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Whenever I see these outbreak stories (sars, mers, etc..) and it affects a US citizen, I always wonder who actually pays for this level of intensive care.

Ambulance trips in the states are routinely $3,000. my trip to the ER after a wreck was $3800. If you dont have insurance, how do you pay for an "isopod" and a quarantine with a medical robot? What reasonable insurance company would ever cover these expenses? (mine hardly covers birth control.)

Healthcare is private here. When i go to the hospital they ask if "i am a member." Do these treatments take place at in-network facilities? is there such a thing as an in-network facility for being quarantined with an incurable new disease? Can I be compelled to pay for health services in this case if i DO NOT want them?

Its at least reassuring to see CNN is dancing around the HIPAA implicationf of misidentifying or identifying the patient...although I wonder if its only because they recently emerged from a slander/libel lawsuit for painting a highschool kid from kentucky as a racist during a rally.

> who actually pays for this level of intensive care

If you have decent insurance, you pay your maximum out of pocket and insurance pays the rest (at negotiated rates).

If you don't have decent insurance, you declare bankruptcy and the hospital ends up paying for all except the few dollars they are able to get out of you. This is pretty much the same situation as when homeless people show up at an ER, which is legally obligated to help them regardless of ability to pay.

I think it is VERY hard to tell what is "decent insurance" anymore.

It might say that your hospital stay is covered on paper ... but then at the hospital the robot (or another doctor) might not be billed through the hospital and some outside group that is suddenly out of network.... there's no way to know.

> you declare bankruptcy and the hospital ends up paying for all except the few dollars they are able to get out of you.

Does that mean the entirety of your life savings and any liquidatable assets?

You don't always declare bankruptcy. Medical debt can't be deducted from your wages and is usually negotiable with zero interest payments and for massive reductions in amounts. And after enough time, most hospitals will just write it off. And in exchange you can walk into any hospital in the country and they have to provide you emergency services.
If the healthcare providers are in network, i.e. the insurance company and the providers have reached a pricing agreement. Otherwise the providers can bill you whatever they want.
Or option 3: they don't go to real hospitals, use perscription medicine, or see real doctors.
> which is legally obligated to help them regardless of ability to pay.

Which tangentially makes all the Rand Paul bullshit about doctors being slaves under a universal healthcare system kinda moot.

I know intelligent people aren't making that argument but it's a reasonable counterpoint in case you come across one of them

>If you have decent insurance, you pay your maximum out of pocket and insurance pays the rest (at negotiated rates).

I think the OP's question was more: who decides this person gets treated by a state-of-the-art robot, while this person gets a prescription and told to go home and rest?

If you can't pay, the hospital absorbs the cost to a degree. Hospitals are most likely also part of a larger "reinsurance" type pool to keep expenses manageable.

My mom worked in healthcare billing her whole career. My understanding is that half the reason medical bills are so high for normal people is they need to cover the costs for the people that need and have received care but were unable to pay.

In this particular case, it's a matter of national security, so I'm sure the needed funds would magically appear if needed.

Only if the hospital is state run. In WA the University of Washington hospital routinely runs losses because of this. Private hospitals can give you the bare minimum and kick you out the door.
>half the reason medical bills are so high for normal people is they need to cover the costs for the people that need and have received care but were unable to pay

Sounds totally fair and reasonable to the people who get crazy high bills for the one thing a year that they need it for, despite paying hundreds a month in premiums for the "privilege" of also paying for people who can't. What a system.

I don't see why the patient would pay for it. If the country / state wants him quarantined and treated by a robot then they are going to have to take that upon themselves.

Otherwise the person could just choose to freely infect as many people as they want because they can't pay for specialized treatment.

