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Comment by bluGill | Hacker News Reader

We are talking about ER rooms here: people who need ER services are not in a position to do any sort of shopping around. When seconds count you cannot afford the minutes needed to get to the next ER. In theory it is possible that one is significantly better and so it would be worth the time, but in practice all the ERs in any given area are going to be not very different in ability to provide care. Even if the closer ER transfers you to the other getting to the first in time started care sooner.

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> We are talking about ER rooms here: people who need ER services are not in a position to do any sort of shopping around.

Yup. In 2006, I was in a serious bicycle accident in San Francisco w/ some head trauma. SF General was the only hospital in the area with a (Level 1?) ER that treats head trauma. I also had two broken arms. Even though I was in shock, I remember very clearly asking everyone involved in getting me from the accident site to the ER if SF General accepts Blue Cross, my insurance carrier. I was more concerned with facing a giant bill than my own health. Eventually someone said they do take Blue Cross, and I stopped worrying.

Later I came to find out that SF General bills Blue Cross, but they do not have a contract with Blue Cross. 100% of my treatment was out of network. Then I got a bill for about 50,000 USD. Between that, trying to pay for physical therapy, and a disruption to ability to earn a living at the job that paid for my healthcare, I struggled for a long time after the accident.

Were you able to negotiate that 50,000 bill down?

Eventually, yes. It took more than a year, and I eventually had to ask Gavin Newsom, the Mayor of San Francisco, for help. I highly recommend never having to negotiate how much you owe to multiple healthcare providers, unless you enjoy red tape & misery.

Isn't that in category of fraud? They lied you about pricing.

The people I was asking were ambulance drivers, paramedics, nurses, etc. They weren't prepared to answer questions about the nuances of insurance agreements the hospital has with random insurance companies. I can't blame them. And it's completely possible I was not asking the question in a precise enough answer to get the information I needed.

My main point was that your basically screwed before you arrive, and you're just gonna have to cope with it after the fact. Expecting a patient going into an emergency room to understand, or have the capacity to, navigate "the fine print" stuff is not realistic, yet that's exactly what they expect that patient to do. It is quite lame.

That does not really excuse the institution and a company might be fined in similar circumstance. It is not really random that you don't have a choice and nurse can't answer pricing issues correctly. Both don't just randomly happen to be beneficial for hospital. A lot of financial fraud by larger I stitutuon work exactly that way - put low level employees into situation where they are frauding either without knowing or by default or under pressure.

If all management has to do is look the other way and collect benefit (and eventually blame paramedic), they will look the other way and punish employees who took longer to get you to hospital - cause you prefered cheaper one a bit further away.

I don't expect injured patient to protect himself perfectly. However, I think we would all benefit if we labeled what happened to you accurately - a kind of fraud - instead of pretending it is ok, because system works that way.

If you're using ERs for what they should be used for, then yeah, you're in shock, or bleeding out, or in mortal peril.

Many people do not use them correctly; I can't blame them sometimes, when that's the only option around, but there's a whole host of issues people drift into ERs for that ought to be solved by an aspirin and a night's sleep, or an urgent care clinic. In the past five years, there's been a huge explosion of Convenient MDs and the like springing up everywhere; honestly, if you just had a nurse practitioner or PA assigned or on-call at Rite-Aids or CVSs to write scripts for no-brainer prescription medications, you'd solve half the healthcare problems people deal with.

And you have conservatives in this country saying that the poor have access to health care anytime they want by using the emergency room. These are the same people who complain about the poor buying steaks with food stamps and still suggest the poor use the most expensive form of health care rather than ensuring a basic minimum of care be allowed for all citizens.

Be careful of that though. I recently went to the ER for "chest pain" it wasn't a heart attack, and I had every reason to believe before I went that it was just a listed side effect of my medication. However since it was chest pain I couldn't ignore it. This is not unusual, ~60% of ER chest pain visits are nothing. (I suspect that increasing that number to 75% would be a good thing as it would mean a few more people come in when it is something)

It turns out this isn't the case. London recently reorganized stroke services because it was shown that survival rates were much better if patients could be taken directly to a specialist unit, and now if you're suspected of having a stroke you'll go straight to one of 8 hyper-acute centers.

It's a perfect candidate for a socialized program. We all pay a tax to guarantee that ERs are available and equipped for everyone at a moment's notice.

Not to mentioned it's already a socialized program... who foots the bill when nobody pays? Me & you.

This is something that really bugs me about the socialized medicine debate in the US. We've had socialized medicine since the law was passed in 1986 that said ERs couldn't turn people away. Everything since then has just been a debate about how to socialize it and how to pay for it.

I would say the current rules are not socialized in any sort of good faith method. Certainly not in a way that provides transparency of costs and effectiveness. Nor in any way how a socialized universal healthcare system would approach it.

I 100% agree with you. Our capitalist overlords are resisting the intelligent socialization of an already poorly socialized program.

Then what happens is everyone without insurance will go to ER for every little issue. Which is kind of what is informally happening now anyway.

Medicare pays cost based rates (for all services) to small rural hospitals in part to ensure this. "Critical access hospital" is the keyword if you want to read more.

> Medicare pays cost based rates (for all services) to small rural hospitals in part to ensure this. "Critical access hospital" is the keyword if you want to read more.

They pay extra to small hospitals that don't receive enough privately-insured patients to break even on standard Medicare reimbursement rates. For other hospitals, they pay rates that are below-cost, and hospitals charge private insurers extra to make up the difference.

Was this for another comment? I don't think I was suggesting any sort of shopping around solution...

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