I feel like we are rapidly reaching jump ship level. My own sister (in her 40s with 4 kids and natural born Texas/US citizen) is actively migrating her family to Canada next year. Her daughter with a clef pallet cost her family 90K last year WITH insurance. Her husband makes $150K a year, so they managed...but Christ! My sister is so serious that she already submitted all her immigration papers and is waiting to hear back.
I work in a clinic. The ER at the hospital I work for has sent critical patients to our clinic because they 1) apparently have no staff that know how to evaluate for a emergency (I say this having 8 years ER experience under my belt). I had a patient go to the ER twice in 24 hours for urinary pain, bleeding 1 week post op. They sent him to the clinic pale AF, orthostatic blood pressure 80/40, bladder scan showed 330 after voiding (ended up being a giant number of clots that I got to try to hand irrigate in the OFFICE!). The ER did a UA at both visits and NOTHING ELSE.
You might want to say this is my institution in particular...however I haven't held a job at 1 institution for more than 3 years. I've traveled. So, yes, there are better and worse.....but they are ALL getting worse. Process improvement usually involve trying to make up care gaps with unlicensed, under educated, unqualified people OR have one qualified person do the work of 3-4 people (both of which create gross care gaps).
I wish I could go with my sister. This has only gotten worse in the 15 years I've been a nurse. I'm not proud of my field.
Specializes in NICU, PICU, Transport, L&D, Hospice.
floydnightingale said:
Living in a city just south of Canada (that should be a giveaway as to where I am), the neighboring Canadian city lacks a minimally serviceable health care infrastructure, their nurses would rather cross the border than work at home and they all shun Canadian care and bring themselves and their families across the bridge when they're sick. Having said that, if she's paying $90K AFTER insurance I can't blame her, but I don't think emigrating to Canada is easy. The whole world is sneaking into the US but Canada doesn't play that.
While anecdote is interesting, Canada spends less on care and has better health outcomes than the USA.
After getting some lab tests and three IV bags, Adams was hit with a multiple-thousand-dollar bill post-insurance. "Yes folks. THIS is America. Land of the free, and home of the medical bankruptcy,” he said, noting that he opted for a monthly plan to manage tackling the large payment.
Quote
In a subsequent interview with Business Insider, Adams describes how "mentally taxing" it was, trying to figure out the reason for his bill. "If I'm in this situation with my knowledge and with my financial resources and with my bully pulpit, then the average Joe doesn't stand a chance. The system is just broken,” Adams told the outlet. Going on to explain that his stay was deemed a Level 5 visit, the most extreme classification that requires more intensive care, Adams said he contested the bill in part because he thought his visit should receive a lower-level code.
Adams noted that his struggle with the health care system is a sign of a larger problem posed to most Americans. "While I can manage this, even as a physician, a $5K surprise bill is unsettling, and such an expense is financially crippling for most Americans,” he tweeted, adding that it's no surprise that medical debt is "the top cause of bankruptcy in the U.S.” Indeed, almost half of U.S. adults (41%), or more than 100 million people, have been burdened with medical bills they can't foot, per analysis from a KFF Health News investigation with NPR and CBS News. While pervasive, the debt isn't spread across the nation equally, as Black Americans are "50% as likely as whites to owe money for medical care,” according to the investigation
There are huge disparities in the cost of care. The ER where I worked wasn't into that gouging people for $4K Tylenols but too many are. My own experience involved a night of vomiting and diarrhea so on my day off I stood in line to pay taxes and then went to the ED to have a coworker start an IV but I made the mistake of sticking a pulse ox on my finger and she saw the 150bpm heartrate and was like oh hell no you're being seen. That meant a monitored bed and I was more orthostatic than I've ever seen but I triaged myself to the lowest acuity (cheapest) area (nobody challenged that decision) and after 3 1/2 bags of NS I made some urine. Looking at the bill I got, the IV start was less than I pay for an oil change. I think the whole visit billed my insurer about $2K, I'd estimate it would've been twice that if I followed protocol and put myself on a monitor. My only regret was the spot I chose ended up with some loud people in the hallway on the other side of the curtain, should've pushed myself down the hall for some quiet.
