Healthcare in the US

Is it correct that you can only receive hospital treatment if you have health cover in the US? That is crazy if it is.

It just depends on where your national priorities are. I'm, if not happy, then at least content to live in a nation that believes people don't deserve to die from lack of medical attention for the simple reason that they're poor.

This is not true. You may not be able to receive treatment at the hospital of your choice, but you will be able to receive it somewhere. My stepson had his leg shattered a few years back when he had no coverage, but was not refused treatment. He will be paying it off for many years however.

I'm not going to pay ridiculously high taxes for a service which is not an obligation of the government to provide--that said, I will also not support something so inherently anti-Constitution.

Egalitarian polemics to enslave me with feelings of guilt over my own material well-being and individualistic virtues have all eventually begun to sound the same.

xxx-post

The fact that the Iraq war is totally wrong and unjust is another matter.

Hypothetically, do you think you should pay higher taxes if one chose to life a self-destructive lifestyle, over-eat, smoke, become an alcoholic, and not take care of myself? That person would have huge healthcare costs. As soon as we socialize healthcare we all have a vested interest in each other's lifestyle choices.

A thing like universal healthcare and being a welfare state just goes against the basic ideology that made this country great.

The single biggest problem is that health insurance is so tied with employment. This really wasn't the case until the 50s and 60s when employers started offering benefits to try and lure in good employees in a booming economy. When the boom leveled off and eventually declined in the 70s and 80s, people were laid off, factories were closed, people lost jobs, and fewer and fewer employers were offering health insurance. What once was common place, is now so rare that people have to look at benefits over things such as salary, environment, and career path when trying to find jobs.

The factories that closed down when NAFTA went though (jobs went overseas not only because of lower production costs, but less restrictions in worker’s rights), and a slew of factory workers that have chronic pain and other conditions caused by their work suddenly became a part of a new social class in America, those that can barely work because of their chronic conditions, and even if they can, will not make enough money to cover their medical bills. Of course, the American ideal that if you work hard and pay your dues, everything will be okay. It’s difficult to work hard though if you have chronic pain that was never treated and you were denied workers compensation when you did have a job. You take jobs that don’t have health insurance, that are often just as unsafe as your old factory jobs, but for far less pay. Your condition deteriorates because of a lack of quality health care. You really reach the bottom of the death spiral once you been to look like you haven’t had proper health care. Your teeth are falling out, you’re obese because you can’t afford to buy healthy food. You aren’t going to get hired for most jobs when your body reaches this level. You become ignored and detested by society.

So many people are fucked in this system. Abused wives, widows, veterans, the marginally employed, people with chronic illnesses, young adults in between coming off their parents insurance and finding a job, prisoners, etc. Free public health is a joke. In Chicago, there is a TWO YEAR WAITING PERIOD for an MRI. You could be diagnosed with an early stage disease, but if you don’t have money or health insurance, it may be in the latter stages once something can be done about it. Even if you go to the emergency room, they may not take you if they think they can shuffle you off to county public health, and if they do take you, you are more likely to receive sub par care because it just isn’t profitable to have someone that can’t pay taking up a bed.

Also say that you are a small business owner. Small business are great! They offer so much for communities, by using local goods, and selling right back into the community, so many people benefit from this arrangement. It seems like they should have the opportunity to offer their employees health insurance, right? Not the case, in fact insurance companies often charge them twice as more for the same coverage that a larger company gets. Larger companies are also given the option to waive the pre-existing condition clause, because they are able to absorb the loss when someone gets cancer or other chronic disease. Small business aren’t give this option though. I know it’s a business, but it just doesn’t make sense to me that so many times health insurance doesn’t cover what you need it for most. A condition that if treat, in the long run could actually make you less of a burden on the government and society in general!

It also infuriates me that medical debts have an adverse effect on your credit rating. You don’t have insurance, you get cancer, you decide you can’t go to the hospital because you can’t pay the bills because you are afraid that you’ll never be able to get a loan, buy a house, anything that requires a credit check. Most of the time people have no choice when they get sick!

Good luck if you are applying for Medicaid or Medicare. In most states, if you work for minimum wage, you will more than likely NOT be eligible for Medicaid. What the fuck? You’d be better off if you were unemployed, or even pregnant so you could get benefits. I don’t think this encourages the American ideal that hard work will get you far in society.

The reason for this is plain and simple. Government officials and well off citizens are so afraid that the system will be taken advantage of, they make it extremely difficult to go through the red tape, and make the qualification requirements so ludicrous that only the poorest of the poor qualify. “I got mine, you work harder to get yours. I don’t want to have to pay for someone that is leeching off of the system.” Even if you do have insurance, that 8 dollar co-pay on some asthma medicine for your son, can make all the difference in the world if you are just scraping by. Yes, people do cheat and fudge the system, they have to, they have no other choice. Not having health care leads to immoral behavior that many people believe is the exact reason that people should not be helped. 40% of Americans do not have health insurance, that’s too many people to ignore, and ignoring them has a much more adverse effect on the economy than if they were healthy.

The system is so irrevocably damaged, there is no way the system could be tweaked, there has to be a complete overhaul. Rant over and out.

We both live now in Spain. She had to go under some minor surgery treatment last July and unfortunately, her particular case hasn´t been successfully managed, true (Not in medical terms, but in bureaucratical terms) and she has wasted quite a lot of time dealing with civil servants and receptionists. However, she disagrees totally with a public health system as any of the ones operating in Europe, including France. I believe that it is kind of a political choice: people who are "worth" it can enjoy high quality, nearly pampering, health services in a model like the one in the States, and the rest, all right, they should have done better. That´s it. There is no way to overturn this judgement that, from an average European point of view, is nearly inhuman

If you pay taxes, you are already paying for their healthcare through Medicare and Medicaid. Not to mention that if you are already paying taxes, you are already subsidizing, through the welfare system and things like free school lunch programs, people who have been bankrupt by their medical bills. If your taxes were diverted into paying for full coverage healthcare that included preventative care, the costs of insuring those 45,000,000 would be considerably lower, since most of those people: 1) only go to emergency rooms because that's the only place you are guaranteed treatment; 2) only go to emergency rooms when there is a serious problem because have you tried to obtain healthcare in an emergency room when you aren't actively bleeding to death? Average wait: seven HOURS. A work day; and 3) emergency room care for conditions that have grown severe and accute is waaaaaaaay more expensive than going to a GP for a condition when it is new and treatible.

50% of the bankruptcies in the US are from medical bills. So 50% of people who, with tax funded health care, wouldn't need to dodge out of other payments and rely on government funded social programs to live if they had government provided health care.

You're taking the short, and very incorrent, financial view of the situation, friend. It's already your responsibility to pay for these people. Universal healthcare would make it cheaper for you.

Yeah, this is an issue where the myth of American generosity and decency is laid particularly bare.

And pullapartgirl completely otm, of course.

I'm guessing that if becomes inevitable that you get some sort of National Health Serice the bribe cheques flying around (*ahem* consultancy fees) will be phenomenal.

i don't mind paying higher taxes if i get an eventual return on my investment (a better-off society).

i guess this guy never heard of food stamps.

