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[Rolan7]

To be fair, his situation was atypical.  Reading the story shows he used 36 vials of antivenim, two hospitals' entire supplies, instead of the typical 4-6.  I don't think they marked up the pharmacy costs much, or at all.  The room charges seem excessive though, particularly if intermediate care means those normal recuperation rooms.

Of course it seems like a "typical" case would still run 20-50 thousand dollars, guesstimating.  Which yeah, is literally ruinous.

Like the article says, it's supposed to be a negotiation with the insurance companies.  I doubt they can legally give discounts to people who don't have insurance.  And I don't know if the government pays them for the patients who go bankrupt.  So financially I don't see any reason to believe that the hospital is overemphasizing profit here.

I don't blame the pharmaceutical company, either, just the economics.  I'm of the unpopular opinion that pharmaceutical companies deserve to make money off their massive research investments.  IP has real value, and research and development depend on market incentives.  This company doesn't have a patent on "antivenin" (this isn't software development, thankfully), just a certain process.  It might be the best process, but there *are* alternatives.  Patents expire after 20 years, and we were certainly curing snakebites in 1995.  If people switched to those alternatives, BTG would lower their prices.  But what hospital would do that?  They don't care, they pass those costs straight to the insurance companies (or the soon-to-be-bankrupted).  Using a cheaper substitute would just ruin their reputation for no benefit.

That's one reason single payer would have solved a lot of this.  The government would force BTG to set a competitive price if it wanted a deal.  Single payer means that everyone's purchasing authority is combined - which is something insurance systems were originally *meant* to do.  They shouldn't be run for profit.

[MetalSlimeHunt]

Atypical situations with antivenom happen a lot. While it does usually work within a predictable range, there are a significant number of cases where it just doesn't "take" (I don't know the biochemistry behind this phenomena) and you have to drown the patient's blood in antivenom to do any good.

But that is a general aside to the obscenity of medical costs and patents.

[Frumple]

Yeah... I mean, according to the article, the largest single cost was the antivenom at 83k, which... if the rest of the article is correct, probably cost the hospital itself 82,800 (36 vials, ~2.3k per, which... I would probably not say is too terribly out of line? The stuff's not exactly trivial to collect, iirc, and doesn't have the largest demand in the world.), which, uh. Would have been less than a percent of markup on the part of the hospital, for the antivenom costs. Now, how much the anitvenom producers are marking things up is a different question, but that part doesn't really strike me as that out of line on the part of the hospital(s).

The rest of the bill was probably excessive, though. I'm not quite sure how five days in-patient totals up to ~70k. I know it does, pretty regularly, but m'not sure how.

[Rolan7]

That's true, I kinda glossed over the room charge and lab costs but they do seem very high.  Even for 5 days with a serious condition.

[Truean]

You can pick apart the parts of the bill, but it is still insane. Each portion of it is incredibly expensive. We had anti venom, long before these guys. IP has value? Yes, to them. That company seems to have driven out all the other competitors.

This isn't a new thing and look at the dates in that article: https://en.wikipedia.org/wiki/Antivenom

People got bitten by poisonous snakes long before the year 2000 when this stuff was approved. Not everyone died. We had something else, what happened to it?

This isn't the only type of anti venom that's a problem: "U.S. coral snake antivenom is no longer manufactured, and remaining stocks of in-date antivenom for coral snakebite expired in the Fall of 2009, leaving the U.S. without a coral snake antivenom."

So, we're just out? We've been out for going on how many years? There's something wrong here.

[Rolan7]

Yep, that's pretty much what I was saying.  "Patents expire after 20 years, and we were certainly curing snakebites in 1995".  The hospital could buy antivenom from another company.  But why?  People expect them to use the best, which is probably this stuff, and they're just passing the huge cost to the insurance company (or in this case, consumer).  Shopping around would mostly much just hurt their reputation.

What I don't get is why the insurance companies don't ask the hospitals to seek alternatives.  I know they often refuse to cover expensive treatments.  I guess this is a case where they'd rather pay more than deal with bad press.  Or maybe they have some sort of deal with BTG.

