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Comment by jdminhbg | Hacker News Reader

I wasn't going to respond to this to avoid prolonging this burgeoning off-topic health care flamewar, but I figured that in the name of cross-cultural understanding, I'd correct you:

Hospitals in the US are obligated to treat any emergency patient regardless of whether they can pay.

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The problem with that is that emergency care is absurdly expensive. I was in an accident last year that put me in hospital for one night for observation, and I was billed almost $20k. Where illness rather than accident is the problem, people postpone going to a doctor or hospital until they are really ill, even though it would be much cheaper to address a minor illness before it becomes a medical emergency - a stitch in time saves nine, and all that. But people without insurance find access to non-emergency care difficult because of cost, and so the emergency spend half their resources dealing with completely avoidable medical problems.

And even if you do have insurance or the ability to pay, or (AFAIK) if a hospital waives payment for someone indigent, there's still a metric ton of paperwork to be filled out, which makes doing my taxes seem simple and fun by comparison. Don't even get me started on the catastrophically bad state of medical record-keeping.

They then charge those people least able to pay a higher rate, add interest, and turn it over to a collection agency.

http://www.democracynow.org/2012/2/15/new_york_hospitals_sad...

http://www.democracynow.org/2004/1/7/state_secret_why_are_un...

[somehow Democracy Now seems appropriate for a Stallman discussion]

This isn't entirely true and varies from state to state and hospital to hospital. We had a trip to the hospital last year (non-ambulance, but was an actual emergency). Prior to checking out, we refused to sign anything from the hospital itself until checkout time. (quick sidebar, I've never seen anything as sleazy as an administrator trying to get someone who's heavily sedated and mediated but hasn't been fully diagnosed yet (triage and stabilization only) to sign paperwork related to billing and insurance, and then to authorize a room change to long term and the to an overnight room...all before they even knew what was going on). At checkout time, they had no insurance info...if we had no insurance, they would consolidate the fees from all groups (contracted doctors, anasthesiologists, equipment use, medications, etc.) and waive 2/3 of it and set up a payment plan (non-loan style, so no interest, or fees). This total was lower than if we used insurance and paid what was remaining on the deductible for the year and happened late enough that we wouldn't have benefited from using the insurance. I have no idea if it was attitude, handling it like business, persistence or just how they do business, but it greatly impressed me.

Medical Care != ER

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