Now we're a handful of weeks after, and guess what they want to cut?

But yeah, the usual narrative with these folks is that "why should I pay for anything that I can't immediately perceive as profiting from right this second?" There have been a coupla interesting studies out there about charitable giving & disaster response.

As Ethan noted upthread, a big part of this is a matter of narrative and "innocence." If you're the innocent victims of them shady arabs, then you're worth giving money to. However, poor people are obviously guilty of being lazy and undisciplined. Why, that's why they're poor, and there are obviously no social forces or circumstances at work here. We shouldn't reward laziness, should we? That would coddle them!

xpost: Yeah, there needs to be a new(or renewed) language about the common good or the common wealth or something.

dude, when has the actual fact that this shit would be cheaper made any difference to those who've rallied against it? It comes from the narrative of "why should I pay for somebody else?" i.e. what happens to you don't mean shit to me, so piss off. The "this would cost too much!!1!" is just their line against it. Jeez, entrenched framing/narrative/story trumping reasoned policy once again shocka...

Hahaha I love this, have you seen the fucking taxes on booze and smokes? I pay WAY more than my 'fair share' of taxes and I never go to the doctor!

What are the excuses not to have universal healthcare at this point? Besides "our representatives are all fuckin' idiots."

I'm waiting for Detroit automakers to start lobbying for universal healthcare so they can become profitable again instead of eating $2600 in losses on every compact car sold thanks to pension bennies

Somebody just did an Ayn Rand book report!

Corporate America is totally missing in action on this. They all bitch about their healthcare obligations, but they refuse to lobby for universal healthcare because it would contradict their "free market" ideology. So their solution is just, "We should pay less for employee health care," let people get "Medical Savings Accounts" (because your average middle-class family is really going to be able to put away enough every year to pay for cancer treatments or heart surgery), and if you're not rich then for god's sake have the good sense to not get sick. (Meanwhile, none of them are too devoted to the "free market" to refuse taxpayer bailouts on their underfunded pensions.)

And I even understand their position, even if I think they're basically immoral assholes. What I don't understand is why the 70 or 80 percent of the country that's getting screwed puts up with it.

the last time I was at a Kaiser center in SF, waiting for a blood test, there were two kids in the waiting room. one obviously had a concussion, and was holding a bloody rag to her head, completely out of it (and to my eyes, not 'acting') and the other was at the desk saying "what do you mean you can't look at us? we've just been in a collision, her head hit the windshield!"

and he was sternly replied to saying that they'd be happy to put them on a shuttle for the city hospital that leaves every 15 minutes, but that policy forbade them from looking at non-Kaiser members at that facility

I want to believe this, and I will if you explain how. How does the numbers add up? Show actual numbers to get the point across.

But...

The problem with using averages is that in Europe, while you can say that everyone recieves the same treatement, in the US you cant. Who's to say at what point what an American spends that they recieve better treatment then a European?

Just an example, in Europe no matter what amount you spend on health care, the public system will always have the same infancy death rate, the same child immunization rate, the same hospital visit rate, etc etc, whether they spend $1000 $2000, or $3000. In the US however, if you seperate it into tiers, you can bet youll see a difference. So while someone who spends $2000 or less on health care might not see a doctor as frequently as someone in Europe, someone who pays $4000 dollars might see a doctor a lot more frequently then someone in Europe. So their comparison is a bit irrelevant and silly. You can't compare apples to oranges

Also, comparing costs of socialized healthcare in other countries to those of costs here in the US is misleading. Most countries with socialized medicine also do not allow for malpractice suits, where we in the US have mountains of them. This is one of the main reasons healthcare here in the US is so expensive in the first place.

that doesn't contradict what people said though. there is a city hospital and they will be treated there. I don't know why they would even be in the kaiser emergency room if they weren't kaiser members; no ambulance would take them there (maybe they were right outside, I dunno).

I wasn't contradicting anyone... just chipping in an anecdote about the reality of 'you will be treated'

someone correct me if I'm wrong but if you go to a state hospital in california for an emergency and tell them you have no insurance, they will treat you anyway and charge it off to blue shield, correct? because my wife and I both did this when we had no insurance and never got billed. was this a fluke? is there a limit on how much the charge can be (these weren't serious problems)?

No, but you also didn't clarify if the injured people had coverage other than Kaiser, just that they didn't have coverage from Kaiser. It also doesn't sound from your post that you were in an emergency room waiting. I've been turned away from treatment at an urgent care center where I had coverage, because the injury I had was too severe for them to treat - and yes, I had to get myself to the emergency room. My statement that it is not true that you will be denied treatment in the US if you don't have insurance still holds. The reality may be difficult to deal with, but the truth is you can still get treatment.

you may be on to something here. call morgan spurlock!

You pay your taxes so that poor people can receive the same police aid, can use the same roads, are defended by the same armed forces; so what's the deal with healthcare?

I recently chose to see a private pay psychitrasit (there were only three on my health plan) and the differnce in quality from past plan-approved psychs was amazing. His whole office is private pay - no insurance accepted - and I had to pay $240 for the initial appointment. (cost of seeing him is not included in my above average). But damn was it worth it. he talked to me for an hour and a half, really getting to know me, my history and family history and past treatments. It was amazing. Unlike past pyschs who would just throw one pill after another at me 'till one stuck b/c the insurance only allowed for 15 minute visits, this doctor truly got to know and I feel better in trusting his judgement for my treatment.

Now I'm not among the poor and uninsured but I'm certainly not rich. Choosing to go to a private pay dr. was a big sacrifice for me, but worth it. It's a shame though that not everyone who needs that kind of care will be able to get the quality I was able to afford.

I save the most money on medications, a presciption drug card is a godsend.

The Reaganite mantra of "waste, fraud and abuse" that was aimed for so long at the federal government should be trained at the insurance industry, pharmeceutical industry and for-profit hospital corporations. The amount of profits being made is astronomical, while the care becomes worse and worse. You can almost track the deterioration year to year, it is crumbling so fast.

However, since the ideology of conservative Republicans and Libertarians both forbid any criticism of profit-making under any circumstances, no matter how it weakens the nation or undermines the economy, we can't expect to see any reasonable discussion of this problem in the political arean as it is currently constituted. Things are going to have to become catastrophic before the issue will be addressed in a serious way.

Maybe not even then. After all, big corporations have discovered that they can use skyrocketing health care costs as a tool to reduce pay and benefits, weaken the working and middle classes and bring them further under control. Americans in general have no idea what is happening to them, mainly because the great majority of the working and middle classes truly believe the picture of the USA that appears on their television screens 24/7 and that picture seldom wavers in its rosy coloration.

And it may be the case that Europe has private clinics too, but when you have to pump money into a public system you dont use, you're wasting money on what could be better coverage for yourself. Not that it's necessarily a bad thing, if you *choose* to do so. But when the government takes the money from you with no ifs, ands, or buts, then you have a problem. Charity should never be forced.

