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Our (then 17 month old) son was having (apparently) an asthma attack back in March. We first brought him into our pediatrician’s office, who treated him with an inhaler and observed him for an hour. Upon not improving much from these treatments, our pediatrician suggested we bring him to the emergency room where he could receive regular treatments until his breathing improved and his blood oxygen levels returned to normal.

Without commenting on the actual experience, I wanted to share a little bit of the billing details with my dear readers.

  1. Here it is in mid-July, and we have yet to pay a penny to anyone.
  2. But we will have to pay a considerable amount. I do not mind this, I expect to pay for services rendered. However, I also expect that when I ask what price a particular service would be, I am afforded a ballpark estimate before embarking. While our son was in the ER, he was administered several treatments, and after 10 hours or so in an ER curtain (shared of course) our doctor wanted to admit him for the night. During the night he largely slept well, recovered quickly and we were released the next day. All told, he received about 10 treatments, which would cost about $100 (my guess) if we administered at home, he had a chest x-ray done, had some blood drawn and tested, and stayed the night. There was never an indication to me what any of this would cost us while it was happening.
  3. I happen to have a high deductible HSA policy – so I am one of those fools that is supposed to be sensitive to medical costs and respond to them. But you cannot respond to prices if you do not know them. Here I am in July and I just learned what the services cost me. I am positive that my prices are different than the patient next to us in the ER and hospital room that night (it appeared several did not have insurance) and different than other patients receiving the same treatment. Here are the costs of the services rendered for less than 24 hours in the ER and a peds  bed:
    1. Room and Board: $935
    2. Pharmacy: $58.40
    3. Lab: $435
    4. XRAY: $126
    5. Outpatient: $1216
    6. Pharmacy: $11.28

    For a healthy total of $2,781.68. Since we have a high deductible policy, we will be paying most of that. Now, I have no idea what the true incremental costs of serving us were, or what prices hospitals need to charge to recover their investments in advanced medical technologies. But clearly if we had known that being admitted would cost $1,000 we would have tried to make other arrangements. What is the $1,216 for being an outpatient? I suppose that is the cost of sitting in the ER with the 30 or so other children that were in there – most with far more serious problems than our son. Those are the two line items that I suspect are adjusted based on who is doing the paying. The problem for those folks who believe we can move to a medical system where less than 80% of the expenses are paid by the customers themselves is that a huge overhaul of the billing system needs to be overhauled, and attitudes of doctors and nurses need to change dramatically in order to encourage them to provide patients with information on costs as well as likely outcomes and medical importance of various procedures. If you ever spend much time in a doctor’s office or an ER, I suspect you might be as skeptical as I am about that ever happening.

Here is a new paper discussing huge hospital price increases in California. They are as flummoxed as I am.

5 Responses to “One Night in the Emergency Room”

  1. Harry says:


    I almost had a chance to serve on a hospital board of directors when my friend, a doctor was on the way out as chairman, and in any case I think I was blackballed because I had the same sort of questions.

    I’ve wondered about whether, say, I checked into the Waldorf, not a suite, but whatever big nice room they had, and called a doctor and nurse to attend, at New York prices. You hire a messinger for $200 to ferry the blood to a lab, and bring back the results. The Doctor costs you a thousand, and the nurse $500, so the doctor, nurse, and messenger are paid $1700 and your spacious room at the Waldorf is another $300, so we are up to near what you paid. Ok, the x-ray with the radiologist reading it may have cost another hundred.

    But then you would have been in a big room at the Waldorf, not with a curtain between you and another groaning patient, and would have had a private nurse, and a doctor who would get a thousand dollars to talk with with your son and you and your wife extensively.

    I’m as puzzled as you are.

  2. jb says:

    Sadly it would appear your concerns are moot. Congress is preparing to abolish HSAs anyway:

    It’s Not An Option
    By INVESTOR’S BUSINESS DAILY | Posted Wednesday, July 15, 2009 4:20 PM PT

    Congress: It didn’t take long to run into an “uh-oh” moment when reading the House’s “health care for all Americans” bill. Right there on Page 16 is a provision making individual private medical insurance illegal.

    When we first saw the paragraph Tuesday, just after the 1,018-page document was released, we thought we surely must be misreading it. So we sought help from the House Ways and Means Committee.

    It turns out we were right: The provision would indeed outlaw individual private coverage. Under the Orwellian header of “Protecting The Choice To Keep Current Coverage,” the “Limitation On New Enrollment” section of the bill clearly states:

    “Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day” of the year the legislation becomes law.

    So we can all keep our coverage, just as promised — with, of course, exceptions: Those who currently have private individual coverage won’t be able to change it. Nor will those who leave a company to work for themselves be free to buy individual plans from private carriers.

    From the beginning, opponents of the public option plan have warned that if the government gets into the business of offering subsidized health insurance coverage, the private insurance market will wither. Drawn by a public option that will be 30% to 40% cheaper than their current premiums because taxpayers will be funding it, employers will gladly scrap their private plans and go with Washington’s coverage.

    The nonpartisan Lewin Group estimated in April that 120 million or more Americans could lose their group coverage at work and end up in such a program. That would leave private carriers with 50 million or fewer customers. This could cause the market to, as Lewin Vice President John Sheils put it, “fizzle out altogether.”

    What wasn’t known until now is that the bill itself will kill the market for private individual coverage by not letting any new policies be written after the public option becomes law.

    The legislation is also likely to finish off health savings accounts, a goal that Democrats have had for years. They want to crush that alternative because nothing gives individuals more control over their medical care, and the government less, than HSAs.

    With HSAs out of the way, a key obstacle to the left’s expansion of the welfare state will be removed.

    The public option won’t be an option for many, but rather a mandate for buying government care. A free people should be outraged at this advance of soft tyranny.

    Washington does not have the constitutional or moral authority to outlaw private markets in which parties voluntarily participate. It shouldn’t be killing business opportunities, or limiting choices, or legislating major changes in Americans’ lives.

    It took just 16 pages of reading to find this naked attempt by the political powers to increase their reach. It’s scary to think how many more breaches of liberty we’ll come across in the final 1,002.

  3. jb says:

    Sorry to “monopolize” the space, (no pun intended) but it occurs to me… Regarding Obama’s absurd argument that offering a government provided health insurance option will provide consumers with “greater choice” and “competition” amidst a sea of existing private health care plans…

    But it’s not ok for even a single private school in Washington D.C. to receive support through vouchers in order to compete with what is irrefutably a government monopoly? Huh?

  4. Marie Moore says:

    In April 2010, my son spent the night in an emergency room in California, and the total cost, not counting tests, was $26,000. They wanted to keep him for another night because he was insured, but he checked himself out because it was by then clear that he didn’t have appendicitis. Not $2,600 – $26,000.

  5. […] might cost to have our son admitted overnight to the hospital during a recent asthma attack – and it took two years for us to learn. The new health care reform act not only ignores this, it actually makes the problem worse. Thank […]

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