What's really criminal is Zuckerberg Hospital, the only level one in SF. I don't know how much he has to do with their policy, they changed the name after he gave them money, but they're set up to only take Medicaid and Medicare (???, I know) and deny all private insurance. A simple visit that involves some basic imaging or a CT will easily be five figures and they'll dog you until it's paid. Completely unpardonable, but it doesn't have to be like that.
But, more to this point. I'm well aware of our profit driven system, however unlike some of you, I think the reach extends beyond one system. I think it's multi-system driven, not just political.
I'll take that one step further - an immediate overhaul to our profit driven healthcare system would likely cause our economy to implode.
There was a article in Medpage last week from a doc who's patient in rural Maine had an $88, 000 helicopter bill. The company is reluctant to compromise.
There was a article in Medpage last week from a doc who's patient in rural Maine had an $88, 000 helicopter bill. The company is reluctant to compromise.
Because they don't have to. The No Surprises Act does not apply to ambulances or air ambulances. They can charge what they want. You have very limited recourse to deal with such a bill especially if you own a house as in some states they can place a lien on your house. Even if you wanted to declare bankruptcy your state determines how much of your house is shielded from bankruptcy. In mine, only $90K and most houses are worth several hundred thousand so if you have any assets you are trapped.
I was doing my laundry one night and at first I thought there was maybe dust in it, luckily I turned the light on and found a bat in my washing machine. Then after figuring out how to safely remove it, I realized how fortunate that I hadn't reached in without thinking as the cost of a rabies vaccine in America can be over 10K to even 14K and will your insurance pay for it! You have to go to the ER as they are the only ones that carry the rabies vaccine and get charged an ER copay for each visit. God only knows what that would have cost and I had just switched to a Bronze high deductible Obamacare plan vs Cobra. https://www.vox.com/policy-and-politics/2018/2/7/16851134/rabies-treament-expensive-emergency-room
I later learned the hard way do not have a high deductible Obamacare plan as they will screw you if you ever need ER care. When I ended up in the ER for anaphylaxis for wasps the discount was a flat fee, less than 1K, a win-win for insurance and hospital system to screw the patient! I learned to get the silver plan, what a waste of money though, the whole ER visit was over 5K plus an ambulance bill over 1K that the high deductible Bronze plan said was out of network so paid nothing, but if I had the Silver plan would have been in network. They really go out of their way to screw the patient any way they can!
I can't wait till I can get decent insurance of medicare. I just hope I can afford it when the time comes as I don't want to be stuck with Medicare Disadvantage! It's sad that Medicare is the closest thing to National Healthcare in that you can go to any Dr and anywhere in the country, but that assumes you live to 65 and that you can afford it.
If you can't afford it you get the bait and switch Medicare Disadvantage where the insurance companies dictate your care and make a profit thru delay and denial and flout medicare rules while CMS and Congress ignore the situation while patients' lives are literally on the line! More insurance companies are lining up to join and expand MA because they make the most profit in it versus any other plan and that is by delay and denial and not following medicare rules while CMS and Congress look the other way. Oh they protest a little and give a slap on the wrist and then it's just business as usual, so beware do not get a Medicare Disadvantage plan if you can afford regular Medicare because your life could be on the line!
Because they don't have to. The No Surprises Act does not apply to ambulances or air ambulances. They can charge what they want. You have very limited recourse to deal with such a bill especially if you own a house as in some states they can place a lien on your house. Even if you wanted to declare bankruptcy your state determines how much of your house is shielded from bankruptcy. In mine, only $90K and most houses are worth several hundred thousand so if you have any assets you are trapped.
I was doing my laundry one night and at first I thought there was maybe dust in it, luckily I turned the light on and found a bat in my washing machine. Then after figuring out how to safely remove it, I realized how fortunate that I hadn't reached in without thinking as the cost of a rabies vaccine in America can be over 10K to even 14K and will your insurance pay for it! You have to go to the ER as they are the only ones that carry the rabies vaccine and get charged an ER copay for each visit. God only knows what that would have cost and I had just switched to a Bronze high deductible Obamacare plan vs Cobra. https://www.vox.com/policy-and-politics/2018/2/7/16851134/rabies-treament-expensive-emergency-room
I later learned the hard way do not have a high deductible Obamacare plan as they will screw you if you ever need ER care. When I ended up in the ER for anaphylaxis for wasps the discount was a flat fee, less than 1K, a win-win for insurance and hospital system to screw the patient! I learned to get the silver plan, what a waste of money though, the whole ER visit was over 5K plus an ambulance bill over 1K that the high deductible Bronze plan said was out of network so paid nothing, but if I had the Silver plan would have been in network. They really go out of their way to screw the patient any way they can!
