True, but it’s also more complex than that. I don’t know the story here, but the $69k bill sounds like he went to a hospital to get treated.
Hospital prices in the US are always lies; his insurance company probably paid around $10k in total and perhaps even less than that. Of course the insurance company doesn’t generally tell their customers exactly how much they actually paid the hospital. He could have gotten a more reasonable bill by asking the hospital for the cash price for everything, writing them a check for that amount, and then getting reimbursed by his insurance company. It might still have been more than his out–of–pocket limit, in which case he still would have paid the $2,500.
But his real mistake was probably going to the hospital in the first place. He probably should have gone to his Primary Care Physician or to an Urgent Care Clinic. Either one of them can admit him to a hospital if it turns out to be necessary, but it probably would not have been. I see in another comment that he needed an X–Ray, a CT scan, and some medication. He could have gotten all of that at an urgent care clinic for $1,000 or so, and slept in his own bed that night.
It pays to shop around, and you can do so _before_ you get hurt.
Finally, don’t forget that in addition to the $2,500 he paid, he also paid his insurance company even in years that he wasn’t injured or ill. Likewise, you pay taxes every year and part of that goes to pay for healthcare, even if you aren’t actually injured or ill.
I was just in the ER in SouthWest Florida: $12K for two CT-scans and blood tests over two days, basically to check if I was having appendicitis (I did not- probably infection from prior kidney stone). No overnight stay, but two visits over two days. $12K is the initial bill to my insurance company, so not sure what they will actually receive.
I had a similar ER visit for "possible appendicitis". It turned out to be a sprained psoas.
I've since had it again, but was more aware of what to feel for and didn't seek out the ER. Might be worth it to keep in mind if you have something similar again.
In Brazil an x-ray exam will cost you no more than 90 BRL, or less than 20 USD in todays rate. And this is out of the pocket, without insurance. If a 3rd world country can have affordable healthcare, why should having minor health complications be synonym to bankruptcy in the richest country in the world?
I live in one of the highest–priced areas of the US, and a simple x–ray exam costs about $200 whether you have insurance or not. The difference in price is primarily due to the higher cost of living here than in Brazil; the tech who takes the x–ray and the doctor who looks at it to diagnose the problem get paid more here than there. I should know; I got hit by a car last year and sprained my thumb when I hit the ground. The x–ray was to check that the thumb was only sprained, and not broken.
But if you go to a hospital to get the same thing you will pay 10× as much or more. You’ll also have to wait a lot longer, as anyone with a more serious complaint will get prioritized ahead of you. Both of these are reasons why people should not generally visit the hospital, unless they have a problem which is immediately life–threatening, or they are admitted to the hospital by their primary–care physician.
> why should having minor health complications be synonym to bankruptcy in the richest country in the world?
It’s not. For all of the problems that our health–care system may or may not have, people don’t go bankrupt because they needed an x–ray.
> I live in one of the highest–priced areas of the US, and a simple x–ray exam costs about $200 whether you have insurance or not. The difference in price is primarily due to the higher cost of living here than in Brazil
Well, most x-rays are free here in Australia I believe, thanks to Medicare, so that "higher cost of living" explanation seems not to be right.
There is no good reason the US can't bring down healthcare costs, but there are also some not so good reasons that some countries have very cheap healthcare.
Genuine question, how are you so confident that reducing prices from current levels wouldn't cause unintended consequences like causing innovation to stifle, hiring to become more difficult, or health infrastructure to degrade? You can point to other countries having lower prices, sure, but just like you said - there are plenty of reasons why other countries can be cheaper than in the US.
Because we have inefficiencies that are baked into the status quo. Insurers, for example, provide little value to health outcomes. Their purpose is purely financial, and there are much more simple ways to shift that money around that requires less administrative overhead, and allows prices to be set by better methods than threats by insurers, which is basically how they're set now.
That's a very fair point. I think transparency in pricing for medical services would help out a lot with cleaning up the insurance mess. Not that either of us have the answer, have you put in any thoughts on how to eliminate those inefficiencies?
You mean back in the 1930s when you stuck your foot in a wooden box with an open X-ray tube and got yourself and nearby customers exposed to radiation at a significantly higher dose than even a full torso x-ray in modern times? Okay, my guy...
