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  #51  
Old 01-21-2018, 03:28 AM
psychobunny psychobunny is offline
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Sorry about the double post and the typos. There was an internet glitch and it wouldn’t let me edit.
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  #52  
Old 01-21-2018, 07:33 AM
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Since we're already in the Pit, I'll tell you that I'd enjoy your sob stories more if you'd answer the fucking question about single payer.
  #53  
Old 01-21-2018, 08:58 AM
Filbert Filbert is online now
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Originally Posted by septimus View Post
Since we're already in the Pit, I'll tell you that I'd enjoy your sob stories more if you'd answer the fucking question about single payer.
You mean if he posted something like this?

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Originally Posted by psychobunny View Post
Tl:dr I have been burned in the past and now oversee my billing personally much more closely. I think single payer would be the best solution. I have no problem with a two tier system as long as there is a basic health plan for all free of charge financed by taxes.
We seem, in England, to be getting multiple politicians making comments about moving towards a 'More American healthcare system'. Threads like this make me want to leave bags of flaming dog poop on their doortsteps.
  #54  
Old 01-21-2018, 11:37 AM
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You mean if he posted something like this?
I read the first of his two almost identical and rather long posts, then skipped the 2nd, where the major (or only?) change was to ... answer my question! Sorry, psychobunny.
  #55  
Old 01-21-2018, 12:31 PM
up_the_junction up_the_junction is offline
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We seem, in England, to be getting multiple politicians making comments about moving towards a 'More American healthcare system'. Threads like this make me want to leave bags of flaming dog poop on their doortsteps.
Do we? I seem to have missed them.

It would also appear to be electoral suicide.
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  #56  
Old 01-21-2018, 12:40 PM
up_the_junction up_the_junction is offline
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Originally Posted by Gary Kumquat View Post
But to do anything else would be socialism, and the US is only in favour of collective funding of national services when it comes to military spending.
The political class has always been keen for the public purse to pick up the pieces of deregulation - in other words when investors have made their money and bought legal exemption in DC for the inevitable consequences; bailing out Wall Street variously, picking up the pieces of the opiads crisis, environmental damage, etc, etc.
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  #57  
Old 01-21-2018, 12:45 PM
k9bfriender k9bfriender is offline
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Originally Posted by wolfpup View Post
No, with all respect, it couldn't be the norm. The essence of any insurance business model is to discourage claims by requiring deductibles or co-pays or some other form of monetary disincentive and cost reduction strategy, as well as (usually) payment limits, and secondly to adjudicate each and every claim with a view to improving the bottom line by either (in the case of health insurance) requiring less expensive treatment protocols or, if legally possible, denying the claim altogether. The lack of a uniform coordinate fee structure and the lack of centralized cost control also means costs will continue to spiral out of control and, as noted, no one will ever really know what they are or know for sure that they're even going to get paid.

I'm glad to hear that you're getting your tests covered in full but this sounds more like a case of your health interests and the insurance company's cost-saving interests being aligned in that preventive medicine and early detection saves them money. It's not because they care about your health.
There are employer based health plans where the insurance actually does care about the patients outcomes, well being, and happiness with the services.

The employers pay alot of money to the insurance company to make sure that their workforce is healthy and productive, and actually has negotiating power, in that, if the insurance company is not keeping their workforce happy and healthy, they will change to a company that will.

These used to be more common, I've had a couple employers well in the past that had such generous plans. They are certainly less common now, but I doubt they are entirely gone.
  #58  
Old 01-21-2018, 01:07 PM
JackieLikesVariety JackieLikesVariety is offline
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They are certainly less common now, but I doubt they are entirely gone.
I wish I could find one.

I wonder how many people THINK their insurance if fine because nothing horrible has happened to them yet? here's the thing, people are forced into bankruptcy despite having health "insurance" and that shouldn't be possible.

Last edited by JackieLikesVariety; 01-21-2018 at 01:09 PM.
  #59  
Old 01-21-2018, 01:38 PM
wolfpup wolfpup is offline
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Originally Posted by k9bfriender View Post
There are employer based health plans where the insurance actually does care about the patients outcomes, well being, and happiness with the services.
I find it hard to associate the idea of "caring" with a profit-making corporation that is simply fulfilling its contractual obligations, and perhaps doing it better than average but only under threat of losing a major corporate contract, from what you just said. Maybe their ethical standards were higher than average, I don't know. But caring doesn't consist in meeting your legal contractual obligations, it consists in going above and beyond. The trouble with most insurers, aside from all the structural nightmares intrinsic to the mercenary insurance approach to health care, is that they fail to meet ethical and moral obligations by finding creative ways to escape contractual obligations. I'd be impressed if they extended you major coverage that they didn't have to.

