Hospital fees rant

Quote: OnceDear

Now.... what if your 93 YO example had no insurance?

They get treated the same. No ifs, ands, or buts. I worked for the last 15 years at my county hospital. A Level 1 Trauma Center. You get in an accident in my town, you are shipped to me. Neither me nor the surgeon nor the hospital has any idea if you are insured or not while the treatment decisions are being made. Your wait time is determined by the severity of your condition, not your ability to pay.

Who pays for those that can't? The taxpayers of my county (It's a county hospital). If you are truly fully uninsured (No private, Medicaid, or Medicare) then you will get a silly bill. If it's a major accident requiring surgery and say a week in the hospital, the bill probably approaches $100k. I'd say the EV on collecting is around 1%.

I am glad you are happy with your healthcare system. I am happy with mine. I am retired now so do not get a penny from it, but will use it until I qualify for our age based program, Medicare.

As far as the Canadian system, I have seen dozens, maybe hundreds, of doctors from Canada trying to escape to the USA over the years. Do you think it is the bottom doctors or the top doctors that are eventually accepted by practices and hospitals in the USA
I also remember we had "Canada day" at our lithotripsy machine for kidney stones, as wealthy Canadians would come over and pay cash rather than wait weeks or months for the free treatment. (Two decades ago) I have also taken care of innumerable head trauma patients helicoptered to my hospital because there was not a neurosurgeon available in southern Ontario. I know of no patient that needed to be shipped to canada because we did not have the necessary resources.

I'll take our overall health care system over England's and Canada's any day.

Someone once told me this joke.... "How do you find a Canadian neurosurgeon in December? Look in Long Boat Key."

My bro in law has a church in
Canada. He has duel citizenship.
His wife has a disease (lupus or
something) that isn't covered
under the wonderful Canadian
'free' healthcare. So they have
insurance in the US and come
here every 6 weeks for treatment.

He needed both hips replaced.
Waited 2 years for the first one,
then 2 more years for the 2nd.
My brother needed both knees
replaced last year. They did the
first in a month, then when it
healed they immediately did
the other.

What do people without insurance
do, you ask? Why would I give
flying doughnut, I take care of my
own and expect the same out of
them.

Wow you have really been accident prone, OD, there's no other way to put it! No wonder you want socialized medicine!


People are notorious in the US for over-using the ERs, using them when they just wanted a doctor's visit it seems. That is one way to cut down on costs in the system right there that still is not fixed as far as I know. We also do have what are called urgent care facilities. I can say for sure when you walk into a regular doctors office you get grilled about everything, and mine tells you up front they "don't do" urgent care. Evidently urgent care facilities, which of course "do" urgent care, are still not so friendly to the uninsured etc?


So I just now looked this up, wasn't sure, but here it is:

Quote: link

The main reason that so many emergency room visits are for non-urgent care is that hospital ERs are required by federal law to provide care to all patients, regardless of their ability to pay. Since they can’t be turned away, patients without insurance, or the necessary funds to pay out-of-pocket costs, often utilize emergency rooms as their main health care provider...

Quote:

... you can go to an Urgent Care Center without insurance and be treated, but if you can’t afford to pay, they could turn you away.
Urgent Care Centers are not bound by the Emergency Medical Treatment and Labor Act and most require some form of payment at the time of service.

https://www.debt.org/medical/emergency-room-urgent-care-costs/

Quote: Face

Or maybe we can drop anecdotal nonsense and just get to facts. 29,000,000 people in America have no insurance. How many in the UK go without insurance, OD?

Hmmmmm, Anecdotally: 0% OK. There maybe some undocumented folks, maybe visitors from outside europe or of no fixed abode that are not registered with any medical practice. But anyone presenting himself for urgent treatment gets it. If they have no money, they pay no money.

Quote: Face

66% of ALL BANCRUPCIES are due to medical bills. How many medical bankruptcies in the UK, OD?

Personal bancruptsies are pretty rare. There may be some that bought private treatment without having the means to pay. But that was their decision.

