HEALTHCARE THREAD

canadians sure seem pretty smug about their healthcare but i dont know how it would compare to the euros.

What I'm interested in hearing is actual ILXors BEEFZ with healthcare. Like, does anyone even know why they don't like it? Do they have any idea why they might think, say, Cuba or Sweden's system is better? Would any Britishes care to tell us about the NHS (ie the worst healthcare system in the western world)?

xp

i dont see why any system wouldn't be scalable?

I would like to hear from a Canadian about theirs.

I would think even the NHS, with its problems, would be better than being uninsured in the US. I have severe, chronic illnesses and have been uninsured many times. Not good. Even with insurance my monthly medical bills average $300. My job choices always center around what insurance is offered. That is life, unfortunately.

my friend gabe is facing like 10k billz after getting hit buy a car, an ambulance ride and a sleep over at the hospital.

Everyone thinks about the poor, who are completely screwed by our healthcare system. However, most middle class Americans are one major illness or accident away from being in that exact same scenario that poor folks are in, whether they have insurance or not.

Uninsured in America is the most depressing book I've ever read, but I recommend that everyone who thinks that the system is okay.

rw: w/o getting too personal, for full disclosure, you work in healthcare/ are in med school, right?

americans arent healthy compared to our universally insured brethren.

Big pharma needs an obvious overhaul but no, I don't know what could be done to improve U.S. healthcare. I would tremble to socialize healthcare should I one day become rich.

It is, you're right (xp misery). And no, you would not be better off in the NHS. See, it is precisely when patients have severe and chronic problems that socialized systems tend to fall down.

But yes, Jeff is right: we're all about one accident away from serious bills. I'm still paying off an ER visit from two years ago that involved a CT and a once-over from the EP.

gr8080: not too personal at all! yeah, i'm applying to medical school, volunteer at the hospital, will hopefully be working on an ambulance here soon, have a vested interest in healthcare as a topic (which is why i want to talk about it!)

preventive care is not being supported in this country because it's not in the interest (ha ha get it interest) of the $ providers. insurance is failing to effectively deflect the costs of medicine as it should. universal public healthcare can be run like regional utilities or it can be run like your local PD/FD/school system; a big federal solution a la NHS would be pretty disastrous here.

insurance industry, v bad.

(also: i'm not claiming that this makes me an authority in any way, despite my attitude)

a big federal solution a la NHS would be pretty disastrous here

what we have now is a disaster

TOMBOT's basically OTM here -- when people think of socialized medicine they think of free, routine checkups for babies and kids and people that just need to make sure the engine's running. also: catching things early drives down costs in a huge way because they can be nipped in the bud. socialized medicine will NOT pay for months in the ICU, however, and anyone that thinks it will is crazy

waht it doesnt in other places?

jhoshea (et al): really? tell me about it! like, srsly! there are people that are very badly in need of care, yes, but who are you thinking of when you say disaster?

The Canadian System isn't doing so great. it could be alot better except for the fact that we're facing a ghastly doctor shortage due to so many heading south to earn more bling. waiting lists is the other problem right now - there's a serious lack of facilities/equipment due to underfunding over the last few decades.

but our problems pale in comparison to the U.S.'s.

huge xpost'n

Isn't there a huge swath of people in the US who make too much money for Medicaid, but too little to afford private health insurance?

The European models seem like good ideas, but where does our country, already running a deficit, get the money to subsidize healthcare for 200 million+ people?

I have a Canadian friend who complains about long waiting lists for appointments and impersonal, assembly-line style treatment. She usually uses providers subsidized by the private insurance she has on top of national healthcare.

