Convince me to support single-payer (US)

Great Debates
121

The medical system that I used for the past several years is incredibly inefficient. It’s a monolith designed to generate billing, and all their “best practices” are designed to maximize revenue from the insurance company.

Note that this is a large urban practice and I know it may be different elsewhere.

I had cataracts in both eyes. They would not perform both surgeries at the same time, unless I selected a special kind of implant that required both eyes to be done at once. There seemed to be no real medical reason for this, just the profit motive of getting paid for two surgeries instead of one.
Plus ( after the initial diagnostic visit) they required two presurgical visits before each surgery. Plus I had to see a physician for a presurgical physical and EKG before each procedure, because the first one aged out right before the second surgery. Which I think was deliberate.

Then there were the five follow-up visits after the first operation. But I only had three after the second operation . Not because I had the option of declining but because the doctor was away. So I called them on it. I said “If these visits were necessary why isn’t another doctor covering them”. And the response was “They aren’t really necessary but we just like to get you in here to see you”. Which should’ve been the motto of the place.

No issue with wait times in this practice, ever. I could always get same day appointments. In fact, their favorite trick was to get you to two or three specialists without having you leave the building, one doctor would just call another one and you’d get on the elevator. They’d get to bill you for three visits in the space of two hours.

And they billed my insurance for all this crap. And they killed me with copays. And they were like this with everything. They were pushing drugs and procedures like they were aluminum siding salespeople. They had people freaking calling me all the time trying to sell me one or another diagnostic screening that was “overdue”.

This monumental waste of resources pissed me off to the point where I decided not to play. I dropped my traditional insurance and went with a different plan that reimburses me for self-pay procedures. And I found practitioners that worked with self-pay patients. And I stopped the bullshit.

I fell on my wrist a few weeks ago. I paid a $199 flat rate out of pocket. They examined my hand and took an x-ray. Then they said nothing is broken. Then the doctor examined the $20 hand brace I had purchased at CVS and said that’s a good one, you can keep using it. Ice and elevate. And I went home.

This is, to me, health care as it should be. And I’m pretty sure if I had walked in with an insurance card, they would’ve scheduled an MRI and a dozen occupational therapy visits and given me some overpriced brace that was less comfortable that the drugstore one.

This is the elephant in the room and I think it needs to be addressed before we commit out tax dollars to universal coverage. I don’t really see the insurance companies as the bad guys, I think the providers are out to bilk the insurers. And I think any universal coverage needs to be accompanied by reforms that will be regarded as rationing by a lot of people, the people that actually want an unnecessary MRI and 10 unnecessary occupational therapy visits for a sprained wrist.
But inefficiencies and price-gouging in the medical industry has been my pet peeve for a long time now and my rants haven’t gained any traction. I’ve done the best I can, which was to opt myself out of this system.

So I think we’re doomed.

122

I may not be understanding, but from what I gather reading this thread, what Magiver wants from a medical system is that he should get his non-urgent problems treated RIGHT AWAY because he has money, while someone having a heart attack should be behind him in line if they have not as much money.

It’s a very odd way to go through life, but not uncommon.

123

I don’t want to wait 3 years for an operation that gets repeatedly delayed because of unannounced emergencies.

124

No, you in the UK don’t have exactly the same options as I do. If that were true there wouldn’t be the wait times. Private insurance doesn’t magically create a doctor out of thin air or an MRI machine. You’re stuck with less infrastructure.

Your safety net doesn’t mean squat if you have to wait.

125

The poor, the elderly and the middle class have insurance. The near poor don’t.

When I lost my job I became the near-poor. I worked multiple part time jobs so I could pay for my insurance. Sadly it was exactly when Obama care came into effect so it raised my rates considerably. At the same time it created extra costs to businesses who in turn cut hrs to escape those costs.

126

Do you think that my private healthcare is dependant only only the MRI scanners that the NHS has? (Private institutions own and run them too)

If I want a private MRI scan how long do you think I have to wait? (I can get one next day if I choose and even without insurance it will cost me £400)

I’m wondering if you know anything about healthcare in the UK at all.

127

No healthcare system has infinite financial resources. No single person has infinite financial resources. This is just obvious.

Every healthcare system must prioritize patients and put limits on who is treated and how much money is spent.

What you are promoting is a system that prioritizes patients based on how much insurance they have, which is a reflection on how much wealth they have. It’s a system that puts top priority on which patient has the funds.

Other systems prioritize patients based on medical need; Those who are in most need get the first service - others may have to wait longer.

I’m not offering any judgement here - but you need to be clear that you DO have limits on the amount spent on your healthcare, no matter who you are.

128

In other words, you would like a system that prioritizes money over need. A system that allows you to buy your way to the head of the line for your plantar’s warts, over someone having a heart attack.

I mean, that’s fine - it’s a point of view. But own it.

129

No, you don’t gather correctly. The Canadian example was a 3 year wait for a serious operation that was repeatedly delayed for lack of available health care. He wasn’t delayed a day or two. It was 3 years of repeated cancellations of his scheduled surgery.

I would have lost my leg if it were Canadian health care. I was already seeing a specialist and had multiple tests done. Nothing showed up. The specialist was convinced my pain was from a muscle tear which showed up on one of the tests. A few more weeks should see me through the pain.