Jeff-PTTL's post, all you've done is point out the nature of a private system. We're aware that some people recieve better treatment then others, that's no excuse to move to a government system. Id much prefer we fix the errors in our private system then have more of our freedom taken away by the government.

Well, if conservatives stay in power long enough, they'll take care of those other things too. (Why should we have to pay for roads in places we never go?!) Except the army. They like guns.

Id much prefer we fix the errors in our private system then have more of our freedom taken away by the government.

Yes, losing our freedom to be uninsured would be a terrible blow to liberty and justice.

Dude, if the boondoggle of the American private health care system doesn't convince you, nothing I say is going to. Who here do you think you're going to convince by moaning about the "loss of freedom" that would come with universal health care?

Disadvantage
-Higher cost in health care coverage
- -consequence: 45 million uninsured
- - -consequence: lower then average rates concerning health

Advantages
-Greater patient comfort
-Different tiers of health care coverage.
-Greater innovation in medical technology
- - advantages are felt globally (even to those nations which dont spend squat on medical innovation and testing)

That last one is very important. I highly doubt you're going to find cures for cancer, aids, or other disease plaguing our world from a public health care system. And though the US will find them, you can sure bet that everyone else is going to take advantage of it.

What is even more sickening is the fact that you seem to begruge the rest of the world access to American healthcare innovations. Perhaps we should paint stars and stipes on these wonderful new cancer pills you've got so everyone knows their are munching on the 'freedom' cancer cure.

before you open your mouth, why not go and find out ecxactly what medical advnaces do come out of the inferioir public health systems that us poor disadvantaged folks suffer in the rest of the world.

Greater innovation in medical technology

you do know that NIH research gets just a lil' public funding, right? and that a publicly funded health system would not detract from private investing in health tech, right?

xpost

So, yeah, wot Ed said.

"A major difference between the Canadian and American health spending is on investment in technology. This is a long-standing difference noted long before government polices on health diverged in the 1960s. American doctors and hospitals are far more likely than their Canadian counterparts to purchase new and expensive devices and technologies. Canadian doctors have a tendency to be far more skeptical and thus wait until technologies are proven and have fallen in price. The United States has far more specialists for each general practitioner than in Canada. Canada has more hospital beds per capita and Canadian patients spend more time in hospitals than Americans. An American patient is more likely to be rapidly treated by a specialist with the most up to date equipment. A Canadian one more likely to be treated by their GP and cared for over a period of time in hospital. Comparisons have found little difference between the effectiveness of the two styles, but the Canadian one is cheaper. The lack of the most recent technology is one of the most common causes of Canadians crossing the border to seek treatment in the United States. To a certain extent sending some patients south is cost effective for Canada. The most expensive medical equipment is also often some of the most specialized. In much of Canada it makes financial sense to occasionally pay to rent a piece of American equipment than to buy it outright and have it sit unused much of the time."

"None of your advantages sound that great to me and your last two are just plain wrong"

Ha, Id like to see what proof you can produce that public funded system produces the same amount of innovation as our private system. And the different tiers of health care is also known as increased freedom, probably the greatest advantage of the three. Leave it to a European to not value it.

"Public universities and public hospitals do a great deal of medical research, as do private drug companies of course"

Which is part of the reason why US medical schools and hospitals are much more popular and generally better, as well as draw the best doctors from around the world. They might do research themselves, but it's nothing compared to what the US does. We dont have the best schools and best doctors because we decided to cut investment to lower insurance prices. Oh yeah, and we didnt get the funds to support the NIH because we support socialist programs. Even with the NIH, Id rather have them and a long list of other research centers aside from just the NIH specializing in different areas of health research. When it comes to R&D, countries with public health care systems just cant step up, because a publicly funded health system does detract from private investing. The proof is in a simple comparison of the quality of medical centers in the US versus the rest of the world.
http://www.usnews.com/usnews/health/best-hospitals/tophosp.htm
I challenge you to find any nation that remotely compares with what the US produces.

"What is even more sickening is the fact that you seem to begruge the rest of the world access to American healthcare innovations. Perhaps we should paint stars and stipes on these wonderful new cancer pills you've got so everyone knows their are munching on the 'freedom' cancer cure."

We pay for it, why should we hand it out to such ingrates? Dont worry though, for now we'll consider it charity to those in need. As big as our economy is thanks largely to the fact that we dont support such socialist policies, we can afford it.

'"You're taking the short, and very incorrent, financial view of the situation, friend. It's already your responsibility to pay for these people. Universal healthcare would make it cheaper for you."

I want to believe this, and I will if you explain how. How does the numbers add up? Show actual numbers to get the point across.'

This UMaine paper points to the fact that the US health care system despite having the hightest per capita expenditure in the world (and the highest expenditure in proportion to GDP), also has the highest administration costs (approachign 25%) due to the fragmented and complex nature of how healthcare is paid for. It also produces the highest infant mortality rate of any OECD nation and is the 37th best performing system in the world (France 1, Italy 2, both fully socialised systems although both have some form of patient contribution, in France up to 30%). Even the Uk which when these figures were collected was spending half that of the US and 2/3rds that of France was still ranked 18 in the world in terms of performance.

They have no financial incentive to do so.

I'm trying to find a citing for this, but many private companies base their work on research already done by publicly funded/gov't group.

why should we hand it out to such ingrates?

makes it so conducive for argument. Or upsupported statements like,

Private and Public Health care coverage produces the same result in treatment

then later mentioning the varying levels of medical specialists in American vs Canada, which of course don't mean shit if you're too broke too ever see one.

Still, ignoring all this, the tone of your posts is illustrative.

Much of the traction against and framing around doing American universal healthcare has a core of "I shouldn't have to pay for health care that I can't immediately see as benefitting me." I.E. only those who can afford it are worthy(the rich as Blessed by God), and poor folks are poor 'cuz it's just their own damn fault, thus ain't worthy for our help. "Ingrates" in our own borders, even!

Poor folks obviously chosen their status, so they should have to live with the consequences. If you spoil them by reducing their costs to a level they can actually afford, they'll never develop the thrifty, hard-working, disciplined character required for success in our obviously meritocratic society. Why, all those poor black folks in New Orleans were stuck in that city since they were spoiled by relying on government.

Why, just look at our Dear President! He'd never have been so successful in life as oilman, ball-team owner, or elected official, were it not for his rugged individualism! Everything he's enjoyed in his lifetime was all earned thru the determined sweat of his own brow, and a product of his labor and his labor alone.

Etc.

So, to thses folks, it doesn't matter that having a baseline, minimal level of treatment for everybody would save plenty of dosh for all in the end, it's all seen in the framing of "the gubmint is taking my money to pay for those lazy, undeserved layabouts." It's a framework entrenched so deeply that no amount of actual facts will dislodge it, as Lakoff would say.

xpost: again, wot Ed said.

Bullshit. Disease prevents consumption of goods. Businesses of all types cannot profit if consumption falls. Businesses are thus incentivized to search for ways to cure disease, prevent disease, or provide care for the afflicted to support further consumption. Q.E.D.

