I don’t disagree. But I’m not sure what alternative I have to hoping this might be the start of something.
In Ontario an ambulance trip is about $40. But in the US it can be crippling.
In Ontario an ambulance trip is about $40. But in the US it can be crippling.
Related to the rest of this thread, a family member was hurt at work about six months ago and needed a 12-mile ambulance ride. The ambulance company billed the company's insurance $1,400. The company's insurance actually paid a little over $300.
However, they're usually managed by air/rescue and therefor part of the fire department or equivalent.
Assuming that was under the deductible, so the ambulance provider did not get paid anything else, and $500 was the negotiated pricing for members of your insurance plan.
Hm? The insurer would've paid the difference (minus some additional discounts depending on the size of the insurer and its bargaining power). That the patient paid $500 does not in the slightest bit indicate that the insurer negotiated the rate down to that pricepoint.
Even at $500 (and let's assume that was an hour-long ride, for easy math that's maximally generous to your argument), EMTs on average make around $20/hour at best, and maybe double that for a nurse - so a fully staffed ambulance would run around $80/hour for labor. Round it up to $100 to be generous and that still leaves $400 for the ambulance itself. Ambulance itself costs up to $150,000, so earmarking another $100 would pay it off after 1,500 hours of service - so less than a year, even if it's only running for 40 hours a week. Maybe it's really fuel-inefficient and breaks down frequently, so we'll say another $100 for fuel and maintenance. Throw in another $100 to pay off $150,000 worth of equipment and medical supplies.
So of that $500 price the patient pays, we're left with $100. At the price billed to the insurer, that's an eye-watering $11,600 of what appears to be pure profit. Maybe there's some excuse for that, but to me it's pretty obvious that something's way out of whack. $500 or even a bit more than that would be reasonable if EMTs and nurses were being paid better, but they largely ain't.
I have no idea how much ambulances and personnel cost, but I do know that whatever the costs are, they have to be distributed amongst the emergency events.
An ambulance and redundant staffing is paid to be available 24/7, but there might only be 3 or 4 or 10 trips per day.
I assume there are also considerable liabilities and hence insurance costs.
That doesn't make the fact that they bill such a ridiculous amount in the first place any less unacceptable.
And if you're uninsured? Or your insurance refuses to cover it? Or it does, but with a high deductible?
My point is that the "well established practice" in question is useless at best and outright detrimental (to say the least) on society. Why even bother throwing out that number unless there's an expectation that someone would pay it?
I would have made the same statement if the government had paid the ambulance company $500, or if the government’s cost for providing that instance of ambulance service was $500.
Those workers are paid ~minimum wage, and the amortized cost of the vehicle and its equipment is not $500/ride.
The reason they charge $500, $800, or $12,000 is because ambulance firms have monopoly licenses, because you're not going to haggle over the price when one arrives, and because they can charge you whatever the hell they want, and when the dust settles, some people might even pay it.
Source: https://www.census.gov/library/publications/2021/demo/p60-27...
Again, I cannot stress enough how insane this sounds to someone from most other first-world countries.
Obviously, the $12k is ludicrous, proven by them being willing to accept $500 for people who belong to an insurance plan.
Health insurance in the US is not just insurance against a one time high cost event. One aspect of it is paying a business to gain access to lower pricing due to volume that you would be unable to get as an individual, which seemingly this person’s insurance plan did.
It only makes sense to talk about volume discounts when there is actual savings from providing volume (for example, less packaging). Many different instances of individual care do not create such savings, for anything but handling the make-work billing paperwork that this system itself generates.
This idea that individuals shouldn't be market participants is a broken assertion that underlies much of our healthcare dysfunction. In the situation you're describing, the "insurance" company has zero market leverage over the ambulance provider, and so you're championing a specious "negotiation". Meanwhile individuals that need a ride to the hospital avoid calling 911 since they have no idea what it will cost, and instead look to markets with price transparency to fill in (ie markets where they're welcome).
A straightforward healthcare reform would be to eliminate this cartel dynamic of providers having a different price for each "insurance" company, and mandate that they charge the same published prices regardless of who is paying. At that point, insurance companies would financially provide real insurance rather than their current function of bundling and obfuscating price signals. There would no longer be this "out of network" nonsense, but rather insurance coverage would be based on percentages of market prices. Insurance companies could then recommend providers that charge lower prices to save money for themselves and their customers, while still allowing their customers to be market participants when their preferences differ.
I do not assert this. I would much prefer transparent pricing and people being able to shop around.
> In the situation you're describing, the "insurance" company has zero market leverage over the ambulance provider, and so you're championing a specious "negotiation".
If this was true, then the ambulance company would not have accepted $500, and would instead demand the $12k they billed. It may be that the leverage is simply political or PR, but it must exist in order for them to come down from their fantasy list price.
I agree with your last paragraph, and that is the situation as of recent due to new laws passed about surprise billing and out of network restrictions for emergencies. As well as publicly listed prices.
Or are you at some point willing to admit that not everything should be a private, purely for profit/shareholder value, venture?
The fact that the insurance company can negotiate the bill to $500 indicates what the real price is. The $12k number is just fantasy numbers that healthcare providers throw out to start the negotiation.
That really depends on your definition of "real price", particularly considering how in a lot of developed countries that'd still be considered a pretty outrageous price to pay for such a situation, particularly while even having insurance.
It does not depend on who pays for it.
I did not intend to comment on who should or should not be liable for paying this price, simply that $500 seems like a reasonable price for an ambulance service.
btw many is cities can barely keep their dispatch for 911 staffed.
One of these things is not like the others.