I bypassed the specialist with a phone call to my doctor who scheduled a different test which was done the same day as the phone call. I had no idea of the severity. Surgery was the next day. I was in the hospital for 2 weeks (actually multiple hospitals). I was in the hospital longer than when I had open heart surgery for a valve repair.

Speaking of heart surgery, I worked with someone who’s Candian father was supposed to have heart bypass surgery. It’s a fairly routine procedure in the US. They kept canceling his operation until he was too ill to go through the surgery.

130

Interesting story. I would like to see the actual details rather than a recounting from memory.

I doubt very much that you would have lost your leg under Canadian healthcare. I think it’s much, MUCH more likely that you don’t have a great understanding about Canadian healthcare, as your information comes from dubious reporting from a local TV news story.
Interesting anecdotes though. I knew a guy whose mother died in the US because her insurance was lapsed. I knew another person who died because their insurance found a loophole, and did not cover a needed procedure.
They’re dead now.

131

One final thing:

Magiver’s example of “a man that waited 3 years for what would be a routine operation.”

For many non-urgent operations or procedures in Canada, there are options. You can get an MRI from a private clinic. Orthopedic surgeries (knee, etc) are available privately. What was stopping this hypothetical man from taking advantage of these private (paid) options? My guess would be that he did not have the money.

In the case of this hypothetical man with no money, what would his waiting time have been like for this non-urgent operation? How about infinite? How does infinite work for you?

132

you’re just playing the “absolutes” card for the sake of argument. I don’t experience delays in healthcare. Or to be more precise, I have options to bypass delays. And I’ve used them.

Yes, when healthcare has insufficient funds the care is throttled. That explains delays in healthcare. My healthcare is sufficiently underwritten as to avoid the need to prioritize patients.

133

But he has UHC. He doesn’t have the option to pay more into the system.

134

What’s the average wait time for a specialist in Canada and how long would it take to bypass that specialist? Once you’ve by-passed the specialist how long would it take to get diagnostic services scheduled?

If it’s more then a day then I would have lost my leg. Nobody knew I was in immediate danger and no test showed any problems. I voiced my concerns to by family doctor over the phone and she scheduled a different test the same day. Done in one.

135

No, you misunderstand. He does not pay more into the system. He goes to a private clinic and pays to get an MRI. Today. Or he pays to get non-urgent care like orthopedic surgery. I can go into a private clinic in Vancouver and pay to get an MRI, ultrasound or CT scan.

Or he could wait if he has no money to pay for this immediate private care. Of course in the US, if he has no money, there is no wait. There is no care.

136

Sems to me that the same result would had taken place in other civilized nations with access to health care for all. Point being here that it was more likely that if you had not complained the result would had been the same in a place with universal care and one without. It would had been an example of incompetence and not a good example to use in a discussion like this one IMHO.

As for me, due to a hole in the amount of money I make I lost my insurance, I have to scramble to find an afordable health insurer that will not tell me, like they told a brother once after an expensive operation, ‘just because we approved a procedure, it does not mean we have to pay for it’…

137

Wow, sounds like a horrendous misdiagnosis - VERY serious. I’m glad you came out of it OK.

I have to say, your anecdote is not filling me with confidence that your system is any good. It sounds like you are lucky to be still in one piece if a single day difference in seeing a specialist would have led to that outcome. Did you sue the first specialist? Sounds like you’d have good grounds.

138

I’d like to see a cite for that so that I can understand the details, since I’ve never heard of such a thing.

That’s assuming the Canadian specialist would have made the same mistake as your first one. Regardless, a competent GP here in Canada would have recognized the potential risk and probably scheduled the same test the same day, just as you experienced. That’s what Priority 1 triage is about. Or you could have gone to the ER for a second opinion.

When I went to the ER with my intermittent mild chest pains, it was a Friday afternoon and I had some nice wine and cheese laid out and I very nearly didn’t go. Then this “better safe than sorry” idea got into my head and I went, expecting to be back in about an hour. I wasn’t back for five days, but Canadian health care saved my life.

One of my good friend’s children had a scary symptom one time that could potentially have been very serious. The family doctor sent them to a specialist who normally had long wait times (months). They were seen the same day. Again, Priority 1. (It turned out not to be serious, thankfully.)

I don’t know where you get these stories, but I imagine those things do happen on very rare occasions, especially where health care might be underfunded (I believe Quebec has a reputation for underfunding and overcrowded hospitals), but horror stories abound everywhere. There is no shortage of horror stories in US health care, including people with good insurance dying unnecessarily.

What I can tell you is that when I was in the hospital, the guy in the next room was in for multiple-bypass surgery, which is perfectly routine here but nevertheless a major operation. He was brought in while I was already there, and taken for surgery I think two days later while I was still there. I think the time was just to prep him. I was there longer because of a lot of testing including two separate angiograms and then a lot of decision-making about whether to go the bypass route or the stenting route. Once the decision was made, the stent surgery (PCI) was the same day – in fact, about an hour later.

I honestly don’t think you know very much about Canadian health care.

139

What I don’t understand is why someone whose total knowledge of Canadian healthcare appear to come from a half-remembered account from a local American TV network and an anecdote, thinks that this embues them with the knowledge to come here and lecture those of us who actually have dealt with the system for our entire lives.

140

It’s a fairly common syndrome down here.