Tim F. at Balloon Juice has been posting about this off and on for a bit (see here for his thoughts last month re: this issue and Obama, specifically:

Needless to say, tossing together American industry behind universal healthcare isn’t beginner chess. Somebody will have to overcome business leaders’ instinctive mistrust of socialist-sounding ideas and Democrats in general. Then we can even start talking about problems like institutional inertia. For that reason it seems unlikely that John Edwards, career trial lawyer, will make much headway. Fairly or unfairly Hillarycare gives me shudders. Obama, though, has a knack for making unlikely friends, a pragmatic tendency to look for common ground and little to no skeletons to get in the way. The idea of marshaling American industry against American insurance may be a fool’s errand for any pol, but I have an odd feeling that Barrack Obama may have what it takes to pull it off.)

Today, he's noted what looks like a big sea change at work -- WalMart and the SEIU joining up on healthcare matters. From the head of SEIU:

It is time to admit that the employer-based health care system is dead—a relic of the industrial economy. America cannot compete in the new global economy when we are the only industrialized nation on earth that puts the price of healthcare on the cost of our products.

That is a major drag on American business competitiveness, and job creation—and it is a stupid 21st century economic plan as well.

American business by 2008 will pay more for health care than they will make in profits. That is untenable.

...

It is time – in fact it is long overdue – for America to come together and insure that every man woman and child has quality, affordable health care by 2012.

That seems to be widely accepted everywhere but Washington, D.C.

We can’t keep tinkering, hoping that incremental change will fix our broken health care system. We need fundamental change, meaning new thinking, leadership, and new partnerships; some risk taking, and compromising.

And that’s why I chose to be here today, standing with several major corporations—some of whom I don’t always agree with, and of some of whom, frankly, I have been critical.

Which is why this partnership of unlikely allies offers even greater hope that we can finally stop talking about health care and do something about it.

That’s what we all owe our country.

Tim F.'s thoughts:

It is about time somebody figured out that Democrats need powerful allies to move healthcare reform forward, and it will never be the insurance biz. I have only pointed this out now in three separate posts. You can read those to get the gist of my point so I will just observe that it is very, very exciting to see Stern working together with Wal-Mart on this. For one, Wal-Mart is the single largest employer in America and a heavy contributor to party politics. That’s a lot of pull.

Equally interesting, Stern’s SEIU is naturally positioned to represent Wal-Mart’s 1.2 million employees in America. As most know Wal-Mart practically stands by itself in the fierceness of its union-busting policies. It has a history of forcing employees to watch misleading anti-union propaganda, firing managers who don’t stop meetings and closing entire branches when the union gains a foothold. Wal-Mart and Andy Stern come pretty close to sworn enemies. Seeing Stern and the Waltons working together on this is about the best possible illustration of my point that real progress will necessitate making some awkward friendships.

...

Finally, I would love to see the right wing boycott Wal-Mart over this. In rural America Wal-Mart has long since quashed the competition. Where else ya gonna go?

His commenters are generally skeptical. *checks watch and waits on Dr. Morb and Roger Fidelity's first posts*

A family friend of ours just had a major stroke at an unusually young age (late 30s or early 40s, I think) and has no health insurance. Her family and friends basically have to take a collection to pay for the treatment. I know this isn't a new or unique story, just a part of it that happens to touch me. This system fucking sucks. Fuck this country.

^^^^^^^^^^^^^

Is this being discussed elsewhere? http://www.nytimes.com/2008/12/03/health/03nice.html

Going out on a limb, I'm going to guess that the real problem is not the British NICE putting a price on six months of a person's life, it's what the drug companies are charging to begin with.

How any course of pills can be 50k is completely and totally beyond me. Patients should be folded into ongoing studies of drugs with FDA/NICE clearance and some cost benefit should be available to the patient in a private system. I am slowly starting to labour under the 'truthy' feeling that in many ways it was easier to suffer with cancer in the early '70s than it is now.

How Pharma and Insurance Intend to Kill the Public Option, And What Obama and the Rest of Us Must Do

http://tpmcafe.talkingpointsmemo.com/talk/blogs/robert_reich/2009/06/the-public-option-smokescreens.php/

Once those who want to kill the public option without their fingerprints on the murder weapon begin to agree on a proposal -- Snowe's "trigger" or any other -- the public option will be very hard to revive. The White House must now insist on a genuine public option. And you, dear reader, must insist as well.

This is it, folks. The concrete is being mixed and about to be poured. And after it's poured and hardens, universal health care will be with us for years to come in whatever form it now takes. Let your representative and senators know you want a public option without conditions or triggers -- one that gives the public insurer bargaining leverage over drug companies, and pushes insurers to do what they've promised to do. Don't wait until the concrete hardens and we've lost this battle.

can't make this shit up

have to wonder if it would have been easier to just apply for medicaid

amazing

http://mit.zenfs.com/102/2011/06/James-Verone.jpg

http://www.nytimes.com/2011/08/23/opinion/cut-medicare-help-patients.html

good piece by the third emanuel brother - wasn't sure how i was feeling about him at first

Single-payer has the momentum!

I've talked to liberals who aren't thrilled with Obama's health care plan but nonetheless think it must still be worthwhile, because a) after all, Obama likes it, and b) it at least does something. The fact that the something it does is to entrench corporate power over health care in the US to the point where it would take a nuclear bomb to dislodge it, not to mention to put a lengthy debate about universal healthcare off the national agenda for decades, either doesn't occur to them or is subsumed by their knee-jerk partisan instinct to at least politely nibble at whatever shit sandwich the Democrats happen to be feeding them at any given moment. And the imperative of dining on that questionable meal also makes them willing to spin tortured rationalizations around the notion that it's ok for the government to compel us to buy a product from private for-profit corporations for our entire lives.

So it's left to conservatives and their knee-jerk partisan instincts to try to nullify this government gift to some of the most predatory and exploitative corporations in the US. Thanks for doing what you can to save universal healthcare from the ongoing assault by Democrats and their misguided liberal supporters, 26 Republican attorneys general and governors!

http://www.tinyrevolution.com/mt/archives/003549.html

While my wife went on a 1.5 year (unpaid) childcare leave from her job, we had to switch to my health benefits (hers are better). Now we want to switch back because we pay so much less for hers, but it means switching all our doctors again because they're not in the network of her plan. Such a ludicrous system.

Sitting by work phone waiting for the mail-order mega-pharmacy used by my health plan to arrange shipment of my cancer drug. Waiting out the last few hours before the deadline after the hematologist's staff SENT THE PRESCRIPTION SIX DAYS AGO never really gets fucking old, even the 20th time.

they are called EXPRESS SCRIPTS

avoid if you can

ugh, I have to go through Express Scripts too. you have my sympathies x1000000

maybe 500,000 more and we can agitate for their annihilation

^ still in favor of this. i would burn them to the fucking ground if i could.

scares me, I go through them now and the auto-refills have been timely? I have a pretty unchanging prescription, though

the problem I have is specifically with Accredo

the Blues (Cross & Shield) may be singin' the blues

http://www.ajmc.com/focus-of-the-week/0515/Antitrust-Lawsuits-Seek-to-End-Cartel-Like-Behavior-Among-Blues-

This morning there was an oldish man asking for money on the subway and he was in a wheelchair, and when I looked down and I saw that he was barefoot and had what I guess you would call an open wound or sore on his foot, but it was gigantic, like maybe an inch long and the width of his entire foot and half an inch deep and raw as fuck. It just made me wonder, can someone with a wound like that and pretty obviously uninsured seek treatment at an emergency room? What can they do?

yes he can

Say it's something that requires multiple treatments to really heal, can he just keep going back?