You’re right about that, but cost is a funny thing. The x–ray photograph itself costs mere pennies, especially with a modern digital imaging system. Even x–ray film is just an incidental cost.
However, when you are getting an x–ray to diagnose a medical problem, you do want more than just the image itself. You want the person who takes the x–ray image to be practiced and able to reliably take the correct image with the correct camera settings and so on. But most importantly, you want the diagnosis to come from a highly educated doctor who knows what your insides are actually supposed to look like. Whether these two roles are handled by one person or multiple, you are monopolizing someone’s time. You can’t really expect them to take x–rays of multiple patients at the same time, or to look at two x–rays and diagnose them both simultaneously.
If it takes the imaging tech 10 minutes to set up the x–ray machine for you and make the images the doctor asked for, then you have to pay 10 minutes of that tech’s salary. If the doctor spends 20 minutes asking you questions about your injury and then 10 more minutes looking at the images and telling you that you will live, then you’re going to have to pay for half an hour of their salary. The staff at the front desk who hand out forms and answer phones get a slice. The nurses who do most of the grunt work get a cut too.
The shoe salesmen didn’t directly charge for use of the x–ray fitting machines, but they did recoup their costs out of the shoe sales. Either by increasing the price of every pair of shoes by a small amount, or just by selling additional shoes (due to the novelty factor, or because it genuinely saved time allowing them to sell more shoes in a day).
The bulk of the price of any good or service comes from paying the people.
> The shoe salesmen didn’t directly charge for use of the x–ray fitting machines, but they did recoup their costs out of the shoe sales. Either by increasing the price of every pair of shoes by a small amount, or just by selling additional shoes (due to the novelty factor, or because it genuinely saved time allowing them to sell more shoes in a day).
Well sure, that's why they were saying the price should be capped at a pair of shoes, not literally free.
And while a few minutes of a doctor's time costs more than a salesman, the entire materials costs of the shoes goes away. It seems like a reasonable benchmark.
The problem is that the cost for healthcare is hidden. In the UK, we have "National Insurance" but it doesn't work like normal insurance. It goes into the same big pot as everything else and gets spent on whatever.
It is a hard balance but sometimes when I see people doing stupid things that land them in the ER, I kind of wish that their premium would increase as a result. That said, I think the largest cost in healthcare is the care of the elderly: We somehow keep people breathing for much longer than 50 years ago but it doesn't stop their bodies needing some big maintenance or long-term residential care.
Health insurance premiums in the US don't raise people rates if they do stupid stuff, with the single exception of smoking. Rates are basically set based on three factors: age, location, and smoking status. You do share costs if there's an accident, but daredevils and school teachers get the same rate at the same age in the same city.
So about 3-4 days of work as an entry-level Facebook developer, or 3-3.5 weeks of work at a McDonalds (based on every fast-food place around me having billboards up offering starting wages of $18-20/hr).
Getting access to emergency life-saving treatment, which leverages billions of dollars in research & development and hours of work from a team of doctors, radiologists, nurses, pharmacists, support staff, etc in exchange for being asked to contribute back to society by cooking burgers for a month feels like a pretty amazing offer compared to how almost all humans have existed in history and most still do around the world today.
The fact that we have better health infrastructure in most places worldwide than ever before in human history is true. But saying a surprise, out-of-the-blue 2.5k medical bill can be taken care of by working nearly a month at McDonalds without factoring the high cut of that wage that goes to living is facile at best and cruel at worst.
Since the typical fast food service worker see almost their entire paycheck go to living expenses before any opportunity for luxuries or savings, that does indeed sound like a crippling if not insurmountable financial burden for someone who incurs an x-ray expense like this unexpectedly. Especially since whatever reason they have for needing an x-ray could affect their ability to earn income from McDonalds. I don't think hourly wage work offers the same perks as entry-level development roles at facebook with regards to paid sick leave.
This example is totally unrealistic. In the USA someone supporting themselves working at McDonalds would qualify for Medicaid and have essentially no out-of-pocket medical expenses.
That's still far more than you'd pay for most healthcare related things across the EU.