I don't claim that a public single-payer system "cares" in some human sense any more than a private health insurer, but there are two huge differences. One, the system is set up fundamentally to serve the public interest and not the stockholder interest. Two, and most important of all, whether they "care" or not is irrelevant because structurally they're out of the picture; it is intrinsic to single-payer that health decisions are relegated to the doctors and their patients, where they belong. And most doctors, in my experience, do genuinely care about their patients.

And that is really the crux of the matter. The most that a "caring" insurance company can do is pay your bills. The alternative is their power to deny coverage and deny you health care. It's the doctors who actually provide care. In single-payer, they are entrusted with that responsibility with a minimum of interference.
  #60  
Old 01-21-2018, 02:05 PM
Stranger On A Train Stranger On A Train is online now
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But to do anything else would be socialism, and the US is only in favour of collective funding of national services when it comes to military spending.
Actually, there is much that the federal government does that is “socialist” in nature, from universal mandatory public education, government owned or subsidized utilities, public health and science research funded by federal revenues, to most public roads that are funded by general revenues at the federal, state, and local level rather than through investment vehicles such as bond issues. The government pays for these things because they are a general benefit to all, and improve the nation in terms of competitiveness, productivity, and general gross domestic product, as well as giving the nation reign to lead the world in how we think things should be done (for better or worse) than following someone else like China or Russia.

The purpose of government is to do those things that commercial entities and joint ventures of private capital cannot or will not do on their own, either through lack of return on investment or the prohibitive sheer capital reqiurements. The Global Positioning System which is now a many-multi-billion dollar industry that is used casually by many drivers and virtually any business that requires geographic information is ‘socialist’ insofar as being a former strategic asset for which access was gifted to anyone with a receiver. The NASA space program is ‘socialist’ in terms of the benefits it has provided to the public at large (telecommunications, weather surveillance, basic science) and arguably an entitlement for small and large corporations which have received massive contracts on the public teat. Rural electrification, public waterways and reservoirs, US and Interstate highways are all ‘socialist’ and all have benefited the nation as a whole such that we aren’t one of those “shithole countries” where fat kleptocrats lord over illiterate starving peasants that nobody wants.

Whether you regard basic health care as some kind of ‘human right’, it is demonstrably in the public interest that people are healthy, and the physically and mentally ill receive attention and treatment so they are not sprawled out on the sidewalk in one of the bankrupt, ‘failing’ cities that looks all to much like one of those “shithole countries” that it is so easy to disdain from a position of wealth. Whether a ‘single payer’ system is the best solution or not (I’m not pursuaded that this alone will do much to fix our otherwise for-profit health system without imposing further controls on cost), ensuring that everyone has access to basic medical care without having to go to the emergency room and then dodge bill collectors, or go into bankruptcy to pay for common procedures or treatments that are an order of magnitude more expensive in this country than they are anywhere else should be the priority of any legislator or political executive who wants to make even vague noises about compassion or improving the competitiveness of the nation.

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  #61  
Old 01-21-2018, 02:24 PM
k9bfriender k9bfriender is offline
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Originally Posted by JackieLikesVariety View Post
I wish I could find one.
Hard to anymore. The place I worked at that had excellent insurance, that pretty much just took care of everything health related that you needed, no longer offers those, or anywhere near those plans. I assume that the cable company still offers a decent enough plan, but I don't actually know anyone that works there anymore, so I really don't know. When Iwas there, it was a pretty nice plan.

I assume that in the current economy, in order to get one of those plan, you probably need a white collar job, or at least a union (and those barely exist anymore these days too)
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I wonder how many people THINK their insurance if fine because nothing horrible has happened to them yet? here's the thing, people are forced into bankruptcy despite having health "insurance" and that shouldn't be possible.
Every person that complained that their healthcare plan wasn't up to the ACA standards and had to get a different plan, and called Obama a liar for saying that they could keep it if they liked it.