Also of interest, especially re: what TOMBOT said: MA passed a law requiring everyone to have insurance, and offers a state-run insurance that is low-cost to those most in need. It seems like a good idea, especially since living costs can vary WIDELY from state-to-state.

the point that needs to be made, seriously, is how much of a leech the current system is on our economy vs. publicly available "free" medical care would be to prop up. The fact that one accident can lead to a massive debt drain on yr median-income american is a hidden cost that i haven't read much about but would like to. I'm sure I'll hear plenty about it when the boomers start needing 7-day pill containers (same for pharma reforms) in a decade or so, which is when we'll get some serious change and any politician NOT supporting major changes towards more socialized medicine is going to be run out of town on a rail.

socialized systems are very good at delivering the cheap areas of medicine cheaply. but that's the thing: it's cheap here, too, you just have to pay for it out of pocket.

if you need, say, a non-emergent but v necessary surgery, you WILL wait.

If I have to pay for it out of pocket, it ain't cheap.

I mean we're all about to see the biggest uptick in voting participation since ladies' suffrage when our parents retire, and nobody else gets crankier about where their money goes than old sick people on fixed income

again, TOMBOT 8080 -- right now, the cost of healthcare is driven up by the fact that the ER will and MUST provide care to anyone that presents, no matter what they've got or they're ability to pay. and i hope it stays that way. however, when ppl default on payments, are uninsured, do a runner, whatever, providers compensate by charging more. also, remember, insurance companies basically dictate how much things cost, save for a very few boutique providers of elective care or hard-core buck the system assholes who only take cash (and there's getting to be more of them)

If I ever break a leg, I'm just going to ask to be put down like a horse.

Isn't there a huge swath of people in the US who make too much money for Medicaid, but too little to afford private health insurance?

Yes, my aunt. She's suffering from shoulder injury that worker's comp has stopped paying for and some undiagnosed liver ailment but can't afford treatment.

The European models seem like good ideas, but where does our country, already running a deficit, get the money to subsidize healthcare for 200 million+ people?

Stop fighting pointless wars perhaps?

The current system isn't that good for providers either. One of my doctors doesn't accept any insurance but the level of care is good enough that I pay full price for him. In the past with sketchier jobs, nothing covered by insurance I couldn't have afforded this "luxury".

i took a year off before my last year of college and was uninsured for a year after graduating.

the morning of my 4th day of classes that year i sliced my finger wide open, requiring a specialist surgeon to repair it and four or five months of therapy.

one month before that year of being covered was over, i fractured my wrist in a bike accident and had to get a cast.

a few weeks after graduating, and six days before my because-of-being-a-student coverage would lapse, i passed out from heat exhaustion and split my forehead open requiring an amblance ride and stitches.

its kind of scary to think of how good my timing was. if i had been only a few days off on either end of that college year, i'd be looking at $30k in medical bills instead of the <$1k co-pay.

some hueg chunk (half) of bankruptcies are related to medical debt.

americans are less healthy and get less healthcare than places w/universal coverage, many of which are far poor than us.

10% of americans have no health care.

the insurance industry is always amongst most profitable in the country.

disaster.

That's a point I've never been clear on, rw. I know about the ED "must provide care thing", and I know that many hospitals are basically writing off a whole segment of care that they give. On the other hand, uninsured/self-pay patients DO get billed, and stuff eventually goes to collections, etc.. I just wonder how far it goes and if the hospital explicity lets anyone off the hook, or just expects to not get paid ever?

xpost

sorry for the autiobiography.

xxp

w/r/t European systems, some theories I've heard (though I don't necessarily subscribe to):

-- many European countries instituted universal healthcare BEFORE many of the huge technological advances of the last 30 years, so, unlike Americans, they are accustomed to physicians NOT pulling out all the stops. whereas here, it's not unreasonable to assume that if universal coverage were provided, a large chunk of the population would clamor to keep 80some yo grannies in the ICU for weeks at a time

-- European countries have up until very recently been socially and culturally homogenous, so ppl don't have as much problem helping their neighbor. in the states, there is a very real, very mean streak of ppl that would find the idea of providing free healthcare to the "undeserving" totally appalling

intended a ? after that half

self xp

there are so many things about healthcare that are fucked, but i think one thing to start with that wouldn't require as drastic an overhaul as national healthcare, would be to drive down the costs for uninsured patients. cost of healthcare is ridiculously inflated, and this is mainly because doctors charge the insurance company one amount, and the insurance provider pays a percentage of that amount because of their arrangement with that provider. people without coverage don't have a relationship with the healthcare provider and can't "negotiate" the inflated amount, in most cases.

