Every time I think the US health insurance industry can't get any worse...

[k9bfriender]

@JackieLikesVariety

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)

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.

@wolfpup

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.

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.

Maybe their ethical standards were higher than average, I don’t know.

Doubt it.

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.

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.

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.

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.

[nearwildheaven]

@JackieLikesVariety

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. :mad: Other people have told me that they’ve seen proposals even prior to that.

[Gary_Kumquat]

@up_the_junction

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:

Richard Branson's Virgin healthcare firm scoops £1bn of 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”.

[Gary_Kumquat]

@Stranger_On_A_Train

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.

[septimus]

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.

[Disgruntled_Penguin]

@septimus

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 …

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.

[septimus]

@Disgruntled_Penguin

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?

[JackieLikesVariety]

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.

[Chronos]

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.

[Really_Not_All_That_Bright]

@pohjonen

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.

[Stranger_On_A_Train]

@Gary_Kumquat

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

[Disgruntled_Penguin]

@septimus

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?

[Disgruntled_Penguin]

@septimus

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.

[Anny_Middon]

@Wesley_Clark

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.

[psychobunny]

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-E53.8*IS 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.

[septimus]

@psychobunny

-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?

[Grim_Render]

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.

[Broomstick]

@Helena330

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. :rolleyes:

[Broomstick]

@Jackmannii

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.

[JcWoman]

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.