Hacker News Reader

Comment by 8ytecoder | Hacker News Reader

Nowhere near as close - I had what I thought was food poisoning and went to the ER. Deeply aware of US ER fees and was already questioning my choice. I go there and was made to wait 30 minutes in excruciating pain. But it got better and I felt good enough that I decided to leave - specifically because I’m scared of the costs. I informed them and left. Did not see the doctor or anyone. Except the nurse who took my weight and height. Got a bill for $1000. Literally for stepping into the ER.

It’a no coincidence that US has such high opioid addiction and homelessness. Even in third world countries these people would have gotten treatment that didn’t bankrupt them.

View on HN

one reason ERs are so expensive is they are required to provide medical services for people who can't pay. so you are paying a subsidized price. also those fees are negotiable if you are patient and can spend a bunch of time on the phone.

How can a private business be required to perform a public service at its own cost? If the service is public, the public should pay for it; if it's not, each pays his own.

Consider this: a public service is financed by taxes that are proportional to one's income. The way it works now, both a minimum wage worker and Jeff Bezos are asked to pay $1k to walk into a ER, to "subsidize" what is effectively a public service.

In the US you pay just as much as us in the EU from your taxes towards healthcare as well. You are being double dipped for the privilege of having portions of the population not able to afford actual care.

Possibly, on average. Some pay (vastly) more, some less.

I don't see the double-dipping in the math though. EU has populations of people who aren't contributing in taxes much or at all.

We’re talking about total sum per head. Not average.

So saying some people pay less and some more is ignoring the fact that you are actually as a whole paying much more.

It’s arrogantly individualistic to assume that “others might pay more therefore I should continue to support this horrid system”

You're putting words in my mouth, complete with quotation marks. I never said anything about what anyone should do. I didn't even say that on the whole people in the USA pay less.

In the EU, people pay a varying amount (overall a greater fraction of their income) in taxes. In the US, people pay a varying amount (overall a greater fraction of their income) in healthcare. I think these are widely accepted facts.

The US healthcare system has endless problems, I was only commenting on the "double-dipping" part of my parent comment, not writing an essay.

The 'Double dipping' is referring to the average US citizen having to contribute just as much as western europeans from taxes towards healthcare, and then on top of that having to spend just as much privately from personal or employers insurance, and cash. US healthcare costs are about double that of other nations and tax contributions at the same level.

Are you saying that taxes in the US don't vary by income?

I think I misunderstood your original comment. I heard "paying for one's own expenses plus for those who can't afford it" (which is same in the US and the EU), where it seems you mean "paying from taxes plus out of pocket".

My uninformed impression is that in the US one does not pay proportionately the same amount of taxes towards healthcare (maybe you have citations to the contrary?).

I would (only from experience and anecdotes) guess that you're right about it costing double, however.

> My uninformed impression is that in the US one does not pay proportionately the same amount of taxes towards healthcare (maybe you have citations to the contrary?).

Each and every report of US healthcare costs and funding. I'll just grab from the wikipedia article [0] for now.

> Public spending accounts for between 45% and 56.1% of U.S. health care spending.

And one of the pretty handy graphs [1]

Worth noting that this is with a lot of people unable to afford treatment.

[0] https://en.wikipedia.org/wiki/Health_care_finance_in_the_Uni...

[1] https://upload.wikimedia.org/wikipedia/commons/thumb/f/f7/OE...

Edit: Has to be coupled with public spending in other nations to be complete. There is another article related to the graph [2] with another easy to understand graph [3]

[2] https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

[3] https://upload.wikimedia.org/wikipedia/commons/thumb/0/0b/OE...

Your citations seem roughly in line with what I said and expected: Americans pay double overall, with a similar dollar amount of public healthcare.

Proportionately speaking, that means Americans are not taxed the same (higher incomes). Interestingly, based on what I'm seeing re: incomes, the /total/ healthcare expenditure is, as a proportion of income, the same between the US and western Europe.

Overall this seems quite unsurprising: healthcare is expensive, the US pays more and the government spreads it around less. Worth noting that health and lifestyle in the US is also "worse" (more cultural than healthcare related).

>people who can't pay

How does it work? Do you need to apply somewhere that and get certified for "cannot pay" status? Do you need to do it before the bill? What if you can pay 1000$ but cannot pay 2500$? What if you can pay but after paying it your life standards lower significantly? What if you have some money and you were about to go to college but an appendix happened and now you cannot affor college?

You just don't pay. They send a bill, you ignore it.

That's about it.

You're imagining this to be more friendly than it is -- "can't pay for emergency medical care" in the US is a euphemism for "got a bill from the hospital, couldn't pay it, so the hospital sold the debt to a collections agency and wrote the account off as a loss", not a reference to a forgiveness program.

Since the hospital takes a loss in those cases (and has to, since they have to treat everyone), everyone else's cost of care goes up to subsidize the loss.

> You're imagining this to be more friendly than it is -- "can't pay for emergency medical care" in the US is a euphemism for "got a bill from the hospital, couldn't pay it, so the hospital sold the debt to a collections agency and wrote the account off as a loss", not a reference to a forgiveness program.

As someone who's family has been in that situation before, not it is not. We had a $35,000 bill forgiven entirely because we couldn't afford it. The process was certainly stressful, distressing, and we shouldn't have a system where it happened in the first place. That doesn't change the fact that the end result was forgiveness.

You can typically try to work out a deal with the billing department which might be a payment plan, cash payment in exchange for a discount (easier to get if you have bad or no insurance), or a combination of both. But once they send it to collections, good luck.

You can negotiate with collections too. If they bought the debt for 5 cents on the dollar (typical) and you make it clear they can accept 50 cents on the dollar or call you for the next 7 years because you just don't care, they may accept.

If the patient is a destitute homeless person they literally cannot pay. The bill can get sent to collections, but it's not like they have an address to collect from, or a good credit score to ruin, so it's uncollectable.

With that theory, the prices would be just as high in countries with mandatory and regulated medical insurance, yet they aren't.

This is a bit of a feedback loop - jack up prices to cover those who can't pay, now more people with bad/no insurance can't afford to pay, rinse and repeat. And it's not just ER prices, the whole medical industry in the US is overpriced - even offices whose patients all have good insurance will still charge large amounts, and of course drug makers still raise prices well after recouping R&D.

This is empirically the least efficient way in the world to systematically handle medical services and payment for them.

The theory is that if the people that couldn’t pay also got lower level services in the first place they wouldn’t be straining the ER rooms.

This is especially a problem in SF with the homeless population. They obviously have no normal healthcare, but the hospital I went to was inundated with them (my own 5 day stay there was billed at over $80k; no surgery).

You know that ERs also provide service to the poor in the civilized world, right? And we don't bankrupt the poor for the privilege of living.

"subsidized price" for heath care is the most horrible and obnoxious shit yet.

That would buy you 5 days of ICU stay in most of the third world countries :)

You can call your doctor's triage line if they have one and they can usually diagnose food poisoning over the phone and call in a prescription if you need one. Otherwise there is urgent care which is cheaper than the ER.

Reply on news.ycombinator.com