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Originally Posted by wolfpup View Post
I find it hard to associate the idea of "caring" with a profit-making corporation that is simply fulfilling its contractual obligations,
There are very few people in this world that actually care about the well being of strangers.
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and perhaps doing it better than average but only under threat of losing a major corporate contract, from what you just said.
But they do care about losing the contract, and if the contract says that they have to at least "act" like they care, then there really is no difference.
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Maybe their ethical standards were higher than average, I don't know.
Doubt it.
Quote:
But caring doesn't consist in meeting your legal contractual obligations, it consists in going above and beyond. The trouble with most insurers, aside from all the structural nightmares intrinsic to the mercenary insurance approach to health care, is that they fail to meet ethical and moral obligations by finding creative ways to escape contractual obligations. I'd be impressed if they extended you major coverage that they didn't have to.
And that is why working for a large employer that does "care" about its employees is nice. They do have to extend major coverage if they want to keep the contract.
Quote:
I don't claim that a public single-payer system "cares" in some human sense any more than a private health insurer, but there are two huge differences. One, the system is set up fundamentally to serve the public interest and not the stockholder interest. Two, and most important of all, whether they "care" or not is irrelevant because structurally they're out of the picture; it is intrinsic to single-payer that health decisions are relegated to the doctors and their patients, where they belong.
And, in the instance of a large corporation covering it employees, it does act similarly to a single payer system. It is set up to protect the interest of the employer, and therefore, the human resources of that employer.
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And most doctors, in my experience, do genuinely care about their patients.
Meh, YMMV. I've had caring doctors, I've had uncaring doctors. I'd be hard pressed to say which is in the majority.
Quote:
And that is really the crux of the matter. The most that a "caring" insurance company can do is pay your bills. The alternative is their power to deny coverage and deny you health care. It's the doctors who actually provide care. In single-payer, they are entrusted with that responsibility with a minimum of interference.
If you are trying to convince me that single payer is superior to what we have, you needn't waste your time, I'm already all aboard that boat. In fact, the similarities in a large copopration getting better "care" from it's HMOs than a small business or individual shows another reason why moving in that direction should improve the healthcare for everyone, both in terms of cost and results.
  #62  
Old 01-21-2018, 05:10 PM
nearwildheaven nearwildheaven is offline
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Originally Posted by JackieLikesVariety View Post
I wish I could find one.

I wonder how many people THINK their insurance if fine because nothing horrible has happened to them yet? here's the thing, people are forced into bankruptcy despite having health "insurance" and that shouldn't be possible.
Medical bankruptcy is often not so much because of the medical bills themselves, but all the OTHER stuff that goes along with serious illness that isn't addressed by health insurance: lost wages, child care, travel expenses, etc.

The earliest reference I've seen to the idea of single-payer health care in the U.S. was made by FDR in 1932, and I don't see the issue being resolved 86 years from now, either. Other people have told me that they've seen proposals even prior to that.
  #63  
Old 01-22-2018, 01:49 AM
Gary Kumquat Gary Kumquat is offline
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Do we? I seem to have missed them.

It would also appear to be electoral suicide.
Hunt et al have made numerous comments about transferring various NHS functions to private companies, and have also awarded a number of contracts. A very recent example would be Virgin's little £1bn windfall:

https://www.theguardian.com/society/...-nhs-contracts

So, it's the death of a thousand cuts, as they slice it up and dish out piece by piece to private companies, strangling what's left with "austerity" funding reductions, until people are forced into private insurance. They're not stupid enough to say "We intend to kill the NHS and then spend our post cabinet years creaming it in from non-exec board positions on the companies we gave the pickings to".
  #64  
Old 01-22-2018, 01:53 AM
Gary Kumquat Gary Kumquat is offline
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Actually, there is much that the federal government does that is “socialist” in nature
I was being glib. I just love the the way that for some reason right wingers don't seem to get upset about huge sums being allocated through government funding when it comes to the military.
  #65  
Old 01-22-2018, 05:19 AM
septimus septimus is online now
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One oft-ignored point about health insurers: While it's true that for any specific patient or episode they want to pay as LITTLE as possible, they also hope for (and actively encourage) healthcare prices that are as HIGH as possible. That's because in the long run they get a (more-or-less fixed) portion of the healthcare pie, so want that pie as big as possible.

This peculiarity — that the payer of medical services wants high prices — is contrary to usual market principles, and is one reason American healthcare costs are excessive.
  #66  
Old 01-22-2018, 05:31 AM
Disgruntled Penguin Disgruntled Penguin is offline
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Since we're already in the Pit, I'll tell you that I'd enjoy your sob stories more if you'd answer the fucking question about single payer.
You would also enjoy the stories more if you fucking read them. From two posts above your demonstration of how much attention you've been paying we read ...

