the same.

[JeremyMorgan]

That "sticker price" isn't a real number. It's used so when uninsured people don't pay it, they can write it off.

[pc86]

Which becomes even more mind-boggling when, if your insurance declines it for whatever reason or there is a problem processing the insurance and it's not caught in time, you get a bill for $6,000 after a "discount." But typically by the time those letters arrive you've already got $1,500 in fees and charges.

[ashark]

The typical billing experience for anything non-trivial in US hospitals is batshit crazy.

One visit can generate three or four bills from different people and institutions. Some of these bills they'll tell you to ignore if you call about them because insurance is covering all or part of it, but they sent the bill before that was sorted out, for god knows what reason. Don't worry, you'll get more, corrected (hopefully? maybe?) bills later. Then explanation of benefits letters arrive, which look sort of like bills but aren't. Almost certainly, at least one of the billing people and/or the insurance folks screwed something up and you'll get to spend most of a day on hold with insurance and a hospital or test processing company or whatever sorting it out. If you miss anything in this mountain of mostly-useless paperwork you may find late notices in your mailbox a month or two later.

Now you get to try to figure out whether the charges on those late notices were legit, or whether they're the result of some seemingly-alway-incompetent hospital billing department's error. While racing against the date on which it goes to collections, and while fees and such accrue.

By four months out you finally, maybe, know what your total costs were/are, after hours of dealing with it and filling half a filing cabinet drawer with documents.

Now, consider that most procedures will include several visits generating a similar number of bills in the months leading up to it. You'll being bombarded with this garbage non-stop for months on either side of the Main Event. You'll also have some follow up appointments and/or tests. Fun!

Basically everyone involved either doesn't care about doing their job correctly or is actively trying to steal your money. Half the time they don't know WTF is going on. You or your loved ones get to deal with that while you're sick or recovering. We call this health care. Some people prefer to pay a premium for this "service" instead of having single-payer or a national healthcare service because... that would make us less free?

That's how bad it is with insurance. Without is, I'm sure, much worse, though probably less complicated.

[pc86]

I had my gallbladder removed in 2009, and was lucky in that at the time I had what is still the best insurance I've ever had. The sticker price of the procedure was approximately $50k (ER visit + admission + emergency surgery the following morning), of which I paid less than 1%. But the amount I did pay was split between the hospital (at least two separate bills), the surgeon (who was a contractor for the hospital and billed separately), and my insurance (who paid something in full but two months later decided I actually owed them $20 for it). This is not counting the $100 ER copay which was refunded to me 90 days after I was admitted (ER copays are typically waived if you're actually admitted to the hospital for non-US folks).

I was barely out of college at the time so had my parents look over everything and it was as far as we could tell correct. But still a mountain of paperwork, and I did miss a legitimate bill and end up paying a $30 late fee on a < $100 bill, which was frustrating.

So yeah. A mess, basically :)

[DanBC]

In England we're currently having a crisis in A&E units with unprecedented volumes of patient ("winter crush"[1]) and a shortage of nurses. Targets are being missed. 95% of people who turn up at A&E must be seen and treated, or admitted into a ward, within 4 hours. At present only about 92% of patients meet that target. At its worst only about 89% of patients met the target.

The trip to A&E would cost you your petrol money or cab fair. The treatment in A&E, and the hospital is free at the point of delivery[2]. The hospital might send you home with a month of medication which would again be free atpod. A regular prescription would cost £8.05 per item per month although there are many exemptions and many people don't have to pay for meds.

If you wanted to pay for your hospital visit you can. You get your own room and a free telly, maybe a bit more nursing and a few more HCAs. (In the NHS beds you possibly have a telly that you pay to use.)

The weird thing is that we get all this while we spend less per capita on healthcare than the US government. Free healthcare is cheaper than the US system. And you don't need to get rid of private provision either - so anyone who wants to pay at the point of delivery can.

[1] more people attend A&E in summer. But the people who attend in winter tend to be iller and to need a hospital admission.

[2] see how I nearly avoided "it's not free you pay for it in tax" comments