Yes.

That's one of the main arguments for why single-payer healthcare is essential -- you'd be extremely hard-pressed to find a politician who will advocate turning away people at the emergency room when they're not able to show proof that they could pay for treatment. So the ER becomes the treatment center of first resort for those without the ability to pay, when it should be the last resort due to immediate need for treatment.

I had a number of little debates with acquaintances during the Affordable Care Act ramp-up about this -- no one will advocate turning people away from the emergency room, but its use for things that preventative care could address, or for situations that are not actual emergencies, combined with an inability for people to pay, is one of the things that raises the cost of healthcare across the whole system.

So you either have to admit that all people, regardless of their economic or social status, deserve emergency care, and that non-emergency services would be a much more cost-effective solution for people without insurance.

Some cities have started integrated facilities that put together medical treatment, case management, and shelter options, especially for people who would be arrested for acting out due to mental health issues or those who would be arrested for vagrancy, but those places are still far in the minority.

The entire system is kind of rigged right now -- people who oppose single payer healthcare do so on a number of stances, but the basic ones flush out to:
- The spoken stance: Barring any personal cost, people will seek out many more medical services than necessary, and the system can't take the load and the overall cost will be greater due to people running to the doctor or hospital all the time. The quality of care will go down due to an inability to address demand.
- The unspoken stance: If you can't afford medical care, you don't deserve it.

The former is possibly true, especially when it comes to specialists that people _should_ be referred to but currently are not. On the other hand, few people argue that the huge-ass lines at ERs would shrink.

The latter is a weird moral point and actually ends up costing more -- people get emergency care that they could have avoided with routine medical treatment, and even the crankiest poor-haters are hard-pressed to admit they think poor people with infections should die outside the hospital doors.

Barring any personal cost, people will seek out many more medical services than necessary

This is such a weird idea, as if health care were like candy.

But even if it were, why would single-payer, free-at-the-point-of-service provide any more incentive to milk the system than private health insurance? In both cases someone else is paying.

because poor people will come in all the time, they love their handouts, Tracer!

(also not really true but definitely a talking point)

My family health insurance premium (through employer) just went up 18%. Thanks Obama.

why are urgent care centers nearly as ubiquitous as starbucks lately?

I have wondered this as well and researched a little out of curiosity. The best explanation I have seen is that we are basically in the "arms race" phase of the industry, where every company doing this is just trying to get a foothold, build a brand, and battle to be the future dominant player, costs be damned. We have so many of them in my neighborhood and it's kind of depressing when you think about all the restaurants and stores not filling those spaces.

I find having one useful, but there are clearly way more than we need or than are sustainable.

They also cost more than regular doctors on my insurance plan now, so I'm hesitant to use them now unless I really have something in the sweetspot between not enough of an emergency to go to the hospital, but enough of one not to wait for a doctor's appointment, which is rare.

However, I have found the resulting experiences mostly good -- short wait times, nice, clean new facilities, and good doctors. The time I minorly injured my head (but produced a lot of blood) at the gym, I was literally able to walk across the street and get it stitched up immediately, go back to the gym, shower, and return to the office with no one knowing.

Occurred to me today that health insurance is a very odd product inasmuch as you pay a lot of money for it and then assume that the company that provides it is always opposed to your best interests.

why are urgent care centers nearly as ubiquitous as starbucks lately?

I'm guessing it's because they can be run very cheaply with most of the 'doctor' labor being pushed off on a nurse practitioner or physicians' assistant and 10-12 rooms in the building that can be filled with patients - the last ten times I went to an urgent care place I never saw a 'real' doctor. Which would be fantastic, if it wasn't more expensive than a regular doctor and all that - there's no reason you need a guy who went to med school to tell your kid she has an ear infection.

As I noted above, they are also not necessarily being run profitably right now. They are in the "start-up" phase, where they have lots of capital behind them and are just trying to get position in the market. The ones near me are so empty at normal times that there's no way they could be making money yet.

A lot of hospitals are getting into urgent care to send business to big buildings and catch new patients with insurance but have not yet gotten a primary care physician.

I don't know if regs vary from state to state, but there's a Doc-in-the-Box here where the M.D. on the masthead only has to do one shift every couple of months iirc; otherwise it's all LNPs, PAs and RNs.

There are a bunch of things where seeing a PCP isn't completely necessary that small clinics, or expanded staff at existing clinics, are really helping with. I went to a walk-in clinic last month and the follow-up email to sign up for their patient care system is somewhat focused on routing you to a primary physician but much more about setting up a patient profile so they can get you back to their clinics/doctors and make that interaction easier.

As far as a regular physical exam, ongoing medication management, or tracking your long-term health, a PCP is essential. But if they can have your base data and treat your flu, cuts, burns, sinus infections and other things where there's just an action to be taken and not long-term care, being able to do so without scheduling your overbooked doctor is awesome.

@tinyrevolution
How awful do you think Dem party apparatchiks are? Nope, you're wrong, they're much worse

INFLUENTIAL DEMOCRATIC CONSULTANTS, some of whom work for the Super PACs backing Hillary Clinton, have signed up to fight a bold initiative to create a state-based single-payer system in Colorado, according to a state filing posted Monday.

Coloradans for Coloradans, an ad-hoc group opposing single payer in Colorado, revealed that it raised $1 million over the first five months of this year. The group was formed to defeat Amendment 69, the ballot measure before voters this year that would change the Colorado constitution and permit a system that would automatically cover every state resident’s health care.

The anti-single-payer effort is funded almost entirely by health care industry interests, including $500,000 from Anthem Inc., the state’s largest health insurance provider; $40,000 from Cigna, another large health insurer that is current in talks to merge with Anthem; $75,000 from Davita, the dialysis company; $25,000 from Delta Dental, the largest dental insurer in the state; and $100,000 from SCL Health, the faith-based hospital chain.

Under the new system, there would be no health insurance premiums or deductibles, and all health and dental care would be paid for by the state through a new system called ColoradoCare. The plan calls for raising $25 billion through a mix of payroll taxes, along with bringing down costs through negotiations with providers.

The filing reveals that the anti-single-payer group has retained the services of Global Strategy Group, a Democratic consulting firm that has served a variety of congressional candidates and is currently advising Priorities USA Action, one of the Super PACs backing Clinton’s bid for the presidency.

http://interc.pt/1Y5QWGn

I wouldn't be surprised if some of the consulting firms advise groups on both sides of issues, especially ones that split in-party. GSG is notoriously present in a number of arenas, although they have a strong NY base.