Quote:
I think single payer would be the best solution. I have no problem with a two tier system as long as there is a basic health plan for all free of charge financed by taxes.
Hope this helps.
  #67  
Old 01-22-2018, 05:54 AM
septimus septimus is online now
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You would also enjoy the stories more if you fucking read them. From two posts above your demonstration of how much attention you've been paying we read ...



Hope this helps.
Evidently I'm not the only one who doesn't read thoroughly. Your "question" was already asked and answered: see #54. I did read #49, but not the almost completely identical #50.

Did this help?
  #68  
Old 01-22-2018, 09:45 AM
JackieLikesVariety JackieLikesVariety is offline
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Medical bankruptcy is often not so much because of the medical bills themselves, but all the OTHER stuff that goes along with serious illness that isn't addressed by health insurance: lost wages, child care, travel expenses, etc.
you have a cite for that? I'm willing to accept that it's both but I think you are kidding yourself, here.

my point is with REAL insurance you can relax because you are covered. with health "insurance" you can't even figure out if your doctor can order a blood test or not. if something serious happens there you are in the ICU and you have no idea how anything is going to get paid for.

great way to go through a crisis.

Last edited by JackieLikesVariety; 01-22-2018 at 09:46 AM.
  #69  
Old 01-22-2018, 10:13 AM
Chronos Chronos is online now
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Quoth FloatyGimpy:

I don't know what's more unbelievable to me, that the health system exists the way it does or that there are actually people who think it's great
Remember, there are a lot of people out there who have never had their insurance cut off when they developed a serious condition, or had a major procedure denied, just by virtue of never having had a serious condition or a major procedure. An individual can't judge the quality of service from an insurance company, because most of the time, by design, you're not receiving any service from an insurance company. And by the time you can make a judgement, it's too late.

The result is millions of people who don't have insurance, not because they didn't go out and get it, but because they thought they were going out and getting it from reputable companies, only to discover that the companies they were buying from weren't actually insurance companies at all, but scammers.

Which is, of course, why the insurance industry needs strict government oversight and regulation at the very least. It simply can't function otherwise.
  #70  
Old 01-22-2018, 10:24 AM
Really Not All That Bright Really Not All That Bright is offline
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Now that this awful system has finally begun to annoy and inconvenience the providers as well as the patients, I don't understand why the professional medical associations don't band together and get their lobbyists to lean on congress for change, if they truly don't like the system as it is. They are the ones with some actual clout. We patients have zilch in the way of clout.
The system has always annoyed and inconvenienced providers. The problem is that primary care physicians serving low-income patients are a relatively small piece of the physician pie. The same system that inconveniences them makes specialists a shit-ton of money (much more than they'd make in any socialized system) and they tend to be the more vocal lobbyists.
  #71  
Old 01-22-2018, 10:44 AM
Stranger On A Train Stranger On A Train is online now
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I was being glib. I just love the the way that for some reason right wingers don't seem to get upset about huge sums being allocated through government funding when it comes to the military.
Oh, yeah, I got it and completely agree with the blindness when it comes to the color of money being spent by the government. “Socialism” has become the bogeyman of the conservative movement because if they admit that government has some functional purpose beyond projecting military force and imposing their particular brand of morality on the population, it thing brings into discussion about how big government needs to be rather than just repeating “Small Government” over and over to justify eliminating any program they personally dislike rather than evaluating them on their performance and merit.

FWIW, I’m all in favor for making government smaller and more efficient, and holding agencies and departments accountable for performance against clear metrics, and on that basis, starting with the largest expenditures gives the best ‘bang for the buck’. Those very large expenditures are, of course, things like military spending, protectionist agricultural subsidies, and should it be funded “that fucking wall” at the Mexican border, while operations like the Consumer Financial Protection Bureau or the National Parks Service that conservatives like to besmirch are barely rounding errors on the overall deficit.

Stranger

Last edited by Stranger On A Train; 01-22-2018 at 10:44 AM.
  #72  
Old 01-22-2018, 03:32 PM
Disgruntled Penguin Disgruntled Penguin is offline
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Evidently I'm not the only one who doesn't read thoroughly. Your "question" was already asked and answered: see #54. I did read #49, but not the almost completely identical #50.