yikes i can't keep up

Jordan: no one ever gets off the hook, ever. my bill very nearly went to collections because the billing dept FORGOT to enter in my insurance information and let my bill sit unpaid for months

jhoshea: a not insignificant chunk of that 10% is healthy 20 somethings that don't want to pay a monthly fee. (devil's advocate)

I was once told that on medical collections (like from the ER), as long as you paid a small sum every month (even if not their minimum), it could never go into default/screw up your credit. True?

fwiw, insurance companies are almost entirely responsible for how much healthcare costs -- they control the pursestrings

not true xp

i mean, as far as i know -- fairly certain people have gone into bankruptcy because of unexpected medical bills

yeah between the anti-tax crusaders and the insurance/pharma/whoever else industries i dont really seea european style system happening here anytime soon.

but it doesnt mean we wont see improvement. all the dems plans seem pretty similar - which may indicate an emerging consensus. unlike the bill/hillary version that just came out of nowhere.

RW, I think you're right in the majority of cases, but there are hospitals that are aware that they're caring for a large indigent population and that they're going to absorb a lot of those costs. It's good publicity for them, at least.

wrt technology:

isnt that (sadly) the biggest threat to affordable healthcare?

i read somewhere that if healthcare technology and life expectancy continue to follow the same pattern of growth, it could possibly bankrupt the entire economy.

bell labs: what are the so many things, though??? like, i don't find the fact that you have to PAY for healthcare to be appalling in any way whatsoever. you have to pay for everything else in the world, why not healthcare? why should it have to be free?

also: preventative medicine is NOT that expensive, but ignoring it or being denied access to it IS.

xp Jordan they definitely DO absorb the costs---but they don't EAT them, they just get passed on

gr8080: exactly. ppl in America have come to expect the very best healthcare in the world (in the cutting-edge, pulling-out-all-the-stops sense), and suddenly making that free to everyone would cost serious $$$$

Maybe we should just require everyone to go to death acceptance therapy. jk xpost moocow etc.

I can only speak from my own experience - the care I have received on my healthcare plan here in the US was no better than the care I have received under the NHS - in terms of wait times, information, quality of staff and access to medication. I've also had fairly major surgeries/procedures in both countries. The US might not be fertile territory for a European-style plan, but that doesn't take away from the fact that Americans are being lied to about the relative/potential quality of care under alternative systems.

RW, preventative medicine IS that expensive for a lot of people. I have no insurance, so my sole provider are Doc in the Box outfits (CareNow, specifically). $105 just to walk in the door. Another $75-100 if I need a shot. Another $15-100+ if I need a prescription.

One doctor's visit for something relatively minor can easily eat up an entire paycheck.

I was once told that on medical collections (like from the ER), as long as you paid a small sum every month (even if not their minimum), it could never go into default/screw up your credit. True?

Only if you have worked this plan out with the hospital and stick with it scrupulously.

i don't find the fact that you have to PAY for healthcare to be appalling in any way whatsoever. you have to pay for everything else in the world, why not healthcare? why should it have to be free?

I'm a socialist at heart and I do believe along with a quality education this is something that should be provided at no direct cost to citizens (I realize taxes fund social programs).

another thing that you are paying for when you go to the doctor aside from medical procedures is the doctor's malpractice insurance, which is often hundreds of thousands of dollars a year...democrats seem to hate to talk about this but doctors are already getting pretty fucked over w/r/t income and expanding low-cost coverage is not going to make this any better :/

river wolf can you break down the costs of a stay in the ICU under observation? I mean is it like lots and lots of overhead for 24/7 staffing and equipment that doesn't depreciate in a helpful fashion? Because if that's generally the case then socialized systems should be able to absorb those costs really well, I would think.

being able to see a doctor the second it occurs to you isn't a very good metric for measuring quality or access, and, i might humbly submit, is a symptom of a late-capitalist consumer economy that overvalues immediate gratification