They're providing consulting services _to_ this healthcare group, not a parent organization of it. As hired guns they'd give advice on strategy and data, but I doubt they give a shit about the actual issue. There are probably less tenuous links to Clinton that they have, but this is an especially weak one.

Priorities USA Action's largest donor is Soros, who was also one of the main people bankrolling Health Care for America NOW! (what a great name), which strongly pushed a national public option health plan. Which the insurance carriers opposed.

So either "Priorities" and its funders switched opinions on healthcare, or the more likely case -- they use GSG's services, and so do insurance companies

It's a stronger link than, say, an insurance provider event using the same caterer as a Clinton event, but still pretty vague

there's probably an article out there about how sodexo did 9/11 or something, though

good move, DOJ

The U.S. Justice Department on Thursday filed a lawsuit in federal court to block a proposed merger between health insurance giants Anthem and Cigna. The move come after a surge of national opposition to the deal, which had been move forward quietly for months.

“If allowed to proceed, this merger would enhance Anthem’s power to profit at the expense of both consumers and the doctors and hospitals providing their medical care,” said the Justice Department in a federal complaint. The department will also seek to block a separate merger between Aetna and Humana. “Anthem’s purchase of Cigna would eliminate it as a competitive threat and substantially lessen competition in numerous markets around the country.”
http://www.ibtimes.com/political-capital/justice-department-sues-block-cigna-anthem-aetna-humana-mergers-2393633

can we merge them all and then nationalize them

commie!

goodness me – anti-trust moves from Obama's DOJ

It just hit me that the total annual cost of my employer health plan (my portion plus my employer's portion) is like $36000 for a family of four. And I still have a high deductible and pay $70 copays to see specialists! It's fucking insane. I probably get maybe, at most, a couple thousand of that back per year in what the insurance pays out to providers. I get that it's, you know, insurance, but it seems like there are virtually no plausible scenarios where I could possibly get back more than I put in other than god forbid getting a rare cancer at a young age. Like it just seems like this can't be properly priced in terms of my risk level.

Nope, and that's the only way it works. Healthy people have to pay way more than they need. There's no other way to offset unhealthy people. It's not social security.

Seems like it just can't possibly be efficient to have this privately-administered and non-transparent tax/wealth transfer. Fucking single payer now.

It's baffling how Republicans have any leeway with this argument that our system is just great as is

But I have this cousin who lives in canada...

I just had a growing mole removed and it cost me $70. At least I can pay the $70. For a lot of people that's a huge sum and they might, you know, take the risk of skin cancer rather than get it removed. Which is exactly the calculus Rep Huizenga of Michigan seems to want people to make:

https://www.rawstory.com/2016/12/gop-lawmakers-obamacare-alternative-make-kids-sleep-on-broken-arms-to-avoid-costly-er-visits/

I have no problem with a transfer of wealth from me to the poor, but I have a problem with a transfer of wealth from me to Aetna. I'm probably profitable as fuck for them even after accounting for the portion of my payments that pay for the unhealthy.

Nope, and that's the only way it works. Healthy people have to pay way more than they need. There's no other way to offset unhealthy people. It's not social security.

this is right - how the cost of insurance is unevenly distributed - but it doesn't account for how insanely expensive basic medical services are. remember that time article from a few years ago (i think it's behind a paywall now, but here's a link to the author talking about it http://healthland.time.com/2013/02/20/bitter-pill-inside-times-cover-story-on-medical-bills/)

· Hospitals arbitrarily set prices based on a mysterious internal list known as the “chargemaster.” These prices vary from hospital to hospital and are often ten times the actual cost of an item. Insurance companies and Medicare pay discounted prices, but don’t have enough leverage to bring fees down anywhere close to actual costs. While other countries restrain drug prices, in the United States federal law actually restricts the single biggest buyer—Medicare—from even trying to negotiate the price of drugs.

Recently saw some good tweets explaining how a certain insurer made a client responsible for $5,000 (what just happened to be the entire amount of the deductible) for a procedure that cost $450 at the negotiated group rate. It didn't make the negotiated rate kick in until the deductible had been paid. It's so unbelievably scammy.

I'm on crappy wi-fi on a megabus right now so it's hard to search diligently, but wasn't there an infamous massive "deal" for the pharmaceuticals as part of the obamacare negotiations? like basically in exchange for not torpedoing the already heavily-torpedo'd negotiations, they got to keep the right to keep completely fucking everyone over with their prices?

Charles Pierce:

On Monday, two Republican senators, Bill Cassidy of Louisiana and Maine's famous "moderate" Susan Collins, revealed something called the Patient Freedom Act of 2017, which purports to be the "replace" part of "repeal and replace." You will note that, once again, Republican legislation validates the words of veteran San Francisco operative Mr. S. Spade: the cheaper the crook, the gaudier the patter.

What Paul Ryan Said to a Cancer Survivor About Obamacare
Cassidy was the chief pitch-person. He's one of what apparently is a limitless supply of rightwing doctors. This seemed to impress Senator Collins, who is impressed easily....

http://www.esquire.com/news-politics/politics/news/a52484/republicans-obamacare-replacement/

if they repeal ACA will insurance companies be allowed to drop customers who enrolled while they were mandated to take pre-existing conditions

I would assume so. Just don't offer than plan next year and force people to sign up for a new one that just so happens to not cover pre-existing conditions.

Even before ACA, there were no plans that didn't cover pre-existing conditions. At the plan level is not where the "risk aversion" comes into play; it was always at the underwriting level. If ACA is no longer law, and there is not a replacement law that also bans insurers from denying coverage based on health history, insurers will jump at the opportunity to do just that again.

to Mordy's question: No. You cannot just drop someone from their policy like that. But yes, they could force them to go thru an underwriting process once that year's policy expires.

The lack of understanding combined with lack of empathy from huge chunk of population wrt this topic is v depressing. How to get around what appears to be the fact that on the main, so many US citizens don't give a fuck about most other US citizens esp if it would cost them financially (or just have the appearance of doing so, eg premiums or taxes go up, but providing more Americans with healthcare actually saves them more $ in long run/indirectly).

I haven't followed, are lifetime limits back on the table? Because that's the other bit, hitting that and then getting dropped

The lack of understanding combined with lack of empathy from huge chunk of population wrt this topic is v depressing. How to get around what appears to be the fact that on the main, so many US citizens don't give a fuck about most other US citizens esp if it would cost them financially

i don't think you can get around it. i get frustrated with myself for being mad with "the US public" so much, but it seriously is depressing and i don't think there is a way around it

"The problem is that the ACA’s ban on annual and lifetime benefit limits and its requirement that insurance plans cap enrollees’ annual out of pocket spending apply only to essential health benefits as they’re defined by law. But the GOP bill allows states to opt out of or redefine essential benefits. If a state defines them narrowly, these protections could be eviscerated. “Indeed, if nothing was considered an essential health benefit,” he writes, “then these requirements would be completely meaningless.”