It would be nice if the real world was as rational as this. However, this is America. We always find someone to pay.
I'm more curious what happens if you try to refuse treatment. The legal basis for forced quarantine is shaky (The CDC tries to justify it on the Commerce Clause of the constitution), and trying to charge someone for a treatment they refused has some obvious issues.
I believe in extreme cases such as this the hospital considers it an academic/research/prestige/security cost and would essentially charge the patient nothing or standard daily rates. I know when the Ebola scare happened in the US the prestigious hospitals near me were throwing $1,000,000's into constructing state of the art rooms for preparedness and to impress the CDC and get federal approval and academic recognition.

Also the hospitals can write these costs off of their taxes in various ways. If outbreaks like this cost them millions in expenses they have tax loopholes and it ends up costing them nothing.

Im continually amazed at the way people think "write offs" work.

If a company spends X dollars on something, they don't pay X dollars less in taxes. They pay X dollars * their marginal tax rate less in taxes.

Now they may be able to apply for grants or other types of funding, but there is simply no way to "write things off" and then get them for free.

Society as a whole benefits from an infected person being quarantined so therefore society should also pay for it.

Is that not the case?

I'd assume the US has programs/budgets for this sort of contingency funded at the federal level?

Until Obamacare, even flu vaccinations were not commonly covered. Your logic is sound but unable to cope with the insanity of the US healthcare system.

I recall an article a few years ago about the google founders (?) paying for kids in San Francisco to get vaccinated. The comments were split between Americans praising the act and Canadians that were confused.

If it's a serious outbreak I'd imagine the CDC would be footing the bill, considering they want as much information about the disease as possible.
HIPAA regulates healthcare entities/providers, e.g. what info they can give out about a patient. Not journalists themselves.
Insurance covers things to a point as others mentioned, but you may not know what tests or procedures they'll run. Will all the doctors you see be "in-network". Sometimes ambulance trips are not covered if you don't get admitted, so it's a gamble. It's exactly what we'd want a life critical service to be. (/s).

In addition to that, workplaces also give out limited number of sick days, so people don't go to the doctor and go to work instead. They ride in public transportation to get there, maybe stop at the store on the way back if symptoms haven't gotten too bad, handle some produce and so on. Well we see where this is headed. I think once something like this virus comes to a large city in US, it just has a pretty good chance of spreading and in large to our broken healthcare system.

I'm not a lawyer, but it looks like the CDC pays (or at least has rules allowing them to pay) for some stuff that insurance doesn't cover. But you may still have to pay deductibles.

This page has a lot of good info:

https://www.federalregister.gov/d/2017-00615

Particularly the "Payment for Care and Treatment" discussion here, which talks about public comments and even gets into the ethics of what you can make someone pay for compulsory treatment or isolation:

https://www.federalregister.gov/documents/2017/01/19/2017-00...

And the rules in 70.13 and 71.30 here and here:

https://www.federalregister.gov/documents/2017/01/19/2017-00...

https://www.federalregister.gov/documents/2017/01/19/2017-00...

Excerpt from the rules in 70.13 (which I think covers domestic stuff):

> Director may authorize payment ... Payment shall be secondary ... after all third-party payers have made payment in satisfaction of their obligations ... For quarantinable communicable diseases, payment shall be limited to costs for services and items reasonable and necessary for the care and treatment of the individual or group for the time period beginning when the Director refers the individual or group to the hospital or medical facility and ends when, as determined by the Director, the period of apprehension, quarantine, isolation, or conditional release expires.

I don’t think that CNN is a covered entity under HIPAA.
I'm not sure what you mean by "implication of [...] identifying the patient". Although I didn't see any personal information in the article, there isn't a law in the US that prevents a news agency like CNN from identifying hospital patients. HIPAA only covers entities like health insurance companies, care providers, and their business associates.
I think the summary answer to these kinds of questions is "if a pandemic gets loose in the present day USA, you're fucked".
In theory, preventative treatment for epidemics should be paid for by underwriters (the people who insure insurance companies).

In practice, that poor bastard is gonna get a huge bill for saving the rest of us from his illness. I hope at least his friends buy him free beers for a while.

I would imagine the cost of isolating patient zero like this is much lower than letting it spread.
Just say "We're still incubating here but I can pay you in exposure!" on the way in. That should get the message across :-)
Can someone explain why /this/ level of isolation is necessary?