"Canada also placed second-last on the availability of doctors on nights and weekends, which contributed to making patients in this country the most frequent users of emergency departments and the most likely to wait four hours or more for emergency care."

if you went to the emergency room and then waited four hours to see a doctor it's very likely you didn't need to be in the emergency room in the first place

we're talking about "well-off" nations, as the very first line of the report states

also this isn't measuring quality of care. the quality of care i, my friends and family received in canada is great

out of curiosity what is your general experience in the er in canada?

i've had to go a few times in vancouver, one for a friend who ended up having apendicitis. we had to wait 3.5 hours and he almost fainted, probably because he was in excruciating pain. er wait times in canada is horrible now that i am in los angeles and can compare

i have no experience with canadian EDs, but they function according to the same basic principles as those in america (with which i have extensive working experience) -- pts get triaged according to their chief complaint and sometimes this can depend heavily on the clinical judgement of the triaging personnel (does that "belly pain" look like constipation or like appendicitis?). very sorry to hear about your friend's wait time -- would you say that's typical of a canadian ED? and by "that" I mean someone waiting a long time for an acute issue? (vs waiting a few hours because you have a cold or something)

i would suggest that wait times ARE a measure of quality of care (why bother tracking them, otherwise), but that they are over-valued if you are primarily concerned with clinical outcomes. as you, and the article, say -- the care in Canada (and Norway etc) is really great (and really cheap), you just have to wait a bit longer. i'd say that's a reasonable trade, and preferable to the US system where you might be able to get in more quickly, but it'll cost you

also

"wait times in the ED" aren't really comparable to "wait times for an appt with yr PCP or specialist"

the former is determined overwhelmingly by the policies/population/staffing/acuity of a given ED, and can vary by the hour. if a bus full of hemophiliacs gets into an accident down the road, everyone's gonna be waiting. staffing/policies can be influenced by the larger healthcare structure, but not the way that more quotidian clinic scheduling is.

I suppose maybe canadians are more likely to go to the ED than americans, since they know it won't put them in the poor house, and that could contribute to wait times, idk

we're talking about "well-off" nations, as the very first line of the report states

also this isn't measuring quality of care. the quality of care i, my friends and family received in canada is great

out of curiosity what is your general experience in the er in canada?

i've had to go a few times in vancouver, one for a friend who ended up having apendicitis. we had to wait 3.5 hours and he almost fainted, probably because he was in excruciating pain. er wait times in canada is horrible now that i am in los angeles and can compare

― F♯ A♯ (∞), Thursday, February 16, 2017 9:32 AM (fifty-three minutes ago) Bookmark Flag Post Permalink

i know anecdotes are not data but my family doctor is p easy to get an appointment with, works evenings, there are a number of drop-in clinics nearby where i can be seen in around an hour, the two times I've been to canadian ER I've waited less than 2 hours. much easier to get to see a doctor here than in scotland ime.

thing i don't like about single payer vs socialized healthcare = recently went to the doctor and found out I've been uninsured for 18 months because a fuck up with my wife's employer's HR department not sending proof of my residence to MSP. no one thought to tell me. still waiting for the paperwork to be done and to be insured again.

xp to gbx

i think maybe canadians have a fundamental difference in how we view health care, and i say this because the article says:

“Over all, Canadians were the most likely to rate the quality of care they receive [from their own doctors] as excellent of all the countries,” said Robin Osborn, vice-president of the international program in health policy and practice innovations at the Commonwealth Fund. “Where it stands out in terms of having room to do better is on the access.”