Did this help?


No, since I asked no question there's no way your post would help. Again, read the posts. It's not that hard. You do know what a question is, no?
  #73  
Old 01-22-2018, 03:40 PM
Disgruntled Penguin Disgruntled Penguin is offline
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Evidently I'm not the only one who doesn't read thoroughly. Your "question" was already asked and answered: see #54. I did read #49, but not the almost completely identical #50.

Did this help?
Well, reading #54 I can see that my response for this was harsh but I knew I'd not asked a question so I fired off my response. I'll retract my snarkiness. Sorry.
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Old 01-22-2018, 03:58 PM
Anny Middon Anny Middon is offline
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Americans hate each other a lot, and because of that we'll never get UHC. Whenever it is discussed, people start dog whistling to turn whites against non-whites and the middle class and working class against the poor. 'why should middle class whites pay so poor black people and latino immigrants can see a doctor' comes up a lot. People think the UK is a classist society, but the US has very deep racial and class divisions that get in the way of any social welfare program.
I wish someone would explain two things to those who question why the middle class and working class should pay for health care coverage for the poor:

1. We are already paying for it. And in a very inefficient way. Without insurance people with health problems end up going to the emergency room instead of the cheaper visit to the doctor's office. (Yes, I know, we've covered this ad nauseum on SDMB before.)

2. Those of us who are paying for our own insurance are helping to underwrite the insurance costs of those getting insurance from an employer. Prior to the new tax bill (and I don't know how it will work now), people who paid for their own insurance could deduct the premiums only to the extent that health care costs including premiums exceeded 10% of AGI. So if the amount of premiums deducted from your paycheck were less than 10% of your AGI and your effective tax rate was, say, 15%, then the federal government (meaning all of us taxpayers) were in effect paying 15% of your premiums.

Plus, speaking selfishly, I'd sure like to be more confident that the person behind me in the checkout line who is sneezing doesn't have some horrible air-borne illness that should have sent her to the doctor but didn't because she wasn't covered.
  #75  
Old 01-22-2018, 08:22 PM
psychobunny psychobunny is offline
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Septimus-I am sorry for not addressing your point in detail more thoroughly but I was posting from my phone (and you all saw how that turned out). Let me tell you my opinions on UHC.

-I believe that having a healthy population is a public good.
-I also believe that preventative health care will save a great deal of money.
-I also believe that cutting down on insurance bureaucracy will save a great deal of money.
-I think that the government should be responsible for basic health care for everyone.
-I also believe that there should be a yearly out of pocket maximum for everyone.
-I don't believe in "Medicare for all" without significant changes. What seems to be lost in the discussion of this is that Medicare does not have any out of pocket limitations. You pay your 20% forever unless you are lucky or rich enough to have good secondary insurance. Those Medicare patients who cannot afford it will go broke (and I wish you could have to take the calls from the patients who can't afford their insulin because they have hit the "doughnut hole" (happens every autumn like clockwork)-heck the insulin for my cat costs $80 a month and that doesn't include the cost of needles and syringes and she is only 10 pounds).
-I don't want to take away the right of rich people to go outside the system and pay cash to get uncovered services or more prompt treatment or concierge care.
-I don't mind as much dealing with bureaucracy if you know where you stand.

Case in point:
Many elderly people have vitamin B12 deficiency and this needs to be screened for, treated, and if low followed. Whoever wrote the guidelines stating which diagnoses justify drawing a vitamin B12 level for a Medicare patient is an idiot (example-anemia secondary to vitamin B12 deficiency-D51.8 is NOT an allowable diagnosis to check a vitamin B12 level but deficiency of other specified B group vitamins-E53.8IS allowable. However, I've dealt with this long enough that I have a pdf of allowable diagnoses for B12 for Medicare on my computer so that I can open it up and select one when needed).

