[Dueller]

Interesting thread...and many of the anecdotal stories reveal the problems of accessibility and affordability in the U.S. healthcare system. But the problem is not systemic alone...it is attitudinal. As to the tetanus shot issue, I personally keep tetanus vaccinations up to date because a) I'm a klutz and b) I own and work on old rusty motorcycles and german cars. I paid about $30 for a tetanus vaccination a few years back at our local health department and its good for what...10 years? That is a minor example of me taking some responsibility for my personal health care needs and knowing I won't need to go to the ER when I stab myself with a rust encrusted cotter pin.

Before I get all stove up patting myself on the back for personal responsibility, look at the systemic problems in our health care models. For example, IIRC Medicare will not pay for a tetanus vaccination unless it is necessary as a result of an injury. Right there is a small example of why our system is broken...we've become accustomed to treating the injury/illness rather than prevention. We, individually/collectively/institutionally, fail to see that prevention is cheaper than treatment. Medicare/insurance companies would rather deny preventative measures as cost saving rather than see that treatment after the fact is much more expensive.

As to ER care being so expensive, the following is an assessment from someone who obviously understands why it is so expensive. They were responding to a question about a high priced tetanus shot in an ER. Again it comes down to acccessibility vs affordability...two concepts that seemingly are intertwined but in reality are very separate issues.

"You're not being charged for "just" a tetanus shot. If it were just that, you could mail order it and give it to yourself. You are paying for a tetanus shot in an emergency department.

You're also paying for access to care - the ability to get a tetanus shot 7 days a week, 24 hours a day, holidays included.
You're also paying for access to advanced care - not just the ability to get a tetanus shot, but to get lifesaving care from a trained and licensed team of professionals at any time. This means access to a full service pharmacy with pharmacists, radiology department with technologists and radiologists, laboratory services . . . all 24 hours a day, etc, ad nauseum.
You're also paying for everyone else's access to care - all those people who don't pay but use the ER for their emergent and non-emergent problems.
You're also paying for the malpractice exposure associated with both your injury and every other person's injury.

It's not cheap to run an emergency department because they have to build in the capacity for every major life-threatening event, whether or not it happens. You pay for the existence of this capacity.

Example - every ED should have a cyanide antidote kit on hand. These expire every 3 years or so, and are killer expensive. Cyanide poisoning is extremely rare, but when it does happen the victim can be saved with the kit - and you have to have it there. It doesn't help to order up from Eli Lilly the next day. So, who pays for that? Do we keep a running tally of how many kits have expired before we use one, and then charge the first person who needs that particular medication the cost of all those other kits? Instead, we spread around the cost to everyone else who comes through the door.

Who pays for our decomtamination showers, to be used in the event of a chemical accident or attack?
Who pays for the homeless guy who fell down and cut his hand, and needs a tetanus shot?

You, that's who. "