I used the VA ER twice in the last 6 months. I prefer the VA ER over the normal hospitals ER since they appear to be less busy and seem to have more specialist staff working in the ER. Also the Palo Alto VA has all labs on site and the results of most blood tests can be gotten within a half hour via computer automatically updating my records. Also the VA seems to have more modern equipment (e.g. for over 5 years, they haven't used the standard pressure test for checking for glaucoma, the ER has portable x-ray machines so the machine is brought to the patient, their radiation lab is one seperate building filled with MRIs and CAT scans, and all records have been computerized for at least 10 years including scans, x-rays, and pictures of the eyes). Everything seems to be very automated except their billing system which seems to be out of the dark ages (billing is very simple but they can't seem to get the bills out in a timely fashion).

The first time I went was on a Saturday morning and suspected that I would have a long wait but I was in and out in 30 minutes. The second time was this Monday morning and it was more busy but I was still out in two hours including a 1/2 hour procedure.

Although cost was not a consideration since I also have Medicare, I'm sure the VA is cheaper since visits to the VA ER are $50 and 20% of the bill using Medicare through a normal hospital ER would cost significantly more than $50.

The $50 seems like a real good deal since prior to the procedure, the nurse filled a table will everything that was needed and they all appeared to be packaged with the manufacturer's sealed wrappings. I wondered if things like scalpels, scissors, and other instruments are discarded after the procedure.

On Monday I initially wasn't going to use the ER and just make a same day appointment but the advice nurse indicated that they will just send me over to the ER anyway so just go to the ER.

If I go to another VA facility other that the Palo Alto VA, it may be different since the Palo Alto VA is a huge complex with over a hundred buildings. In fact it appears to be larger than any other hospital in the bay area and over twice the size of Stanford Hospital.

I also wonder if it would be easy for a non vet to use the VA ER. Every time I've gone to the ER, they didn't ask for the ID but only asked for my name and last 4 digits of my social security number. Usually for normal visits, I have to show my ID.

I was wondering about that afterwards

In all seriousness though I worry a lot about having to go to the hospital or ER for something 'big'. It feels weird enough at the Dr's office asking 'and how much will this cost?’ that I just don't do it, although lets face it they can't seem to give you a straight answer anyway.

I can't imagine being in the ER with a sick kid and asking each Dr 'Why are you here, will you be charging me for this' and especially if it was a child 'Do the pretty casts cost more?' 'Are you in-network?, No?, That's OK we will leave them in pain until an in-network Dr becomes available'.

I don't know of any other 'service' where you give someone carte blanche to do and charge what they want without question and just hope for the best and wait for the bill.

I watch Grey's Anatomy and shout at the TV - 'Good luck, bet that's not covered'

Interesting write up! Thanks! As I've said elsewhere, I love the pics of the cast

I just realized that I missed the entire exploding Fallopian tube episode. I am so sorry to hear (read) about that.

I hope that you are all able to get enough rest.

Sorry to hear you've been in the wars again....hope the young 'uns doing ok.

My finger crushing son seems to be keeping out of medical trouble at the moment (his finger nail grew back although it and the rest of the finger are a bit of an odd shape.....he may have a future as a Hollywood Villain), but in the interests of sharing medical experiences (and some cost info) I'm typing this while his younger brother is in surgery at Texas Children's Hospital.

He should have been done yesterday at a different facility, but didn't quite go to plan. Tuesday afternoon I had calls for prepayment by the facility (1400), the anesthetist (1000) and the surgeon (300). Son had a nervous, restless night, and woke him up at 4.45 to get him in at 5.45 as instructed. Several weeks ago we'd gone over medical history, and the fact that there is an allergy to certain GA in the family. At some point between payment around 3pm tues and arrival at the clinic 5.45am Wednesday, someone decided that they weren't comfortable doing it at that facility. It seeems everyone was told, apart from the actual patient, who I would have thought was fairly critical to the whole thing!! Anyway, they tried to send us home and said that refunds from facility and anaesthetist will be forthcoming in 2-3 weeks. WTF?? I told them if they didn't refund on the spot, I would just file a fraudulent charge with the cc and let them sort it out. Walked out with the refund - kind of a hollow, minor "victory"....