i understand this statement completely. i can separate the quality and the wait times and assess them on their own. on average, i feel a little more confident in a doctor practising in canada than in the us, where i feel every other doctor is very impersonal and doesn't demonstrate any interest or concern for the individual. but of course good ones do exist in the us, and even better ones i'd argue, but you have to really look hard for them (which is in itself stressful), and they're always more expensive

i don't know how patients waiting to be helped are prioritized in british columbia. i guess i thought it was first come, first serve, unless you have a life-threatening illness/condition. so from experience, it seems quite normal for most people, who suffer minor to more severe, non-life threatning conditions, to wait long hours; this from what friends/family tell me of their experience in bc as well. i think it varies by province, and i do hear people say it is a lot worse in montreal, but i have no experience there

in terms of going to the ER vs your family doctor, at least in vancouver, a lot of them are closed on weekends and after work hours, and i may be wrong, but after-hours clinics don't seem to be as common as in the states, at least they aren't in my circle in vancouver

jim my family doctor in vancouver is easy to set up an appointment with as well. there are limited ones one can choose from if you're looking for a new doctor these days, is what i understand though

we're talking about ER wait times, though. two hours seems okay. i can get helped in LA in the ER in 45 minutes to 2 hours

i guess drop-in clinics is becoming more a thing in canada now? good to know. i went once to one on cambie/broadway. on the second floor above london drugs, i believe it was. pretty decent

just to be clear -- i think minimizing wait times in the ER and for clinic visits is very important! i guess i'm just so used to hearing them brought up as a reason why non-US systems are actually worse and that doesn't wash w/me (not saying that you're doing this, btw!). i think that if more ppl having insurance/access means longer wait times, that's a reasonable trade-off

w/r/t ED triage -- in the EDs I've worked in, there's a graded scale of acuity (1-5). so if you get triaged as a 5, and then there's a steady influx of 3s, you're going to end up waiting.

Patrick Caldwell of Mother Jones on his leukemia and coverage

https://twitter.com/patcaldwell/status/844929075026296833

Conversation with our team doctor re surgery on Toms collarbone. Highlights the extreme expense of US healthcare. pic.twitter.com/usZ5SKDQem

— Jonathan Vaughters (@Vaughters) May 16, 2017

toms skujins is a latvian pro cyclist who had a pretty horrifying crash yesterday in the tour of california (i saw it live and the footage of him staggering around, clearly concussed, was pretty disturbing)

basically, it'll be cheaper for his team to fly him back to europe to get treatment than it would be to get treatment here

Amazing.

jesus

Just had surgery twice in two days in a Parisian hospital, one under local, one under general. I was amazed tonight at how much conversation there was in the recovery room, even among patients. We even talked hoops!

What I'm interested in hearing is actual ILXors BEEFZ with healthcare.

I use very few healthcare services for myself, and so have few beefs of a personal nature. The one which springs instantly to mind is doctors who are so focused on getting past me to the next patient that their minds disengage with what I am telling them, because they've already decided what they are going to do with me in the first three minutes.

I have not come in to see them in order to be disposed of. I am not theirs to do with as they please. It is my body and my health and I will make the decisions about what is to be done. I am there to access their specialized knowledge and get their informed opinion so I can use these to make a decision. Forming that plan for restoring or maintaining my health is a mutual process that requires mutual respect. Some doctors manage to understand this and earn my respect. Others will never learn it and my invariable response is to scorn them and seek a new doctor as soon as I can.

my doctor doesn't remember who i am

giving me a sick feeling

GOP moderates in the Senate are open to ending federal funding for ObamaCare’s Medicaid expansion, but want a longer deadline for ending the additional funding than their leadership has proposed.

Sens. Rob Portman (R-Ohio) and Shelley Moore Capito (R-W.Va.) have proposed a seven-year phase-out of federal funding for the Medicaid expansion, beginning in 2020 and ending in 2027.

Senate Majority Leader Mitch McConnell (R-Ky.) proposed a shorter, three-year phase-out that would end in 2023 at the Senate lunch on Tuesday.

Portman’s and Capito’s willingness to end the program is significant, in that it suggests centrists will not demand that the Medicaid expansion be permanent, and that Republicans may be able to find common ground on the critical issue if the additional federal funds are phased down more slowly
Portman told reporters Wednesday that a “significant glidepath” is needed, saying “we have a proposal out there for seven years, and we'll see where we end up.”

http://thehill.com/policy/healthcare/336814-key-gop-centrists-open-to-ending-medicaid-expansion

This part of the GOP Medicaid cutbacks has nothing to do with Obamacare, they're just seizing the opportunity https://t.co/laug2v2yOO pic.twitter.com/nEHhggTPOy

— Jon Schwarz (@tinyrevolution) June 21, 2017

President Donald Trump is trying to do with the stroke of a pen what Republicans in Congress could not — bring about the end of the Obamacare markets.