I would say that I see enough Medicare patients to have learned what they need to approve something and if there was a set standard of care (hopefully evidence-based) for all patients it would be something I could expect to deal with and help patients with.
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  #76  
Old 01-23-2018, 04:06 AM
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Originally Posted by psychobunny View Post
-I believe that having a healthy population is a public good.
-I also believe that preventative health care will save a great deal of money.
-I also believe that cutting down on insurance bureaucracy will save a great deal of money.
-I think that the government should be responsible for basic health care for everyone.
-I also believe that there should be a yearly out of pocket maximum for everyone.
-I don't believe in "Medicare for all" without significant changes. What seems to be lost in the discussion of this is that Medicare does not have any out of pocket limitations. You pay your 20% forever unless you are lucky or rich enough to have good secondary insurance. Those Medicare patients who cannot afford it will go broke (and I wish you could have to take the calls from the patients who can't afford their insulin because they have hit the "doughnut hole" (happens every autumn like clockwork)-heck the insulin for my cat costs $80 a month and that doesn't include the cost of needles and syringes and she is only 10 pounds).
-I don't want to take away the right of rich people to go outside the system and pay cash to get uncovered services or more prompt treatment or concierge care.
-I don't mind as much dealing with bureaucracy if you know where you stand.
Thank you, very much! (And I apologize for my abusive language earlier — in fact I find your "sob stories" very informative and useful.)

I must say I agree with you on every single point. A "two-tier" system is appropriate: wealthy people can and should be able to buy what they want — that's what "wealthy" means.

Changing the subject slightly: When Obamacare was passed, my reaction (which can be seen in my SDMB posts at the time) was How can such a hodge-podge half-way solution be a good idea? But Paul Krugman and other experts I admired insisted that it would be a huge improvement and bring medical costs down. After several years of experience with ACA ... was Krugman correct?
  #77  
Old 01-23-2018, 05:06 AM
Grim Render Grim Render is offline
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It constantly amazes me how much time, effort and resources the financing and money part of the US healthcare system sucks up.

I am becoming more and more fond of the delivery of basic education as an analogy for how it is provided in many other nations.
  #78  
Old 01-23-2018, 08:57 AM
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Originally Posted by Helena330 View Post
Back to the OP, no disrespect intended, but I find it nuts that you're annoyed with this patient. You've told them they may have a possibly serious disease, so of course, they're freaking. You then tell them they need another test to confirm it or rule it out. Of course, they'll jump at it without thought to their insurance. THIS is the point where you should've informed them they should be sure their insurance covers it. They can't be the first person you've encountered who doesn't know their insurance doesn't cover something. It sounds to me like you need some procedures in your office to deal with those situations. I doubt very many people know the mind-numbing minutiae of what tests and re-tests in what situations their insurance covers. You stressed this patient and made their already-scary situation worse.
While most doctors and facilities I've encountered DO tell their patients to "check with their insurance companies" you know what? If we had universal single-payer they wouldn't have to do that. But, of course, we live in a third world shithole when it comes to medical coverage (it's all about how much medical care can you afford - if you can't afford it, sucks to be you).

But lets say the patient DID ask the insurance company... and was told "no we don't cover that". NOW what is the patient supposed to do? They have a potentially serious illness and they can't afford to have it diagnosed, much less treated!

Why do people not see how cruel this "system" is? Ha-ha! You're sick but you're a loser and can't afford treatment - we'll just dangle it in front of you so you know you COULD be better but CAN'T be. Ha-ha!

On top of that - I used to work for one of the largest, if not the largest, health insurance empire in the US and even I have trouble figuring out what the hell the fine print in a policy says. And that's when I'm calm and NOT having a medical crisis.

The average person is NOT equipped to make good decisions in regard to what health care is and isn't needed, no, not even the financial giants of Wall Street or CEO's - because they're not doctors. That's why you GO to a doctor - for his or her expertise in medical matters.

A bunch of you are nitpicking the wrong details - an entire skyscraper is burning and you're complaining the firefighters are tracking muddy boots across the carpet in your living room. The fucking building is ON FIRE!!! Can't you see that? No, you can only see the mud being tracked in by the guy trying to save your ass.
  #79  
Old 01-23-2018, 09:02 AM
Broomstick Broomstick is offline
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Originally Posted by Jackmannii View Post
It shouldn't be unbelievable that people think current U.S. healthcare has decent coverage, because for most it does. It's the exceptions (and there are too many) that furnish the horror stories.
Here's the thing - many, many people THINK they have adequate coverage, and they do for a broken leg or a sinus infection, but they DON'T for cancer, major accident, or major surgery. They don't find out until they have a medical crisis and discover just how little their "adequate" insurance actually covers. It happens over and over and it's a reason why medical bankruptcy is a significant slice of the bankruptcy pie... and most of those folks HAVE insurance yet are still bankrupted by medical costs.