I understand that comparison of mortality rates is difficult, so this does seem "more deadly" than the flu, but likely we have no idea of the actual number of people with it, both for reporting reasons and because many people may just have minor symptoms.

But, if we use SARS as a comparison which also had this level of pandemic fear+isolation (and was way way worse handled in China at the beginning) I think final stats were like 1000 deaths worldwide. Compare that to what, over 2k deaths in just the US every year from the flu?

I'm not saying we shouldn't be concerned (it is new and unknown, and seems to have a higher mortality rate than other viruses) but it seems this level of treatment (and entire city-wide lockdowns in China right now) is like Ebola level precautions for what seems like a difficult but fairly standard level respiratory virus?

Honestly curious here from medical professionals/epidemiologists..

Any new flu could be the next ...

https://en.wikipedia.org/wiki/Spanish_flu

> The 1918 influenza pandemic (January 1918 – December 1920; colloquially known as Spanish flu) was an unusually deadly influenza pandemic, the first of the two pandemics involving H1N1 influenza virus.[1] It infected 500 million people around the world,[2] including people on remote Pacific islands and in the Arctic. Probably 50 million, and possibly as high as 100 million (three to five percent of Earth's population at the time) died.

Lowering risk to medical personnel is crucial to prevent degradation of health care capability.

You said it:

> It is new and unknown

Better be safe than sorry. Can you imagine what we sould say if the virus ended up spreading and killing a fair amount of people just because we couldn't be bothered taking a few precautions?

The reasoning is simply that there is no good reason not to do it.

A single "super-spreader" in Wuhan infected 14 healthcare workers. Is that sufficient reasoning for you?
_not a doctor_

This seems to cover it [0], an "early estimation" gives a high R0 number indicating a higher transmission rate (more worrying than mortality rate).

Also worth noting, WHO initially suggesting a lower R0.

[0] https://www.reddit.com/r/China_Flu/comments/et8zs8/novel_cor...

It's a new virus, so we don't really know what it'll do, do we? Maybe it has a 100% mortality rate after 180 days -- we won't know until more time has passed. This is like introducing new code into a system. You have no idea what it's going to do in the long run, and all you can do is patch it out or wait to see what problems it causes in the long run.
Perhaps the deaths will be equal to deaths from the flu if it spreads widely. That would still be bad, no?
Slightly related and not worth it's own post, but someone in Chicago has been diagnosed with the coronavirus, making them the second person in the US with it.

https://www.chicagotribune.com/news/breaking/ct-coronavirus-...

Sadly not available in Europe. Three years after GDPR and these big news outlets still haven't figure how to provide content without invasive privacy breaches.

> Unfortunately, our website is currently unavailable in most European countries. We are engaged on the issue and committed to looking at options that support our full range of digital offerings to the EU market. We continue to identify technical compliance solutions that will provide all readers with our award-winning journalism.

I would like to take this moment to say that the virus is very serious and any people thinking of traveling to China in the next few months should strongly reconsider. Death counts and infected counts coming out of China seem to not be very accurate, as they don't match other organization's models.
They've had these telepresence robots for a while. Good for this scenario - reducing contact with an infectious patient - and super useful for rural clinics that might not be able to staff an in-person full-time doc.
"Please state the nature of the medical emergency"
It doesn't look like a robot in the sense that it cannot move or manipulate anything. It looks more like a conventional nursing terminal station fitted with a video camera for remotely viewing the patient. There doesn't even seem to be an input device for the patient to use other than voice?
Finally, a work-from-home solution for Nursing!
The weird thing is that nursing staff move the robot around in the room. I guess they get dressed up in suitable isolation suits?
I read it as nurses remotely moving the robot around from outside the room so they didn't risk contact.
Who is going to clean the robot??
One of these UV disinfectant robots: http://www.uvd-robots.com/
I assume they just send it through one of those drive-thru car washes.
robot.clean_self()