The fact that AHCA is a proposal at all is indicative of the collective short-term memory US suffers from. It's like the all the reasons why preACA healthcare was a disaster have been completely forgotten, because as far as I can tell AHCA is very close to just going back to that "system". The driving sentiment of reforming/repealing ACA among the general public seems to be "I don't care wtf y'all do, just make my premiums go down". And of course Republican politicians are all to happy to oblige while never laying out the true, inhumane trade-offs that must occur to accomplish that.

remember the 24,000 word Time article in 2013 (link to actual article annoyingly broken up into 11 internet pages; link to PDF) on all sorts of things related to the costs of healthcare? i don't have any new perspective on it, so this is a bad revive. but the unbelievably exploitative "chargemaster" bullshit still sticks with me - hospitals charging people $18 for a single diabetes test strip that can be bought on amazon for 55 CENTS, or $199 for a Troponin test that would have been $14 under Medicare. before i fuck off for life, i just want to confirm that yes, this article did come out and was given 36 pages to make its case, that the journalist did get news coverage and was interviewed and people listened to what he said, that everyone registered outrage at the time, and that nothing was ever done about it, even though numerous solutions were provided by the author. a lot of people eye roll at the whole "democracy is over" thing. people roll their eyes at it because maybe it's not over for them. but it is over for a lot of people, and has been for a long time. it couldn't be clearer with these medical costs. it is a ridiculously exploitative system that explicitly targets the poorest people. yet nothing happens. nothing happens.

brb, gotta check in on that important bump stock legislation

I just bought a small painting off a friend who was selling a bunch of his art to raise money to pay for the surgery he needed to fix his broken leg. The broken leg also cost him his job, in which he already didn't have health insurance. I fucking hate this country sometimes.

I've seen a few funding requests from friends-of-friends lately because they *had* insurance but a single incident resulted in either a co-pay or maximum out of pocket amount of $4k+

I mean, I guess it's great it's "only" $4k but what the hell kind of system is it where you have health insurance and that's our lower boundary? The argument, I guess, is that your finances will be screwed up for a few years rather than the rest of your life, as if fucking up your financial situation doesn't have repercussions

xpost can he file a discrimination claim?

its come down to this - I have health insurance but I ALSO have a special extra health insurance to pay for the stuff the health insurnace doesnt pay for (deductables)

ITS A SCAM

Big Medicine and Big Pharma LOVE that Big Insurance is around to take a lot of the heat for them

xpost can he file a discrimination claim?

― fuck the NRA (Neanderthal), Monday, March 19, 2018 11:34 AM (five minutes ago) Bookmark Flag Post Permalink

He has workers comp/personal injury claim underway. I think he's also thinking about a discrimination claim but that's harder from what I understand.

I'm sure administrative costs for billing and coding make US health care higher cost than places that have a simpler single payer format.

Of course health care isn't always cheap eitehr way but then again we have so many billio9naries and millionaries in this world, the money is there its just not shared.So every life may not be spared

I wish some countries would initiative a US healthcare refugee program. Literally, most people can't retire or get old in the US.

Right, it's one reason I left the USA. Once we get citizenship here (in the next couple years) we can think about bringing our parents here (who are included under our social security).

I am a newly temporary resident in another country right now and I can't even fathom going back to the US permanently unless they get their shit together. It's cool to be broke and sick...america...fuck yeah.

My parents are luckily under military/tri-care healthcare so they are set for life. Or as set as people who think no one else deserves affordable healthcare.

I'm pretty lucky to be on NYC teacher healthcare but it still has its problems -- I get "balance" bills all the time and 3/4 of the time they're improper (1/4 of the time it's some extra co-pay I didn't know about because it turns out you have to pay for the doctor visit AND the quick lab test AND the 3-day lab test and they didn't charge me at the office for the 3-day).

I also have leftover bills I'm trying to straighten out from the brief period where I switched jobs but my wife hadn't gone back to work yet, so I was on three different insurances in about 4 months and shit got all fucked up.

two of my colleagues decamped for canada (medicine hat!) in part because, as physicians, they were frustrated with how broken the healthcare system here is. so much easier to feel like you're actually doing well by your patients when you don't also know that your interventions might also bankrupt them.

Yeah, I had really good insurance through my employer when I lived in NYC. Although it got noticeably worse over the years. And I was lucky enough that we had a health advocate so anytime there were issues with insurance or bills you would just tell the health advocate and they called the insurance company and straightened it out for free.

I have friends who are in healthcare and they are always lamenting that all the money is going to administrators and not to actual healthcare workers. They are all looking to leave the US too.

I forget if I've already mentioned it but my co-worker is still fighting a $15,000 helicopter medevac bill from her baby's birth. Hospital said it was an emergency and absolutely necessary, then the insurance company disagreed. The hospital and insurance company are owned by the same parent company. This is a well-paid professional, but $15,000 is not chump change to a single-income family with two kids in our metro even on a good professional salary.

Also emphasizes how it hits even the middle and upper middle class here, just as my above-mentioned friend who was selling his art to pay for his surgery debt was a guy with a degree from a good state university.

Not only is the whole system bogged down by coding/billing bureaucracy, half the time they dont even code right or the insurance messes up the claim.

Always fight them! I recently had a bill for 1,000$ paid because of a small oversight on the biller's part

Yes, always fight them! But the irony is that it adds yet more grit into the system, more delays, more expense, more paperwork, and less accomplished.

if anyone missed this it's my favorite piece of writing on current American healthcare

https://splinternews.com/how-to-not-die-in-america-1822555151

Some worthwhile horror stories in the comments, as well.

so my personal health care journey this year has been a comedy of errors.

- beginning with being denied coverage due to not signing up properly during the Open Enrollment window. yes, even though i had signed up for employee-covered medical and dental at the start of last year, when it came time for open enrollment, i was tasked with doing the same. because it makes a ton of sense to not be able to buy health care for 11 months out of the year. why this dumb fucking rule?

- so i figured i'll just pay cash for now until OE comes around again. i had a medical emergency and ended up going to a popup clinic to see a doctor. they were nice, they told me i did not have a heart attack, referred me to a cardiologist, etc. i ended up paying like under $100 nbd.

- i go to my first appointment at the real hospital. they have me pay cash on the way in, ~$900. when i get home i look at my bank statement to see that i have been charged this amount twice. a couple of hours on the phone gets this straightened out in a week. i don't know how you can accidentally charge someone an extra thousand dollars but it occurring on the first doctor visit in decades is not promising!

- the fuckery continues. i got a bill in the mail saying i owe them $300 more dollars. i have been charged 3 times for one fucking doctor visit.

seriously fuck this.

