HEALTHCARE THREAD

My mom on end-of-life planning: "but what if Grandma isn't 'shovel-ready'?"

GUILTY LULZ

Could do with some advice or consolation:
I was at a swanky party a few weeks ago when I passed out, actually lost consciousness twice. Would have been happy with a sit-down and some water but this guy who I assumed was an on-site medic (because he told me he'd been a medic for 20 years) but could just have been general security or something, had already called an ambulance, wouldn't let me have water until I'd been checked out, then told me "no-one faints for no reason" and that there could be something seriously wrong. I am healthy with no other medical probs and have had a history of passing out before - although not for years. Anyway he scared me enough that I got into the ambulance and had a hospital visit. Now I'm getting bills I thought my insurance would cover - by all accounts it's very good insurance but I didn't have my card on me at the time it happened. My claim for an acute care admission has been denied because I was otherwise healthy - all things I told him and the ambos - so it wasn't medically necessary, and now I'm bloody livid because I let myself be scared into going to the hospital based on this AND there was no mention of what costs might be even when I asked about them. I'm scared I'm going to have to pay thousands out of our savings just because I took the advice of this guy who was obviously just covering the arse of the venue. The doctors at the hospital wanted to keep me in overnight because it was the fainting twice that worried them and I'm covered for the observation stay.

I have been stressing out ever since and wishing I'd had a bit more information before getting into that ambulance or just stuck to my instincts but I honestly (stupidly) believed that if there was a potential major cost that was unlikely to be covered, someone might have pointed it out while I was trying to decide what to do? I KNOW it was stupid and I KNOW I should've at least gotten a cab but the guy had already called the ambulance and I was scared and tbh didn't have much memory of what had actually happened to me, so was relying on his judgment. Do I have any comeback with the insurance co?

bumping because someone here probably has advice that knows a lot more about it than i do

Call the hospital and speak to the billing dept. Ask to have your bill reduced. Call your insurance company and harass the shit outta them, too. It'll probably take multiple phone calls to both organizations, but your should at least get a reduction in your bill.

Thanks kate, will do.

Correction: The observation overnight stay was authorized. Something called "acute care inpatient hospital admission" has been denied because it wasn't medically necessary - I don't even know what portion of my highly enjoyable evening that refers to (the time on the bill is a few hours after I actually came into the hospital)... but surely they can only tell it wasn't necessary because they did the tests and it turns out I was fine? If it wasn't necessary why would they have done it? Reason for their concern is because it can be a symptom of arrhythmia/ heart problems but seems like it can also be nothing.

interesting article from Michael Pollan on some promising side effects of Obamacare re: the food industry

http://www.readability.com/articles/cpcdx1xn

whole thing is a t-bomb, and makes me p jazzed about primary care

great article gbx

this is v. troubling:

The clinic encountered similar troubles with some of the doctors who saw its hospitalized patients. One group of hospital-based internists was excellent, and coördinated its care plans with the clinic. But the others refused, resulting in longer stays and higher costs (and a fee for every visit, while the better group happened to be the only salaried one). When Fernandopulle arranged to direct the patients to the preferred doctors, the others retaliated, trolling the emergency department and persuading the patients to choose them instead.

yeah, the bit about the cardiologist calling the pt at home and saying she was "at risk" or something if she discontinued her biannual screening was a little o_O, too.

for real, though, a friend of mine in school (who also happens to be maybe our most accomplished student?) thinks that that article is the Future, and is deeply committed to the "outpatient intensivist" model. he's in africa right now and, if we can put aside some troubling sociocultural/ethical issues for a minute, reports that the developing world is where you're going to see some of the more exciting healthcare systems develop. wherein foreign doctors will be experimenting with healthcare infrastructure instead of pharmaceuticals, but still

anyway, as someone leaning strongly towards general practice, i'm pretty excited about new models of care that not only improve the care for our sickest people, but also seem to revitalize the practice of primary care. having had two dismal personal experiences with generalists i was souring a bit on the field, but dudes like Dr Brenner give me hope

That article is FANTASTIC and I'm still not done with it. Making it seem even more immediate, I think that risk-assessment company has an office in my building! I've always wondered what they did....

Insurer's health care site always "down" or "unavailable" this week, shame they couldn't give me A FUCKING PAPER HANDBOOK.

I am unsurprised to find that the mail-order pharmacy my insurance plan forces me to use, which essentially fucks up the delivery of a chemo drug EVERY TIME, is unpopular with other patients who are shackled to it.

And speaking of that drug, a retiree charts his efforts to get it covered.

http://www.nytimes.com/2012/12/02/opinion/sunday/a-health-insurance-detective-story.html?pagewanted=all

The nation’s largest labor federation closed its quadrennial convention Wednesday by challenging President Obama on the Affordable Care Act, pledging international solidarity and bipartisan politics, and promising to make good on the week’s themes of opening up and doubling down.

An hour before gaveling the convention to a close, AFL-CIO delegates passed a resolution expressing support for aims and accomplishments of the Affordable Care Act and deep concerns over its implementation. The resolution urges that the act “should be administered in a manner that preserves the high-quality health coverage multiemployer plans have provided to union families for decades and, if this is not possible, we demand the ACA be amended by Congress.” It calls for more penalties for employers who cut hours to shirk coverage, curtailing some new taxes and fees applied to union health plans, and extension of tax credits to them. The debate on the resolution stood out for the number of union presidents who personally took the floor to press their case and, more so, for the pointed comments they directed at the White House.

Noting Obama’s pledge to fix what was broken in healthcare and build on what was working, International Brotherhood of Electrical Workers President Ed Hill told the hall, “The ACA as it currently stands is not meeting his promise.”

http://www.thenation.com/blog/176143/afl-cio-convention-closes-obamacare-critique-and-call-bipartisan-political-action#axzz2emqVRXtA

"Whatever the Republicans are going to do, they've got to make it look as different from the ACA as they can" for political reasons, said Edward Fensholt, a senior benefits lawyer at Lockton Companies, a large insurance broker. "There are some pieces that aren't broken, and the more you ... make something different from the ACA, the more you risk screwing up things that look OK."...

Leaders in big business worry that Republicans may be tempted to limit the exemption from income and payroll taxes that job-based coverage has enjoyed for decades. Taxing workers and employers for health benefits could raise billions to pay for a replacement plan.

Such a measure has occasionally been floated by Republicans since the days of President Ronald Reagan, often under the argument of leveling the field between employer plans and other coverage that the tax code treats far less generously.

http://www.npr.org/sections/health-shots/2017/02/03/513104554/employers-fear-gop-health-overhaul-could-damage-job-based-insurance

canada places last (out of 11, including the US) for how quickly you can see a doctor

and

The survey also found that waiting times to see a specialist were longer in Canada than in any of the other countries, as were waiting times for all elective surgeries.

http://www.theglobeandmail.com/life/health-and-fitness/health/how-quickly-can-you-see-a-doctor-study-shows-canada-lags-behind-other-nations-on-timelyaccess/article34043606/

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