Hacker News Reader

Comment by throwaway5752 | Hacker News Reader

Why did he go to the ER?

Thumb injuries are actually treated very seriously (at least more seriously than you might think) by medical professionals because thumb injuries can have very high consequences for quality of life. You can live a totally normal life without an index finger but a missing or disabled thumb is a much more significant impact.

I know. To elaborate (and reply indirectly to will_brown) I think it's impossible to say how egregious $14k is for billing without knowing how severe a sprain it is and how much they had to do to diagnose it. Maybe he walked out with a bandage, but maybe he got an x-ray or mri? And ERs are expensive because they have to handle anything from a MI, stroke, poisoning, massive trauma, or ID case. If you go to one, you have to pay for use of that very complex facility. Then you pay for diagnostics that they deem necessary. Then you pay for the attending/specialist(s)'s time. A thumb trauma could be super severe and it was probably a good call, and it's great he walked out with a bandage. But I don't think that a $14K er bill is that out of bounds given what they are intended for, nor do I think that a bill needs to be commensurate with treatment rendered.

edit: since this thread is about cancer, I will not reply more because it's OT in pretty fundamental ways. The US healthcare system has massive issues, but I am not sure this particular case relates to the thread or is a great example of the dysfunction in general. A price sheet is not possible for "my thumb really hurts" ... it will depend on a lot of situationally appropriate decisions being made by the attending that cannot be predicted.

> I think it's impossible to say how egregious $14k is

I live (well, lived. currently in the UK) in Australia, and the concept of a $14k bill for a sprained thumb is so out of my world. I cannot fathom how anyone would find that even remotely acceptable.

In the USA, what a hospital charges does not necessarily have any correlation with the cost of servicing your problem. In the same city, the price of a procedure from hospital to hospital can vary by up to 10x.

On the weekend my 83 year old mother in law fell and broke her ankle. One hour ambulance ride to a metropolitan ER. Examination and diagnosis by a trauma specialist and an orthopedist. X-ray. Moonboot applied, a night in hospital as community team were assigned to make her adjustments to her apartment for recovery period. Physiotherapist consultation and ongoing support. No insurance. Total cost zero dollars. In New Zealand and proud at times like this.

I am breaking my word replying, but madeofpalk and you highlight something I failed to distinguish in my comment. I'm talking about "bill" in the sense of summing up the cost of services rendered, like a check in a restaurant. Not policy talk about how is responsible for paying it. All that care for your grandmother (who I hope is okay) isn't zero dollars. It is thousands or tens of thousands of dollars, but she didn't directly pay it. And that is totally cool, and probably a good model. But I was justifying the cost of care the hospital rendered, without touching on who ended up reimbursing them.

I did understand your point, and I could have been clearer by using the word "bill" rather than "cost". Obviously there was cost. In New Zealand cost is not something that a person suffering sudden trauma has to worry about. I am glad you agree this is a good model.

I have another story that is cancer related. Four years ago I had cancer surgery, in the private system. The public system judged that I could wait a month or two (our system isn't perfect), but I was fortunate to have health insurance and elected to be treated immediately. After a few days at home I awoke in the most excrutiating pain imaginable. I was just able to stagger to the phone to call for an ambulance. I would judge it was less than five minutes before I heard the wonderful siren of an approaching ambulance with well trained paramedics and their lovely lovely morphine. It turned out I had a relatively rare complication, a urinoma, my resectioned kidney was leaking urine into my abdomen. Ambulance care (google "Wellington Free Ambulance" it's a wonderful thing), ER assessment, CT scan, stent insertion to help the kidney heal, five days in hospital. Total cost: Who knows, probably astronomical. Total bill: zero dollars.

I love capitalism, I'm a true believer. But I believe even more in a compassionate society and it seems to me that means not using capitalism as a solution to all problems. It makes total sense to have a model that relieves victims of sudden medical trauma from financial stress and spreads the cost across society. The victims are not well placed to play the role of rational economic actors.

> Total cost zero dollars.

You mean total bill zero dollars. Cost was much greater than this, it just wasn't covered by your mother.

I think you are trying to make some point about wasting resource...but the ER is how accute injuries like this are generally treated. Sure there may be urgent care centers equipped for this, but that isn’t a guarantee and those often have more restrictive hours than an ER, especially acces to urgent care services like x-rays or mri/cat scans.

Sure in hindsight it’s a sprained thumb, but likely because of pain thought to be broken or worse...requiring x-ray and being set by a trained professional or maybe even surgery. It is a thumb so it would be less than ideal to lose feeling or mobility or the thumb itself (say there was nerve or circulatory damage).

Reply on news.ycombinator.com