So I spent yesterday going through all the paperwork with the new facility, including more payments, apart from the facility fee which we couldn't get as we played phone tag all afternoon, then she went home without giving us the info. Bad feeling which came to reality when we checked in this morning....facility fee 3900!!!! Still trying to negotiate that down, but kind of a weak position. Decided to go ahead with the procedure which took less than 20 minutes, went OK and son is now in recovery room sleeping it off. Rather annoyingly, the anesthetist that handles him today couldn't understand why the procedure couldn't have been done at the other facility yesterday.......didn't really need to hear that it'd just cost me another 2.5 grand for no reason!!

So, a scary reminder of how much fees can vary from one hospital to another.


As a footnote, when we got home yesterday, I decided to take the kids to the movies....we went in, paid, sat in a darkened theater for 30 minutes with no movie playing, and then were told to leave cos the projector was broken....really wasn't our day! At least they agreed to refund our entry and popcorn

That was another bizarre episode, of the missus spending the day on a ER trolley in a corridor from 1-6pm before getting a room and a proper exam before getting emergency surgery at 10pm. That hospital, our PCP was partnered with in some way. Went well though

As for the kid, she's back to being her sassy self and you wouldn't even realise it.

Though it was pretty scary stuff when they put her "under" the ketamin, didn't really realise how nasty that date rape drug can be. The eyes were open, but the lights were definitely out in that one and she really didn't feel or realise a thing and doesn't remember anything about them setting her arm.

Luckily she didn't feel sick after or get the bad dreams that they said could be the side affects.

We have a $250 per person deductible but they never seem to apply it. I've no idea why not. I've been in the ER this year too and they didn't apply it to that either.

No wonder i read in the uk media recently that the US is becoming more popular as a destination for UK doctors.

It appears that in the US the docs have free reign to empty your wallet for whatever amount they see fit and there is absolutely nothing you can do about it apart from not have the treatment in the 1st place which if your limb is hanging off aint an option!

That sums it up quite well........

What I dont get is from my experiences in the US its mainly expats that complain the most about the system given the contrast from what they are used to. Why dont Americans moan more about it? They seem to just accept it and think thats the way it should be. Thought of the NHS fills them with fear! Maybe if they heard about Mid-Staffs they would be petrified!

Maybe the poor on medicaid etc have access to much reduced cost services I dont know. I hear americans complaining about those on welfare seeming to get everything and using the ED as primary care. Thing is they sound like Brits now regarding that.

Thing is you read in the news all the time about hospitals on the edge of bankruptcy. How can this be with these huge bills? Is it because only a fraction of them gets paid or is this the true cost of decent healthcare and the whole NHS was just too good to be true?

Anyway a medic friend in the UK said there is a great NHS exodus of docs to the US/Canada and Oz with lots coming to the US for the $$$. Sad truth it appears it will soon be RIP NHS.

I suspect the reason that you don't hear many Americans complain is that system has worked or is currently working very well for most of them.

Since you brought up Medicaid, we'll start with that. Families that are eligible for Medicaid are required by the federal government to have no deductible and very low co-pays at a minimum but states can supplement that minimum and get additional aid from the federal government. For example, in California there isn't any co-pay for Medicaid (MediCal) recipients and also includes dental and prescription eyeglasses. As an example, my maid and her husband are on MediCal and her main complaint is that after the 4th prescription drug, she has to pay 20% of the cost of the drug. Also her son joint sponsored her mother (from El Salvador) for immigration and when her mother had a stroke and was in the hospital and nursing home for over 6 months, her mother immediately became eligible for emergency MediCal and it didn't cost anyone in the family anything. So for her, she would be 100% happy with the system if MediCal would increase the number of drugs that are paid 100% beyond 4 drugs.

Other states aren't as generous as California for Medicaid benefits but if bills are run up with co-pays, usually hospitals and doctors generally don't pursue payment since they are likely collecting well over 80% of the bill from the government and pursuing someone that can't afford their small share will likely just cost them money.