Single payer wouldn't have that problem.  It would be a buyer's market, with all the purchasing power working to get the citizens a good deal.  Ironically it would *encourage* capitalist competition in the pharmaceutical industry.

[Bauglir]

I'm not quite sure how five days in-patient totals up to ~70k. I know it does, pretty regularly, but m'not sure how.

Oh, pretty easily, especially in what I assume was an ICU. Labor costs are probably going to make a couple thousand of it, for starters; he's going to have somebody attending to him 24 hours a day, more or less. What you have to realize is that between nurses, doctors, technicians, and various support staff (cooks and janitors), somebody in an ICU is functionally consuming the work of maybe a dozen people at any given moment, throughout their entire stay. And many of those people aren't exactly cheap.

Disposable equipment might be significant, depending on whether or not he had to get intubated or something like that that's more intensive than syringes and gloves. Given that the number we've got is the entire pharmacy bill, there's a good chance the hospital took a (small) loss on the antivenom since there's all the other shit you're going to wind up on, to handle pain if nothing else. Transportation's another thing, and don't get me started on the costs of getting labwork done.

But, yeah. Even that's all before the atrocious markup hospitals have to make in order to get anything out of insurance companies and in order to cover the costs patients who couldn't actually pay (because life is full of bitter ironies). Inpatient stays are fucking expensive, and there's no way around that - you've got to fully handle somebody's base cost of living before you even get to medical care and the things they're too incapacitated to do themselves.

Which is, of course, why we need universal healthcare - it shifts the burden of paying for the folks who can't pay (and whom we're paying for one way or the other) off the people who can least afford it, it reduces the number of people who are so badly hurt that they need this kind of care, and it's more cost-effective, to boot! But God forbid we raise taxes in order to benefit the needy, even if it's only because they're a subset of the people helped ("nearly everybody", in this case).

But, yeah. I just want to be clear on this - while there are problems with bills like this, the biggest problem isn't that the cost is too high, it's that we as a society aren't willing to pay it. It's the ol' "We want something for nothing" schtick, where people want a functioning, affordable healthcare system but insist that "somebody else" pay for it.

[Truean]

Agreed Bauglir.

The problem is there is no fair freaking way to pay for it. I won't get into my personal experiences with that, but yeah. The fact is I don't know.

I don't know what a "fair" price for ... snake anti venom is.
I don't know what a "fair" price for research into snake anti venom is.
I don't know if we need additional research to create a better snake anti venom for a certain type(s) of snake(s).
I don't know how much should be individual payer (per transaction, per "policy premium") or insurance, or society/government.

What I do know is that it feels terribly wrong that one guy just gets screwed here and that medical debt is STILL a major factor in bankruptcy.

Basically it feels like the rug is being pulled out from everything, because nobody and nothing wants to pay for anything. Government, business, individuals, rich, poor, anybody, nobody wants to pay for anything. Somebody freaking has to, because society wasn't built like that and it can't go on like that.

[Arcvasti]

* Arcvasti bops the greatorder

Could you please remove the Truean quote from your post?

[Frumple]

What I don't get is why the insurance companies don't ask the hospitals to seek alternatives.  I know they often refuse to cover expensive treatments.  I guess this is a case where they'd rather pay more than deal with bad press.

Last I checked it wasn't so much "bad press" as "massive lawsuits" -- from what I can vaguely recall, hospitals et al being sued because they used "usually good enough" instead of "best", even when there's like a 1% effectiveness difference and the former costs a slim fraction of the latter, has resulted in fairly major legal kurfluffles. It's one of the reasons hospitals and whatnot default to the most effective (which generally means most expensive, as well) treatment in the US, even when they very often don't need to. You often have to request generic prescriptions and whatnot, ferex. Basically, the alternatives have some hurdles to be reached, and can be risky for the medical side of it to actually administer. If you have two medical options, one with 99.1% effectiveness with .1% the cost, and the other with 99.2%... and you give the former, and the person dies? Even if they would have died with the latter, shit is about to go down. And to be fair, the difference in lives between those two would be a hundred people per 100,000 population -- for a country the size of the US, as an example, that's... not exactly trivial.

