Emergency care seems to account for less than 10% of healthcare spending in the US [1].

[1] https://www.annemergmed.com/article/S0196-0644(13)00313-2/ab...

To me, that sort of proves a point.

Cancer and other disease are extremely expensive to treat and fairly common in the population. Yet, somehow, emergency care which is a minority of health costs, eats up 10% of the spending.

Anyone that's been to an emergency room knows how excessive the price gouging going on there is. Pills that cost $0.10 OTC (or less!) routinely see 100x markup. That same pill can cost anywhere from $10->$15.

> Cancer and other disease are extremely expensive to treat and fairly common in the population. Yet, somehow, emergency care which is a minority of health costs, eats up 10% of the spending.

Emergency care is not actually uncommon. Heart attacks, car accidents, these are the leading causes of death. It's completely reasonable to expect this to legitimately consume 10% of healthcare resources.

> Anyone that's been to an emergency room knows how excessive the price gouging going on there is. Pills that cost $0.10 OTC (or less!) routinely see 100x markup. That same pill can cost anywhere from $10->$15.

This is just opportunism, but it isn't really the core of the problem.

Emergency care is inherently expensive for a specific reason. You need an emergency heart surgeon on premises in case anybody needs heart surgery regardless of whether anybody does at any given time. You also need a neurosurgeon and one for every other specialty, and all the supporting equipment. It's very expensive, which is why it amounts to 10% of healthcare costs.

They then try to recover some of those costs by massively overcharging for ibuprofen and band-aids, which is silly (charge insurers the actual cost for emergency heart surgery instead), but it's not going to be a source of major net cost savings just to do the accounting differently.

They also mark up everything to cover uninsured patients. Who by the way commonly use the ER for primary care and probably explain a lot of that 10 percent.

It also doesn't help how insurance handles ER visits.

I was in the ER earlier this year. Had an ultrasound done and a BUNCH of labs. $500 copay for the whole visit and insurance eats the rest - regardless of where I am on my deductible.

I'd had the exact same ultrasound done "routinely" 2 days prior, at the same hospital, and similar lab the week before.. I had to pay about $1,300 for the privilege because that all falls to my deductible. (Insurance paid nothing)

So it cost me almost 3x as much to go during the day than it costs during the ER - but my insurance paid out about 6x as much for the ER visit. I wonder how many "ER Abusers" have figured out it's actually cheaper for THEM to go to the ER than "normal doctors"?

That makes perfect sense, assuming your annual deductible was met after you paid your $500 copay. Deductible means you pay for the first $x in a year. After that, your insurer starts paying some portion (your portion is called copay). Then you hit your out of pocket maximum (for in network services), after which insurer pays 100%.

No - I hadn't hit my out of pocket max, by a long shot, even after the second encounter. They could have happened in either order - and the emergency visit would have been MUCH cheaper out of pocket for me.

Then I don't know what definition of deductible your insurance company is using, but it doesn't match my experience with any insurer ever, health or otherwise.

It's simple - I have a flat $500 copay for an "ER encounter" regardless of what they do in the ER. Just like you have a $40 or whatever copay for a regular doctor visit.

The deductible must be paid before copays come into play. If you have a $2,000 deductible, then you will pay whatever the insurance company has negotiated with the in network provider for the billing codes the provider bills, up to $2,000. After that, the copays amounts come into effect.

https://www.investopedia.com/ask/answers/051415/what-differe...

No, that's not how it works.

Most health insurance plans have a few services that are copay-limited even before you hit your deductible. i.e., the $40 for an office visit to your primary care doctor, $90 to see a specialist, and in my case $500 for the ER visit. Imaging and procedures are my problem from the start, up to the deductible though ... apparently unless they happen in the ER.

Like I said way up-thread, the way it's structured puts the incentives in the wrong place for me. Had my two visits for ER and scans been in the opposite order, I would have been out of pocket the same total.

Anyway - I'm done arguing with you. I know how my plan works and what I've paid this year, whether you believe me or not.

I also had an emergency hospital visit a few months ago. Multiple X-Rays, a CT scan, two surgeries and innumerable drugs. I don't have health insurance. Cost to me? Zero.

But then I live in Australia.

There is a lot of overhead in a hospital ER. You need medical equipment to handle all types of injury/trauma. You need advanced and very expensive diagnostic equipment (e.g. MRI, CT scanners). You need treatment/operating rooms and all the supplies. You need physicians and nurses and supporting staff. You need lab services. All of your patients arrive more more or less at random, unscheduled, so you can't really optimize any of it. It's probably the most expensive way to deliver medical care that you could think of. Even if it's only a minority of the care delivered, it's very expensive to deliver it.