Hospitals and clinics charging twice/thrice for the same visits/tests/whatever is like so common it must be in their manual. No other for profit business would get away with that.

it seems like medicare for all might be happening, right? it's pretty much the mainstream position of elected democrats under the age of 80 at this point, and it seems to have plenty of public support. so it's just a matter of time until the senate, congress and executive are democratic. which may not be soon, but it's not going to be never (unless nuclear war/climate change).

so i'm not concern trolling here, but i am a little worried about tactics. here's why:

the NHS is being quietly and successfully dismantled by a relatively moderate government in a country where public health seemed politically untouchable https://www.lrb.co.uk/v40/n07/james-meek/nhs-sos. presumably the end game here is based on an acknowledgement that it's hard to take away a benefit people depend on (e.g. obamacare!). but if you make that service really really suck first, then you might have a chance.

so given the "success" of the right in the UK, i'm worried about what a more ideological government (the conservative party has cranks and headbangers, but it's got nothing on the congressional GOP) could do to a public system given a majority, and an electorate where a significant fraction of people are pretty much opposed to the premise of government.

i assume whatever medicare for all law will be built with supreme court challenges in mind. but how do you protect it from sabotage by future governments?

basically that LRB piece really bummed me out about how bad things can be in more favorable circumstances than we can expect in the US

Those are certainly reasonable concerns. In fact “making it suck” is arguably exactly the GOP strategy on Obamacare — some of the suck was inherent but some was definitely engineered by the opposition.

Im not a Medicare wonk but i imagine dealing with state govts would be one potential attack point - GOP states can just weaken their state level programs on purpose and blame it on the fed.

Ultimately on the more minor end of things, but my wife and I both got COVID tests through a drive-through service provided by a local hospital. Through her cheap and relatively good but complicated benefits, we have separate plans for hospital, general medical and prescription. We both used the hospital plan, since it was at a hospital. We both got calls from their billing department, which tried to bill us $150 each claiming it wasn't covered. I suggested they try the medical plan instead, which they did, and so far I haven't heard from them again. My wife said the same thing, and they told her that was incorrect, that they were a hospital so it had to be a hospital plan.

Just example #18,257 of our health system being ridiculous and inefficient and so complicated that even hospital billing personnel don't fully understand it.

Spouse and I both have relatively decent employer-sponsored health insurance. Even with said insurance, getting our joints (knee for me, shoulder for him) fixed is costing thousands of dollars out of pocket. WITH OUR INSURANCE COVERAGE!

Clearly America believes that functional joints should be limited to rich ppl. With insurance.

Also fuck orthopedic surgeons who triple-dip by having ownership interests in the radiology clinics and outpatient surgical centers to which they send their patients. I'm looking at you, Dr. Ryu!!!

ugh, that's awful

this is a great book https://www.anamericansickness.com/

it can't see the wood for the trees at some points (spends a lot of time on details and only rarely acknowledges that the premise is insane) but it's good!

https://www.sicknote.co/p/aetnas-itty-bitty-titty-committee

wow

Just maddening dealing with this system on every fucking level. Thankfully not a serious health problem at the moment, but a typically frustrating experience:

Had my annual physical set for mid-December. Morning of my appointment, I tested positive for COVID. Obviously had to cancel the physical part, but was still able to do a virtual visit for a Paxlovid prescription. Tried to reschedule my physical, but was told I had wait until day 12 after testing positive to do so. Okay, I get it, but the next available appointments weren't for three plus weeks out. Called to ask if I could reschedule it anyway, since it would be well past day 12 no matter what. No dice, was completely blocked from rescheduling until day 12. Whatever. I get past that date and reschedule - March 30th was the first available appointment, so I took it.

Fast forward to today, got my confirmation email yesterday and did all the pre-visit check in stuff. Great. Get a phone call first thing this morning that my doctor has to cancel. Okay, when can I reschedule? "It looks like our next available appointment is mid August".

Just fucking burn this whole system to the ground.

To cover my family on the cheapest Obamacare (five of us) it is $4200 a month. And yes since I am a mercenary my employer is not "paying" for my insurance. We are a very healthy family, btw.

We switched to this in January:

https://sederamcs.org

$363 per month and it's basically catastrophic coverage. Pay out of pocket. For big bills, we only pay $2500 and they cover everything beyond. Incredible deal for us.

xp I had a similar experience this past year. Scheduled a physical, my doctor called out that morning, wasn't allowed tor reschedule for six months. I don't know what the heck's going on, gimme the so-called social healthcare dystopia!

Your time means nothing to providers anymore. Cancel day of and they charge you for the visit. They however can cancel 15 minutes prior and you just have to deal with not getting a physical until next year

and it got worse:

🚨Judge Reed O'Connor STRIKES DOWN a major provision of the Affordable Care Act requiring insurers to cover a vast amount of preventive care cost-free (contraception, cancer screening, PrEP, a ton of pregnancy-related care). The ruling applies nationwide. https://t.co/wL26vkIPsd

— Mark Joseph Stern (@mjs_DC) March 30, 2023

"cost free"

Obviously small beans in the "biggest US healthcare problems" sweepstakes, but still - I have a doctor's appointment coming up on Monday. So far I've been asked to confirm my appointment via the app, been sent two separate text messages to confirm my appointment via text response and just now came back to a voicemail telling me that I also have to call them directly to confirm or else my appointment will be rescheduled.

Just.. what.

have you been a flight risk in the past?

sounds like a policy specific to your doctor's office - if you had already confirmed via the other methods I would definitely bring it up with them

My guess is they've had a lot of no shows recently? I just don't get the point of managing things through an app and efficient text messages if you are still also going to insist on taking the time to have someone from the office also call me and make me call them back.

I did just learn from a coworker that she had the same experience and apparently there is a setting in the app to uncheck that will stop them from also calling you. Good to know now.

A coworker of mine has been going through this with appointments lately, too. I’ve had doctors do this to me in the past.

It’s weird.

I abhor all appointment reminders. Don’t punish me for being 100% reliable.

i doubt it's due to recent no shows. HIPAA compliant medical scheduling software is a huge grift and impossible for the people in the office to maintain/configure. multiple reminders from different systems is exactly the sort of thing you end up with.

mine sometimes reminds me at weird times like 9 days in advance, and then never again, and when you reply "yes" to confirm it says "we don't understand that command"

we don't

understand

that

command

sorry thought I was Thom Yorke for a moment carry on

I had a prescription for mere antibiotics sent to Walgreens over an hour ago. their status said they already filled it, but it's in that dreaded "verifying prescription" status, which is controversial because the AMA claims Walgreens pharmacists are overstepping their bounds and delaying access to needed medications: https://www.namd.org/journal-of-medicine/1632-walgreens-secret-checklist-reveals-controversial-new-policy-on-pain-pills.html

except mine are fucking run of the mill antibiotics, what in the hell. I refuse to wait all night so I requested to move them to another Walgreens that's open later because this one closes soon.

SORRY I FAKED PRESCRIPTION SO I CAN KILL ALL MY GUT BIOME AND BLAST THE TOILET WITH DIARRHEA U GOT ME

https://www.rd.com/article/how-honest-are-dentists/

reader's digest huh

I've always thought that dentists are particularly prone to upselling, perhaps because they are maybe the only medical profession where the most effective care protocol - brushing and flossing - is in the hands of the patient. A lot of the time dentists only seem to be checking that you are doing a good job, so then they shift the focus to cosmetic bullshit in essence to make work for themselves.

I've generally liked my dentists, but I had this one guy, a sub, look at my teeth and suggest some treatment that none of my other dentists have ever suggested. When I told him I never noticed a problem, he countered by saying "oh, you can bank on it." And I told him that was a very poor choice of words.