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

[txjim]

@Wesley_Clark

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.

[Broomstick]

@septimus

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.

[Broomstick]

@JcWoman

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)

[BeenJammin]

@Broomstick

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.

[wolfpup]

@nearwildheaven

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-healthcare-bankruptcy/medical-bills-underlie-60-percent-of-u-s-bankrupts-study-idUSTRE5530Y020090604
Nerdwallet also did an independent followup that came to the same conclusions:

NerdWallet: Finance smarter

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.

@JackieLikesVariety

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.

[JcWoman]

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. :mad:

[Nava]

@Stranger_On_A_Train

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 :mad: