Two days before his wedding this past April, a man called Cameron Fischer got very drunk at his bachelor party, felt very ill, and had to go to an emergency room. His medical bill that was initially $12,460, all told, just to be re-hydrated .That was more than twice the cost of his wedding.

There are few constraints on how emergency rooms set prices. Hospitals have jacked up rates and are coding patient visits as more complex than they used to be, which increases the payments they receive from insurance plans. The result: ER services have some of the fastest-growing prices in the health care system.

Many health economists think free-standing ER facilities, like the one Fischer visited — which are banned in many states but thriving in Colorado — are particularly culpable. While such ERs maintain that they can’t survive on rates paid by Medicare and Medicaid, data suggest they are profit-seeking engines built primarily in high-income ZIP codes.  Why?  Because they can get away with it.

In Fischer’s case he was given an IV, two bags of saline and a dose of Zofran, an anti-nausea medication.  Then she drew blood (why he didn’t know, but it cost $500 for a complete blood count; $20 in a doctor’s office). He left only 45 minutes later.  Later he received the bill, including  a $7,644 “facility fee”, an expense that hospital systems charge to cover their overhead costs of keeping an ER open 24 hours a day and ready for any emergency. There are no limitations on the facility fees that they can charge, and the charges nearly doubled from 2009 to 2016, outpacing overall health spending four times over. In Colorado, the average facility fee charged for a Level 4 visit grew from $1,064 to $2,336.  Insurance companies apparently paid out an average of $1,754 for a Level 4 facility fee in 2018.

The fact is that Emergency rooms tend to lose money on critically ill patients, as well as on Medicare, Medicaid and uninsured patients, and try to make up the difference with less sick, privately insured patients, like Fischer.

For Fischer, the negotiated rates under his health plan knocked the $12,460 bill down to $4,694. The plan paid $2,102. That left Fischer with a bill of $2,593, an amount he says he cannot afford to pay. “That’s quite the expensive bachelor party,” Fischer is quoted as saying.

(An edited version of an article from Kaiser Health News, a non-profit with no links to Kaiser Permanente.  22 Sept 2019)

My comment:  A few years ago, concerned that my (American) GP would stay in business-as-usual, I asked him ‘if he was making enough money out of my wife and I myself as patients (Epicurean question). If not, let us talk about it.’ Slightly surprised, he told me he didn’t go into the medical profession to get rich – he did it to help sick people and make them better.  Phew!

This is the sort of person needed in medicine. The healthcare companies are run by single-minded capitalists, totally profit-oriented, particularly the pharmaceutical companies.  The whole “industry” (as it has become) needs a big re-think: what is it there for?  In theory, a single payer system (e.g like the NHS) would greatly improve outcomes, but it has little chance of happening – too much money is at stake, and the politicians are just fine with that, thank you.

An essential aspect of Epicureanism is setting aside selfish instincts and thinking of the interests of others.  In this way you get the very best out of them and have good relationships. But good relationships, working together, thanking doctors etc. count for little in the ultra capitalist atmosphere of some branches of the US health industry.