Quote: Face

The vast majority of our population is one accident away from permanent financial annihilation. OD? Any words?

We have lots of folk living paycheque to paycheque. I guess that being disabled and off work would financially cripple them. But not from the debts from treatment.

Quote:

A Morris Marina is no Bentley, but it beats walkin'. And I'm pretty f#$%ing tired of doing my own excisions, setting my own bones, and stealing my dog's meds.

Indeed. Piss poor NHS waiting lists whups not being able to, or not daring to join the queue.

I've set my own broken toes and finger because I didn't want to queue, and in the case of the finger, I went much later and still got treatment. I've also bought my own medicines because I couldn't be arsed to see the doctor. But that's the only reason.

When I was employed, I could have had seriously discounted private medical insurance. I was happy not to. For a minor treatment, I just chose to pay out of pocket to save a few months waiting.

Evenbob and his MIL can obviously afford the Bentley. Good for them.

Face would probably have his other arm fixed by now in Canada or uk.

Quote: odiousgambit

Wow you have really been accident prone, OD, there's no other way to put it! No wonder you want socialized medicine!/

You're not wrong. How many people do you know that knocked himself senseless with his own golf ball? had a javelin through his big toe, or tried to cut his arm off with an angle grinder or who broke three legs in the same car crash ( 3 guys )... or got his face splatted by a fire door while up to mischief at work. Then there's my recent accident with the SDS drill.

I'm a fumsy clucker when I'm doing DIY.
It's also why I don't want to own a gun.

Quote: OnceDear

Still, broadly in topic, I'm curious about how Accident and Emergency services and walk-in services operate in the US and Canada.

Probably impossible, as anecdotes can run the gamut. But I'll share mine for an idea...

ER = A+E, yes. It's a place you go to get "patched up" as opposed to "fixed". An ER will get you stable, then another separate appt would need be made for care. Cut finger? ER will stitch and stop bleeding; tendons, nerves, and circulation would be someone else. Broken leg? Xray and immobilize. Set, cast and care would be someone else.

We also have "Urgent Care Centers" which is like Diet ER. They have an Xray and AED, can stitch you up or immobilize, but lack the life saving aspects of a typical ER. No surgeons, no OR, basically just a shack to serve as an ER for non-"E" patients.

I damn near have an EZPass at my local (what y'all would call a MetroCard) so could give examples aplenty, but they seem pretty comparable. I've gone for anything as simple as a sprain, to serious as compound fracture, as painful as cluster headaches (suicide migraines), irritating as glass in eye, and everything in between. Every one seems similar to yours. Sometimes I don't even sit; hand in the paperwork and they pull you right in. Other times I have waited so many hours I was too incapacitated to tell you how many. That's just the nature of ER and triage; Worst is first, be glad you're going last. As far as treatment goes, I've little to bitch about.

UNTIL you get the bill. You must have missed it, but I posted my last ER visit. Foreign object in eye, which is a process I'm familiar with. Florocein drop to check for corneal scratches, saline flush, one q-tip swipe across the cornea to remove debris, and an antibiotic drop. Takes 7 minutes, cost $1,500USD. Just attending is $700, and that's just that portion of just the hospital's bill. There's also a separate bill for the doctor, which in my 7min q-tip example, was $700. Ambulance? >0% of the reason I carry a gun is to keep my ass out of one (I kid. I think?) Minimum $400 if you even step into it (slight hyperbole). Can easily, and I mean EASILY, be over a grand for transport. Bend over to pick a flower, take care to make a clean break, then stand up too fast and pass out? Better hope no one saw you lol. We mental health types are always urged to "reach out" and reminded that "help is available". And it is. If you're to that point where you feel you can't stop from killing yourself, help is quite literally one phone call away. And they will help you, and you won't kill yourself. For $1,000 a day. That might not even be your choice, if you reach out and say the wrong thing. And for a problem that ain't gonna get solved in a week. Ever struggle with mental health? How many days it last for you? Yeah.....

