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.

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.