I agree, yet other countries have and operate ERs at a fraction of the cost of the US simply by virtue of having single payer healthcare.

> You need medical equipment to handle all types of injury/trauma.

This is equipment that most hospitals already have for other reasons. It's not like they have ER MRIs that sit idle and then an MRI for everyone else.

Further, a lot of that diagnostic equipment simply isn't needed in most cases. For ER related problems, xray machines are commonly all that's actually needed. Those are fairly cheap in the grand scheme of things.

> You need physicians and nurses and supporting staff.

A lot of the need for that gets cut dramatically by having a single payer system. The reason we have big ERs is because they are required to treat before seeking payment. As a result, many uninsured and underinsured people are using the ER as a primary healthcare system. Give everyone 0 or low deductible healthcare and you'll see the number of ER visits drop dramatically.

That's probably true but a lot of medical cost is scheduled like follow up or specialist visits, surgery and things of the less urgent nature.

How is that solving the car crash situation?

The same way you don't get super gouged when choosing a restaurant while hangry - non-urgent shoppers keep prices down across the board, even for urgent participants.

I'm not saying this makes for some total solution - just reacting to rejection of the market dynamic having any worth. It's foolish to cast aside entire paradigms of approaches because they don't fully solve every corner case. (The dual would be to ask how single payer healthcare solves purely elective procedures like cosmetic surgery. It doesn't.)

Obviously any market dynamic for urgent care needs to recognize that no contract has been formed, and so hospitals can't unilaterally set charges under a fallacious idea of contract. For instance when your car gets towed under duress (accident on the highway, expired papers, etc), the state sets the rates they're allowed to charge. They're still inflated, but at least within a factor of 2-3x the usual market.

(FWIW I think single payer is a good pragmatic way forward)

I didn't mean to suggest that there shouldn't be the option to freely chose alternative treatment options under a free market model, in cases where you're not happy with what a single payer model would cover.

Rather my point was that when you need urgent or critical medical care there should be a baseline assurance of a solution to your predicament as you may not be in a position to shop around.

Your analogy with restaurants is not a good one, since you are unlikely to be in a situation where you're about to starve to death, and the only restaurant in town has 3 Michelin stars, grocery stores don't exist, and passers-by are not qualified to give you food :)

The problem is that we've taken on this hidden assumption that "free market" somehow means that a hospital can create an arbitrary bill for urgent care, and you have no choice but to pay it. That's not really intrinsic to the free market paradigm, but rather an orthogonal corruption pushed via the legal system.

In a different thread I pushed the lack of a contract argument, and got back a more fitting legal theory that hospitals are allowed to charge you under the idea that you not paying would be "unjust enrichment" - they treated you, incurred expenses doing so, and therefore its your responsibility to compensate them. But that still doesn't support them charging you some arbitrarily high price, rather just expecting to be reimbursed for their costs. And so such bills should actually be constrained by the lowest rate they have with contracted insurances.

As for the analogy, I've been pretty hangry to the point where I wouldn't have been able to form a contract. It was also just a more straightforward example than the overall food market still functioning even though we're all just three weeks away from starvation.

> It was also just a more straightforward example than the overall food market still functioning even though we're all just three weeks away from starvation.

Eh, the overall food market doesn't quite fit as an analogy here. I know I'm not alone when I say I have close to a year of food storage; it's not really the same for surprise healthcare bills.

There are still people who don't have such stores of food though. But sure, another example is a pedestrian with a gas can arriving at a gas station. The point is there are many things that are necessary for modern existence, yet there's a competitive market of not-completely-powerless actors keeping prices in check for the nearly-powerless ones. Healthcare is an outlier by being an extreme market failure, through both not enough regulation and too much regulation (that is to say, corruption).

(Although maybe with the rise of big surveillance and fine grained price discrimination we'll start to see these situations in other markets get exploited more)

It's not, but if 50% of your business cares about prices and 50% doesn't, that's still a lot of pressure to have competitive prices.

It sounds like this conversation needs a usage breakdown to see where most bills come from from a total price experienced perspective.

It seems like most people's greatest fear around hospitals is a surprise ER visit that blows through their savings.

Pricing transparency through a public ally available database would at least help with more competitive or uniform drug/scheduled treatment costs?

Some level of price transparency becomes law in under 2 weeks on 1/1/2021.

https://www.foley.com/en/insights/publications/2019/12/price...

I believe this was fought out in court this past summer and upheld.