---

... as for the paying stuff, it's just... weird. I meet a lot of people that actually want to pay for whatever, but they have trouble understanding how much stuff costs (I have fairly regular trouble with my grandparents regarding that, actually, because they have the occasional issue recognizing that prices have changed and/or what goes in to what they're asking for -- they want to pay what they think the service or item is worth, but don't quite know what that amount is) or can't really (/don't think they can) afford to pay for X, and so on and so forth. Most folks I meet are pretty down with paying for what things are (what they understand as) worth. The amount of folks I run in to that actually want something for nothing has largely trended towards slim, for me (the closest exception I've noticed would probably be regarding music, and even then people often want to support their favorite bands).

Most of their balking seems to come from either (lack of) capability or wanting to spend their money well* and running into that lack of understanding.

It does seem that that changes when you get to higher order stuff -- corporations, politicians, etc. -- but... honestly, a lot of that seems more like (highly) perverse incentives than anything. The politician can't raise taxes because much of their constituency is already on the edge (do remember that the median wealth/income for a US citizen is not exactly impressive, and there's a pretty significant portion doing substantially worse than that), or would have to make pretty significant non-trivial exchanges to cover for it (at least in the short run, which is often a daunting prospect, even if the 5-10 year outlook would be a net gain). The business runs into problems with increasing expenses because that cuts into investor interest, even if it would otherwise be better for the health of the company, and so on, and so forth. Still... it often looks like there's not really an ideological opposition against consummate payment and whatnot, stuff just... gets in the way. They don't want shit for free, they just have pretty strong incentive to act like they do.

*Or at least things they'd prefer to be spending it on -- see the healthy young adult that doesn't want to spend for healthcare because they haven't been to the doctor in the last half decade and are highly likely to not need to for the next, either, but are having trouble keeping a house and transportation. Yes, there's very good reasons they should be contributing anyway, but it's understandable why they'd be resistant, and it doesn't boil down to wanting something for nothing. It's more not understanding that that's what they're asking for.

[Truean]

Please no quoting, thank you.

More anti human being pro business crap.

This system wasn't set up with bankrupt non existent colleges in mind. Literally and absolutely worthless degree because the place is completely GONE, means the student got entirely screwed. Same deal happened with Everest....

Taxpayers are going to loose money? Hey, newsflash, so are the students. Follow the money, man, this is really simple stuff. Who has the money and who should deal with their fraudulent actions instead of trying to find any way to cover it up:

The fraudulent bankrupt colleges businesses.

And look at this: Complete attempt at covering up fraud.

Wait wait wait, so these people fraudulent companies KNOW they are currently under investigation for fraud, but rather than preserve the documents, they're looking for any way to get rid of the proof of their bad deeds. They know they can't pull an Enron and just shred everything, so now they're going to abandon them (have them thrown out), which is effectively just as good....

Here's a thought, go after the frauds, not those who were defrauded. Yes, taxpayers stand to loose money, but so do students. The companies are the ones who made out like bandits. Go after those bandits and leave the victims alone.

Heaven forbid you say anything about this, they'll retaliate. Don't ever be a whistleblower kids, even if you prevent your boss from defrauding people out of millions upon millions of dollars, you're just screwed, because even though you didn't do a damn thing wrong and your boss did, they'll get you.

Please no quoting, thank you.

[Rolan7]

Without addressing the article's main point...  $100,000 in student loans for an art degree?  Come the hell on.  My four years of engineering at a good university would "only" cost about 60k today, including food and housing.  And as a junior and senior I worked a part time job which countered a lot of that.  Taking student loans is often unavoidable, but jeez.

I don't know anything about fraudulent colleges but that sounds awful.  Fuck those colleges, I do hope the students involved get help from the government.

[Bauglir]

Well, if we're going to make student debt survive bankruptcy, some sort of similar responsibility on the part of the school seems in order.

[Sheb]

I don't really get why the fact that the school disappeared suddenly makes your degree worhtless.

[Antsan]

Degrees aren't validated by governmental institutions?