Healthcare in the US

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?

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.