There's no need for gun control once a society has implemented the other three; violence and suidice (with or without access to firearms) is a direct function of socioeconomic inequality - and I'm uncomfortable (to say the least) with disarming the very working class most impacted by said socioeconomic inequality at all, let alone before actually addressing that socioeconomic inequality.
Suicide is a direct function of depressive issues and circumstances that peaks on you at the same time you get that one too many "it's gonna be a bad day" piece of news. I'm a suicide survivor (I say survivor because I didn't attempt anything. I succeeded.) whose only alive because my bulldog lead my youngest brother to where I was outside as he had dropped by to see me. A lethal dose of methadone is 50mg. I took 500mg and washed it down with Jim Beam. I was legally dead three times (once in the ambulance and twice in the ICU). I'm not going to say it doesn't happen....giving someone with depression all kinds government reform will do exactly nothing to cure that depression. More affordable opportunity to seek mental health, sure...I'm with you. But even that is maybe 10% chance to prevent if they're down on a day when something happens. I had divorced as well as having my middle brother pass away within weeks of each other.
As far as violence? If you made everyone a millionaire today, there'd still be violence crime, hence violence to retaliate to that, tomorrow. Because people are never satisfied. And unless every physical asset was a cookie cutter model of every other item like it, people are going to be jealous of what someone else has. The best way to cure a lot of the violence is for people to leave each other alone and show some decency to each other.
Because people generally don't kill themselves or others for shits and giggles.
> Suicide is a direct function of depressive issues
Which largely go unnoticed, undiagnosed, and untreated until it's too late, in no small part due to the absolute shitshow that is mental healthcare access here in the US.
> and circumstances that peaks on you at the same time you get that one too many "it's gonna be a bad day" piece of news.
For large swaths of the American population, those pieces of bad news skew heavily toward socioeconomic circumstances. Job loss, debt (incl. medical debt), homelessness, being convicted of crimes because you couldn't afford any better than an already-far-overworked public defender... the list goes on. Even for the things outside that list, they become a lot easier to bear when you can actually afford some degree of treatment.
> giving someone with depression all kinds government reform will do exactly nothing to cure that depression
It will do everything to solve it in the vast majority of cases, and in the remainder of cases will at least prevent "I can't afford it" from being an excuse to get help.
> If you made everyone a millionaire today, there'd still be violence crime
There would be a hell of a lot less of it.
> The best way to cure a lot of the violence is for people to leave each other alone and show some decency to each other.
Which is a lot easier to do when you don't have to resort to crime for basic survival.
Does that imply you'd support an armed insurrection? That seems pretty extreme! And if not, then why exactly do these people need guns?
It implies that I support the right to self defense - including against an oppressive regime and the enforcers thereof. Specifically, it implies that I support the exercise of that right among the class of people typically excluded from it. Violence is the last resort, but it is a resort nonetheless.
"Under no pretext should arms and ammunition be surrendered; any attempt to disarm the workers must be frustrated, by force if necessary" -- Karl Marx
"That rifle on the wall of the labourer's cottage or working class flat is the symbol of democracy. It is our job to see that it stays there." -- George Orwell
"A man's rights rest in three boxes. The ballot box, jury box and the cartridge box." -- Frederick Douglass
> And if not, then why exactly do these people need guns?
Because even when a government is not actively oppressing its people, it is demonstrably (with considerable regularity) incapable of protecting each and every one of its citizens from one another. Like the saying goes: when seconds count, the police are an hour away. Every person has the right to ensure one's own safety and security, even if their government can't or won't ensure it for them.
And that's entirely ignoring things like non-combative use of firearms, like hunting or pest control or defense against predators or marksmanship or what have you. Quite frankly: the purpose for one's ownership of a firearm is the business of none but oneself.
I can potentially see this in rural areas. Not so much in urban areas, where the police are much nearer and it seems that the guns are the main conveyer of harm.
I don't think you can ignore that they are also used in offence, not just defence. I live in the UK and I don't need a gun to defend myself, because any attacker is extremely unlikely to have one either (because the penalty for even being found carrying one is so severe that it's not worth the risk for them). One of the best ways in which a government can protect its' citizens from each other is removing dangerous weapons from their possession!
I guess my question is: what are you scared of? To my mind the most likely thing to be a victim of is burglary, in which case isn't it much better to just let the robbery take place (and then claim on insurance) while being safe and unharmed than to risk being shot in an armed conflict? Seems to me you make yourself less safe not safer by bringing guns into the equation.
Unless you have a cop on every street corner (and even then), you wouldn't have enough coverage for cop intervention to be something upon which you can rely for your own safety. At best, they might catch your assailant after you're already dead.
> I live in the UK and I don't need a gun to defend myself, because any attacker is extremely unlikely to have one either
You're ignoring the vast differences in available socioeconomic safety nets between the US and the UK. The UK's still pretty shitty on those metrics (which is why there's no shortage of violent crime), but it's certainly better than here in the US.
> I guess my question is: what are you scared of?
I'm scared of my government deciding that it's time to round up everyone of $ETHNICITY or $RELIGION or $IDEOLOGY or $SEXUALITY or what have you and send them off to internment camps. I'm scared of white supremacists deciding it's time to bring lynch mobs back into fashion. I'm scared of the ownership class using the state to coerce (with increasing severity) the working class into continuing to work despite continuing to get the increasingly short end of the stick. I'm scared of theocrats deciding that "separation of church and state" is no longer necessary and therefore empowering themselves to impose their own religion (or more precisely: a very twisted and corrupted version of it) on every other American. I'm scared of GSRMs losing the rights we had just so recently won.
> isn't it much better to just let the robbery take place (and then claim on insurance)
It would be much better to deter the robbery in the first place. It would be much better than that to give people a safety net such that they don't have to resort to robbery in the first place.