HEALTHCARE THREAD

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.

i'm not too crazy familiar with the way it works stateside but don't hmo's basically add another level of cost to the overall heath care equation there?

more xposts

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 $$$$

people are getting it now and our economy isn't dead, what's the harm in cutting out the insurance companies, spanking big pharma, adding some cost effective preventative medicine and inviting the poor along for the ride?

NOT THAT I THINK THAT WILL HAPPEEN LOL

not enough ventilators

spanking big pharma,

TOTALLY. For starters, stop with the TV ads for every fucking symptom under the sun.

as an aside, some beefs with the NHS:

-- aunt waited for MONTHS before she was able to see a specialist about her bizarre illness (woke up paralyzed one morning...totally terrifying). then, when she did, no one knew what was up. they took spinal taps to get at her CSF, and she got awful, post LP headaches that lasted for weeks. i had a conversation with a PA here the other day, and dude not only correctly diagnosed her from my poor description, he also asked why they didn't give her a blood patch, which is an extremely routine treatment for post-LP headaches that is pretty much guaranteed to work. asked my uncle, and he said that when he brought up blood patches, the docs flatly refused to do it, with no explanation

-- uncle fell and broke his hip for the third time, was not given morphine for TWO DAYS. paramedics hand that shit out like candy over here, wtf

i agree that big pharma needs to be dealt with, i'm just not sure how

xp - Malpractice insurance is only 2-3% of our total healthcare cost and more a function of insurance co. profitability than anything else.

yeah shit like that happens aaaaaalll the time here too

xxp

In many cases, doctors really are paying upwards of 100k/year. moreover, the ones carrying the most are the kind we're running out of: OBs, in particular

my wife likes to yell at the TV when an ad comes on, and she claims that there is only one other country in the world that allows pharma ads. i wonder if that's true.

At least health care IT in the U.S. is improving and, I think, >>> other places :>

And make sure you don't have any behavioral health problems while uninsured, you will be blacklisted for life by insurance companies. Even under a group healthcare plan, they will fuck you over and make it extremely difficult to get a claim filed. The insurance companies want you to give up.

jhoshea: not really, dude. i mean, certainly not the morphine thing.

price caps for starters.
xpost to big pharma

http://www.sourcewatch.org/index.php?title=Direct-to-consumer_advertising

Direct-to-consumer advertising (DTCA) is the promotion of prescription drugs through newspaper, magazine, television and internet marketing. Drug companies also produce a range of other materials, including brochures and videos, that are available in doctors offices or designed to be given to patients by medical professionals or via patient groups.

The only two developed countries where DTCA is currently legal are the U.S. and New Zealand. (See Direct-to-consumer advertising in the United States and Direct-to-consumer advertising in New Zealand for more country-specific details). While banned elsewhere, the drug industry is mounting major lobbying campaigns to have DTCA allowed in Europe and Canada. (See Direct-to-consumer advertising: The Campaign To Overturn Europe's Ban and Direct-to-consumer advertising: CanWest's Bid to Overturn Canada's Ban for further details).

Fucked up.

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?

i have no problem having to pay for it, but individual health policies are NOT affordable b/c of the way that insurance works. group policies are not available to everyone, and to those who don't have access to group policies paying for procedures and hospital visits are unfairly inflated.

maybe were generous w/the morphine - but sloppy misdiagnoses, yes

xp

yeah, most of the cost of an ICU stay is the fact that you're paying for facilities as much as care. i'll see if i can find a breakdown (which may prove difficult? i had to yell at peeps to get one for my ER visit)

i'm not too crazy familiar with the way it works stateside but don't hmo's basically add another level of cost to the overall heath care equation there?

more xposts

-- The Cursed Return of the Dastardly Thermo Thinwall, Monday, June 18, 2007 4:52 PM (Monday, June 18, 2007 4:52 PM) Bookmark Link

I think the argument wrt that is that HMO's add an extra level of administrative costs/waste?

More than anything I'd like to see pharma companies BANNED from advertising to the general public. These commercials that don't even really tell you what the drug is for/talk about it in a way that makes it sound like YOU MUST HAVE IT need to stop. Bad for doctors, bad for patients. :(

CON: GB healthcare misdiagnosed my grumbling appendix for 8 months
PRO: When they finally got around to extracting my burst appendix, they did not kill me
DECISIVE PRO: They also gave me the morphine button

I think the argument wrt that is that HMO's add an extra level of administrative costs/waste?

also, plz note guys that i'm totally open on this issue at the moment. like, something's definitely wrong, but i'm not entirely sure what the solution is here in the US

xp totally, jessie: while patients should absolutely have a say in how they're cared for, they really shouldn't be telling docs they NEED to have $DRUGSEENONTV

an argument I've heard for single-payer in the US is the drastic reduction in administrative bullshit. there'd simply be one bill that the patient would never see, and entire billing depts would no longer be necessary

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