Besides Medicaid, there is the EPSDT program for children of low income families whose incomes are higher than the threshold for the family to receive Medicaid.

Then there is the IDEA program which provides health care for children with disabilities or and severe illnesses which is available to children with families of all income levels.

The above programs pretty much takes care of the neediest in the US and most that are receiving those benefits are fairly happy with the system.

Most on Medicare (mostly retirees) like the system since Medicare covers 100% of hospital care after about $1,000 deductible and it allows the patients to chose their doctors and hospital. The government pays 80% of outpatient care but that can be supplemented to 100% with supplemental insurance. People on disability also get Medicare. People that are poor and are receiving Medicare also get Medicaid.

Veterans are eligible for VA medical care with no premium costs. The care can be 100% free depending on income or service related illnesses to a maximum cost of $15 co-pay for primary care, $50 for a specialist or ER, $9 for brand or generic drugs, and free hospitalization ($1,000 deductible for some).

Many unions have negotiated very good employer provided health care including teachers, government workers, and private manufacturing workers.

Up until recently, many non union workers had very good employer provided health care packages with low deductible and low co-pay for the entire family with very small premiums paid for by the employee. However over the past decade, more and more of the costs have been passed on to the employee as health care costs have skyrocketed.

Finally there are state high risk pools and some states have laws governing COBRA allowing an ex employees to remain on COBRA indefinitely.

With all of the above, about 85% of the population has good health care coverage with about 15% left out. Most of the 15% include the lower middle class, the self employed, and single people.

Although many Americans are unhappy about the rising costs of health care that they must pay, many are also worried that if the government gets more involved, their choice of doctors and treatment will become limited and also worry that may have to wait for treatment. Surprisingly some of the biggest opponents of ACA are single people without health care since even if the government pays 80% of the premiums, they feel invincible and don't want to pay even 20%. Also there are many people that are just ideologically opposed to more government involvement in health care never stopping to think that they or someone in their family could be one of the statistics. Many recipients of Medicare oppose ACA even though they are the major recipient of government provided health care. Finally I suspect people feel a false sense of security since most don't know someone that filed for bankruptcy due to medical bills.

I have been to the ER twice with hubby and twice with my daughter. Each time they were seen promptly...the only snag was that the 'attending' on the last visit wasn't in network. Annoying because he didn't treat my husband...we were asked to wait before leaving as he wanted to say hello. Ca ching ! The last time my daughter went to the ER we were told she had sprained her ankle. 2 days later we were visiting a podiatrist...he asked if he could take a look at her ankle. He took x-rays and sure enough she had broken her ankle...which he treated.

3 weeks ago I spent the day in the ER of a hospital in Toronto...then I was moved to a trauma unit for 5 days. IMO it was comparable to a UK hospital. Aetna were very good...asked if I was happy with the hospital/service...did I wish to be moved to another hospital...did I wish to be repatriated? We had to settle the hospital bill for the room and ER before we left...in the region of $30K+...the doctors' bills are to follow. I have no idea how much of this we will have to pay out of pocket. From what I remember...because I was in a morphine induced haze...the doctors and nurses in the ER were very good. Can't really say the same for the doctors when I left the ER. A quick early morning visit which lasted about a minute...walking backwards towards the door as I was asking questions. Unlike my surgeon down here...who was constantly phoning and emailing my husband for updates while I was in Canada.

I cannot compare it to a US hospital because I have not been admitted here...unfortunately that will soon change...

Hope you get better soon, JG. Don't know what happened in Canada, but it doesn't sound good.

Thank you...it's not something I wish to repeat. Although I think healthcare should be a basic human right for everyone...IMO if you have good healthcare insurance and can afford the extra costs...the US is the place to be. I can't tell you how relieved I am to be back...to have a doctor I can call anytime with my concerns. I had a CT scan yesterday afternoon...my doctor called me at 9.30 last night with the results. She is on vacation now for a week...but assured me that her staff and fellow doctors had been updated and to call them anytime.

I'm very impressed with your doctor, JG. Sounds like she really cares about you as her patient.