Some months ago, I was awakened by my wife to see my daughter having a very bad nosebleed in the middle of the night. She was sick, had a fever and now, a nosebleed. My wife and I had seen my daughter with nosebleeds before from digital exploration of her nose. But nothing like this.
So we all went to the nearest emergency room to get some help and see what was up with my daughter. If it were just me, I’d be dressed and gone in less than 5 minutes. But small kids require a lot of extra attention and care just to get anywhere. It is a difficult transition for small kids to make because they are learning everything, all the time. If they knew what to do, then they would just do it. And then there is decision fatigue. Late afternoons are difficult. The middle of the night only more so.
When we finally arrived at the ER, there was nobody there. Nobody waiting, nobody at the desk to check in. Crickets. But there we were, looking for someone to assist. By then the bleeding had stopped, but her nosebleed was impressive and we wanted to be sure there weren’t any serious problems brewing.
About 10 minutes into our visit, someone finally appeared to help out. Then we signed in and were shown to an exam room. Then we waited. And waited. Is this the ER that I’ve seen on TV? Nope. Late night in a small town (relative to LA), and there isn’t much going on.
Finally, a nurse came, and then a doctor. They gave my daughter some pain relievers and she checked out to be just fine after more than an hour of observation. We were relieved to learn that there was nothing serious going on with my daughter.
A couple of weeks later, I get a call from their billing department. I learn that I owe the hospital $500. Well, $497 to be more precise, but I’m rounding up. I hadn’t even received an invoice or statement or anything. Huh. My insurance card says, “Urgent Care: $50”. Why am I getting this big bill? I don’t really know who the caller is, so I say that I’m not ready to pay yet.
A couple more days roll by and I finally get a statement. I read the statement to find that the total cost was $1,100 and that the insurance had chipped in. I wait a little while longer to respond because I already got a ton of stuff going on. My basement is almost done and I want to see how that settles out. I have an expectation of what I will pay per contract, but I am worried that I’m going to be hit with change orders.
My wife mentions the statement one day. Then again the next day. Then I finally relent and call them to get a better picture of what is going on. Then I call the insurance. I mention the text on my card. “Oh that? That’s for walk-ins to clinics, not the ER. We’ve paid all we’re going to pay.”
So I read the fine print at the bottom of the statement. There is a 25% discount if the bill is paid within 14 days of the statement date. Then I call the billing department and ask about the discount, even if the discount is expired by a few days. They agree to give me the discount, as discussed. Then I ask my wife if we can pay it all at once with the discount. We do. We’re done and that cost was $373 instead of $497.
Most people in America don’t have the money in the bank to shell that out all at once as we did. In January of this year, CNBC reported that only 39% of Americans have enough savings to cover a $1,000 emergency:
According to Bankrate’s latest financial security index survey, 34 percent of American households experienced a major unexpected expense over the past year. However, only 39 percent of survey respondents said they would be able to cover a $1,000 setback using their savings.
Add to that the uncertainty that everyone experiences at the ER, and we might as well say that the ER is a casino where the house always wins. There is no transparency at the ER. There is no sign at the door that says:
This trip will cost at least $1,100. Good luck.
All that for an exam and some ibuprofen? This is the outcome of public policy decisions made by people with the most influence. Hey, there’s that phrase in my mind again, “Stake based voting”. The people with the most money had the most influence to make this outcome possible.
Doctors have influence in Congress through the AMA and other associations, we’ll call them “unions” because that is what they are, in a very real, if not overt sense. Doctors have used their influence to limit the number of doctors who can practice in the United States to ensure that the average doctor can pull down $250k a year in America. Land of the free.
Those same doctors also have enough influence to get the US to implement a trade policy that suppresses the wages of most Americans. American doctors are protected from international competition. Our manufacturing jobs are not. The trade deficit we have with the world is not just how economics is supposed to work, it is a feature of our trade agreements. How else can you explain why the median income in America is $30,000 a year? That is also an outcome based on public policy decisions.
I could go on, but it’s clear that it’s all business all the time in America. A free market is transparent. The health care market is not. I know. I’ve tried and failed to find out how much a procedure is going to cost before we do it. No matter how much research I did, the best answer I could ever get was, “you’ll have to wait until you get the bill”. Can you think of any other industry that acts this way? If not, then you know how much political power the health care lobby has.
I’m not sure what the answer is to this problem, but I think it’s fair to say that the high cost of an emergency room visit has more to do with public policy decisions that most ordinary people have near zero influence over.
Originally published on my other blog on Steemit.com. Revised for clarity, grammar and new ideas that came to me during editing.