Trump is expected to sign an executive order on Thursday directing an overhaul of major federal regulations that would encourage the rise of a raft of cheap, loosely regulated health insurance plans that don’t have to comply with certain Obamacare consumer protections and benefit rules. They’d attract younger and healthier people — leaving older and sicker ones in the Obamacare markets facing higher and higher costs.

It’s not yet clear how far the administration will go, or how quickly it could implement the president’s order. But if successful, the new rules could upend the way businesses and individuals buy coverage — lowering premiums for the healthiest Americans at the expense of key consumer protections and potentially tipping the Obamacare markets into a tailspin.

“Within a year, this would kill the market,” said Karen Pollitz, a senior fellow at the Kaiser Family Foundation who previously worked at former President Barack Obama’s Health and Human Services Department.

http://www.politico.com/story/2017/10/12/trump-obamacare-executive-congress-243696

A new bill from Elizabeth Warren would allow the government to manufacture generic drugs https://t.co/FEBQM7Z4c5 by @ddayen

— Jon Schwarz (@schwarz) December 18, 2018

Few things

1) this is an op-ed posing as straight news
2)“covered” doing a ton of work here
3) glossing over 30M uninsured by saying “90%” are insured is total marketing bullshit
4) high out of pocket costs ignored
5) relys heavily on insurance-funded “think tanks” like Kaiser https://t.co/NRCph87IiC

— Adam H. Johnson (@adamjohnsonNYC) July 27, 2019

ie coverage that sucks is not really coverage

luv2brandish impressive stats about my healthcare system that is also the worst in the developed world by any reasonable measure

https://talkingpointsmemo.com/edblog/the-wages-of-bamboozlement-or-harriss-struggles-on-private-insurance

This at least gets at a basic issue in this debate which has drawn very little focus, at least in the political realm if not among policy analysts. Current Medicare itself actually doesn’t eliminate private care. Roughly a third of beneficiaries choose a Medicare Advantage private plan. This is still significantly different from anything that now exists in the private market. These are private plans but they have to abide by a tight regulatory framework defined by Medicare. Of course, beneficiaries can opt back into traditional Medicare or choose a different Advantage plan if they choose, so that provides competition beyond the regulatory regime.

Thoughts on @ewarren's new #MedicareForAll funding plan. A thread...

First, it's FANTASTIC that we have several candidates who are serious about real, single-payer healthcare. Warren's team took a serious crack at financing M4A that doesn't water down the facts of M4A

1/

— Abdul El-Sayed (@AbdulElSayed) November 1, 2019

the line where politicians tell us insurance should be something “you choose” is a transparent play to our vanity just as “school choice” and “at will employment” are, poll-tested by the same Madison Ave zombies that told L’Oreal to say “because you’re worth it”. Complete drivel

— Adam H. Johnson (@adamjohnsonNYC) November 4, 2019

This thread is really incredible.

THREAD: Let's examine all the possible ways this @ebruenig tweet represents #FakeNews -- and one of the sillier arguments for #SinglePayer I've heard in a long time... 1/ https://t.co/4giYHyH4g4

— Chris Jacobs (@chrisjacobsHC) January 30, 2020

Millions of people have lost their employer-tied health care over the last two weeks because of the pandemic.

It's an easy call: Re-open the health care exchanges. https://t.co/otTxOpyB3b

— Hillary Clinton (@HillaryClinton) April 2, 2020

40% of Americans cannot afford a $400 emergency.

Avg deductible for a silver plan on exchanges: $4000

Avg deductible for a bronze plan on exchanges: $6000

Good plan...

— Walker Bragman (@WalkerBragman) April 2, 2020

kachinggggg

https://www.cnbc.com/2020/05/29/coronavirus-biden-sees-surge-in-health-exec-fundraising-as-trump-slumps.html