Most people think they have decent coverage because they're more or less healthy. It's not until they really need it that they discover they don't have it.
  #80  
Old 01-23-2018, 09:12 AM
JcWoman JcWoman is offline
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In regards to asking if my insurance covers $X procedure I'm also puzzled by how we're supposed to get a correct answer. We hear lots of stories from doctors about how their office accidentally mis-coded something so they had to fight to get paid. Generally the patient isn't told what code the doctor is planning to file the procedure under. And for a large procedure, say cancer treatment or major heart surgery, it could be a collection of codes, right?

I also have a beef with the summary of benefits that you get handed when you sign up for medical insurance. They're usually so dumbed down that you just don't know what they cover (aside from vague statements like "80% emergency care"). I've gone into a couple of open enrollment periods for my employer-offered medical care plans and been completely unable to compare the offered plans. So how do we choose wisely? I think it's impossible.
  #81  
Old 01-23-2018, 09:32 AM
txjim txjim is offline
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Originally Posted by Wesley Clark View Post
He doesn't help, but you can't blame the republicans. In states like Vermont (under Shumlin) and California which have massive democratic majorities, they aren't willing to pass state level health reform either. Sure they'll talk about it, but they won't actually do it.

Neither party wants to take on the medical industrial complex. The democrats just want to tepidly expand coverage while leaving the brutal, broken, overpriced system intact. The GOP is worse, but the democrats aren't willing to fix the system.

I don't know what the answer is.
(Bolding mine)

This Freakonomics podcast addresses the issue to some extent as it covers Nurse Practitioners and why they are not more prevalent in the US. Spoiler: AMA is big business.
  #82  
Old 01-23-2018, 09:34 AM
Broomstick Broomstick is offline
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Originally Posted by septimus View Post
Changing the subject slightly: When Obamacare was passed, my reaction (which can be seen in my SDMB posts at the time) was How can such a hodge-podge half-way solution be a good idea? But Paul Krugman and other experts I admired insisted that it would be a huge improvement and bring medical costs down. After several years of experience with ACA ... was Krugman correct?
Well.... prior to the event he pitiful healthcare reform represented first by the Healthy Indiana Plan (thank you Mitch Daniels) then by ACA my spouse and I could not get health insurance. There's even a thread on this forum detailing the bullshit I had to go through to get a tetanus shot as an uninsured American.

With the ACA we were able to obtain health insurance. When my spouse came down with terminal bladder cancer it was because we had such insurance that he was able to get treatment and die in a medical facility equipped to care for him and keep him relatively pain free rather than dying at home screaming in agony because we couldn't afford sufficient morphine for his pain. And I mean that literally - I asked how much his morphine prescription was costing. It was as much as our rent at that point, and it only increased as time went on. That was just for the painkiller, not for anything else.

So yes, for some of us it was, indeed, a huge improvement over what we would have faced without it.
  #83  
Old 01-23-2018, 09:43 AM
Broomstick Broomstick is offline
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Originally Posted by JcWoman View Post
I also have a beef with the summary of benefits that you get handed when you sign up for medical insurance. They're usually so dumbed down that you just don't know what they cover (aside from vague statements like "80% emergency care"). I've gone into a couple of open enrollment periods for my employer-offered medical care plans and been completely unable to compare the offered plans. So how do we choose wisely? I think it's impossible.
You can, in fact, ask for the detailed information on what's covered but you have to ASK FOR IT, and often you have to know WHO to ask.

You will then receive a VERY dense, large document.

I agree, the summaries are so dumbed-down as to be nearly useless.

I used to do that religiously - which is why in either 2002 or 2003 (I don't exactly remember which year) I discovered that my company's insurance no longer covered ANYTHING related to a terrorist attack. Period. I pointed out the absurdity of this, that they would cover me if I was maimed in an airplane accident involving a homebuilt aircraft in which I was responsible for said accident, but NOT if someone blew up our office building in the name of some ideology. Keep in mind - this was a company that had had its NYC branch housed in the World Trade Center and had had employees injured and killed on 9/11. All of those injured people were covered by our insurance then, but no one else was anymore. This had been put into the plan covering us without the knowledge of senior executives, who also were no longer covered in that circumstance.

Did I mention I was working for a health insurance company? Yes, yes I was. This is what they do to their own employees. They care even less about you.