Oh, and do not forget, eyes and teeth are, like, aftermarket accessories not covered under manufacturers warranty over here. Those are each their separate insurances and separate systems not tied to health benefits. I recently dove in myself to address years of neglect. From roughly 10/16 to 2/18, $24,000 was spent in my mouth. 1 removal ($150) 9 root canals (~$1,400 each), 6 or 7 regular ol fillings (unknown), and all the titanium / porcelain pieces to reconstruct my biters. I may, with my federal job, have the widest range of options to choose from re: insurance as anyone in the country, and I with my dentist's clerks sat down and picked the Cadillac of plans, specifically aimed at all the things I would need. I mean, does it get any better than that? To have that level of expertise guiding your decision, ensuring you max your benefits and pay little to nothing on the unnecessary? That's a $24/mth plan, and I still paid >$9k out of pocket. And, 100%, completely honest, real talk, I am THRILLED about it.

They got us f#$%ed up over here, OD.

Quote: Face

Shall I recount the tale of the $700 q-tip?

Well, if you stuck it in your ear... my Dr advises that the only thing you should poke in your ear is your own elbow....

Thinking back,
Actually, it was probably q-tips that bu66ered up my hearing .

If it was poked down the Jap's eye, you should have lubed it first. Schoolboy error. :)

Quote: Face

I damn near have an EZPass at my local (what y'all would call a MetroCard) so could give examples aplenty, but they seem pretty comparable. ...

Oh, and do not forget, eyes and teeth are, like, aftermarket accessories not covered under manufacturers warranty over here.

Hmmmm Eyecare here. Eyetest free for over 60s mostly available free to about $15 anyway.

My varifocal specs, I paid for myself for about $400. Could have paid about $50 for ugly single vision specs.

Cataract lens replacement. No invoice but wait 2 - 6 months

Cataract follow up laser treatment if needed No invoice wait a few months.

Tooth fillings or extractions between about $30 and $75 IIRC

Root canal surgery. never had it, but affordable with capped cost.

I think implants are generally expensive at a few thousand. NHS more likely to provide dentures.

BUPA is a frequent medical benefit with good employment, https://www.bupa.co.uk/

Quote: SOOPOO

They get treated the same. No ifs, ands, or buts. I worked for the last 15 years at my county hospital. A Level 1 Trauma Center. You get in an accident in my town, you are shipped to me. Neither me nor the surgeon nor the hospital has any idea if you are insured or not while the treatment decisions are being made. Your wait time is determined by the severity of your condition, not your ability to pay.

Who pays for those that can't? The taxpayers of my county (It's a county hospital). If you are truly fully uninsured (No private, Medicaid, or Medicare) then you will get a silly bill. If it's a major accident requiring surgery and say a week in the hospital, the bill probably approaches $100k. I'd say the EV on collecting is around 1%.

I am glad you are happy with your healthcare system. I am happy with mine. I am retired now so do not get a penny from it, but will use it until I qualify for our age based program, Medicare.

As far as the Canadian system, I have seen dozens, maybe hundreds, of doctors from Canada trying to escape to the USA over the years. Do you think it is the bottom doctors or the top doctors that are eventually accepted by practices and hospitals in the USA
I also remember we had "Canada day" at our lithotripsy machine for kidney stones, as wealthy Canadians would come over and pay cash rather than wait weeks or months for the free treatment. (Two decades ago) I have also taken care of innumerable head trauma patients helicoptered to my hospital because there was not a neurosurgeon available in southern Ontario. I know of no patient that needed to be shipped to canada because we did not have the necessary resources.

I'll take our overall health care system over England's and Canada's any day.

Someone once told me this joke.... "How do you find a Canadian neurosurgeon in December? Look in Long Boat Key."

Everybody is ignoring this post
by an actual doctor who lives
near Canada and has watched
CA doctors for decades trying
to escape the healthcare system
there and come to the US. That's
how great 'free' healthcare is,
even the doctors don't like it.