I can't wait till I can get decent insurance of medicare. I just hope I can afford it when the time comes as I don't want to be stuck with Medicare Disadvantage! It's sad that Medicare is the closest thing to National Healthcare in that you can go to any Dr and anywhere in the country, but that assumes you live to 65 and that you can afford it.
If you can't afford it you get the bait and switch Medicare Disadvantage where the insurance companies dictate your care and make a profit thru delay and denial and flout medicare rules while CMS and Congress ignore the situation while patients' lives are literally on the line! More insurance companies are lining up to join and expand MA because they make the most profit in it versus any other plan and that is by delay and denial and not following medicare rules while CMS and Congress look the other way. Oh they protest a little and give a slap on the wrist and then it's just business as usual, so beware do not get a Medicare Disadvantage plan if you can afford regular Medicare because your life could be on the line!
I'm feeling so lucky now:) My recent ambulance ride to the ER was only $800 for a 5 minute ride that I can do on my bike in 10. My feet will be off the ground for the rest of the day and I'll give a thumbs up to my higher power for giving me gratitude again.
Specializes in Surgical Specialty Clinic - Ambulatory Care.
floydnightingale said:
There are huge disparities in the cost of care. The ER where I worked wasn't into that gouging people for $4K Tylenols but too many are. My own experience involved a night of vomiting and diarrhea so on my day off I stood in line to pay taxes and then went to the ED to have a coworker start an IV but I made the mistake of sticking a pulse ox on my finger and she saw the 150bpm heartrate and was like oh hell no you're being seen. That meant a monitored bed and I was more orthostatic than I've ever seen but I triaged myself to the lowest acuity (cheapest) area (nobody challenged that decision) and after 3 1/2 bags of NS I made some urine. Looking at the bill I got, the IV start was less than I pay for an oil change. I think the whole visit billed my insurer about $2K, I'd estimate it would've been twice that if I followed protocol and put myself on a monitor. My only regret was the spot I chose ended up with some loud people in the hallway on the other side of the curtain, should've pushed myself down the hall for some quiet.
What's really criminal is Zuckerberg Hospital, the only level one in SF. I don't know how much he has to do with their policy, they changed the name after he gave them money, but they're set up to only take Medicaid and Medicare (???, I know) and deny all private insurance. A simple visit that involves some basic imaging or a CT will easily be five figures and they'll dog you until it's paid. Completely unpardonable, but it doesn't have to be like that.
Floyd, have admit here, you sound a little nuts. You went to the ER you work at, was able to not get yourself fully triaged (cause it sounds like IF you were the average Joe coming in off the street you would have been a far higher level of care than you were able to make yourself) and are happy with a 2K bill?!
Your argument is that healthcare in the U.S. is better and sustainable because YOU manipulated a system you have more familiarity with than most to get a lower bill? Sorry sir, that is hardly an argument. On average at a decent hospital with standards a middle aged man (just guessing, maybe young man?) comes in to the ED with nausea, vomiting, diarrhea, HR in the 150s and orthostatic is going to get a line, fluids, a monitor, an EKG, CBC and BMP or CMP.....possibly a troponin x 2 which means at least a 3-6 hour stay since most places I worked at required 3 hours between trops.
Also the statement "made the mistake of sticking a pulse OX on my finger....is there an urgent care or ER that doesn't record a full set of vitals? Is your argument that the average lay person shouldn't allow themselves to be fully assessed? What am I missing because I don't believe that made much sense?
toomuchbaloney
16,033 Posts
While anecdote is interesting, Canada spends less on care and has better health outcomes than the USA.
https://www.nber.org/bah/fall07/comparing-us-and-canadian-health-care-systems#:~:text=Canada spends far less of,mortality rate and life expectancy.
Our health system is unsustainable and expensive. Our health outcomes are in decline.