Healthcare in the US

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.