Healthcare in the US

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.