(The next year the "act of terrorism" exclusion was removed, but for one year we were fortunate none of us were victims of terrorist acts because we would have been shit out of luck in regards to medical coverage)
  #84  
Old 01-23-2018, 10:07 AM
BeenJammin BeenJammin is offline
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Originally Posted by Broomstick View Post
I asked how much his morphine prescription was costing. It was as much as our rent at that point, and it only increased as time went on.
Thanks for a perfect example of why the healthcare industry, including the consortium comprised of insurance, PHARMA, doctors and business/administrative entities running the hospitals is so eff'd up today. They all collude to maximize PROFIT, not good health.

That morphine gets started from poppies in places like Afghanistan, where dirt poor farmers raise it as a subsistence crop. It ends up on the street in heroin addicts and pill junkies, the same as it did in your husband. Somebody just figured out how to legally make alot more profit from it out of your husband.
  #85  
Old 01-23-2018, 11:07 AM
wolfpup wolfpup is offline
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Originally Posted by nearwildheaven View Post
Medical bankruptcy is often not so much because of the medical bills themselves, but all the OTHER stuff that goes along with serious illness that isn't addressed by health insurance: lost wages, child care, travel expenses, etc.
Those other things can be factors, sure, but do you have a credible cite that they predominate? There have been a number of studies done on this, one of the most reputable being the one from Harvard in 2007. There have been attempts to discredit such studies, but all of them seem to come from right-wing interests shilling for the insurance industry.
Medical bills are behind more than 60 percent of U.S. personal bankruptcies, U.S. researchers reported on Thursday in a report they said demonstrates that healthcare reform is on the wrong track.

More than 75 percent of these bankrupt families had health insurance but still were overwhelmed by their medical debts, the team at Harvard Law School, Harvard Medical School and Ohio University reported in the American Journal of Medicine.
https://www.reuters.com/article/us-h...5530Y020090604
Nerdwallet also did an independent followup that came to the same conclusions:
https://www.nerdwallet.com/blog/heal...al-bankruptcy/

It isn't hard to understand. America is the only country in the industrialized world where access to health care is premised on the individual's ability to pay for it, directly or through insurance. And insurance is often inadequate, its coverage incomplete or sometimes denied altogether, in whole or in part.
Quote:
Originally Posted by JackieLikesVariety View Post
you have a cite for that? I'm willing to accept that it's both but I think you are kidding yourself, here.

my point is with REAL insurance you can relax because you are covered. with health "insurance" you can't even figure out if your doctor can order a blood test or not. if something serious happens there you are in the ICU and you have no idea how anything is going to get paid for.

great way to go through a crisis.
Agreed.
  #86  
Old 01-29-2018, 04:40 PM
JcWoman JcWoman is offline
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Since this topic died down a little, I think I can piggyback onto it without hijacking the OP. I have another example of our stupid health insurance industry:

I just learned that the maintenance medication I take for my arthritis, and have taken for the last 5 or more years, now requires pre-authorization from the insurance company. Yes, like how surgical procedures require a pre-auth. My med needs that also, once a year. Because clearly my doctor is too stupid to know how to correctly diagnose and treat my condition, he needs some insurance company flunky looking over his shoulder second-guessing his treatment.
  #87  
Old 01-30-2018, 02:25 AM
Nava Nava is offline
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Originally Posted by Stranger On A Train View Post
FWIW, I’m all in favor for making government smaller and more efficient, and holding agencies and departments accountable for performance against clear metrics, and on that basis, starting with the largest expenditures gives the best ‘bang for the buck’.
Sadly, that frequently ends up meaning that government workers get traded off for subcontractors. Any project goes to a bidding process, any steady work gets bidded periodically. I particularly hate it when the bidding rules force the job to go to the lowest bidder, irrespective of other information such as whether their bid actually covers the requirements or whether the government branch handling the bidding already has several suits against that contractor for shoddy work. And as for the idea that bidding processes can't be manipulated, that would be a joke if the results didn't so often manage to be painful.



I got a survey from a Spanish consumers' union about different types of insurance. The questions on health insurance were clearly translated from Americana; they asked about preexisting conditions (in Spain that's just not a concept). There was no option for "I'm perfectly healthy". The idea of someone being perfectly healthy other than for being 49yo and overweight (but my size ratios are fine, nyah nyah!), and under no treatment at all was inconceivable. Well, some of us are healthy and up yours to people who translate polls without taking cultural differences into account. And to whomever came up with the concept of preexisting conditions in the first place
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Last edited by Nava; 01-30-2018 at 02:29 AM.
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