Healthcare in the US

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?