What happens to people who cannot get health insurance? (U.S. obviously)

[Subway_Prophet]

The health insurance problem has hindered me in seeking a better-paying job, because my daughter has had cochlear implant surgery.

I was looking at leaving my job and going into consulting work, which has the potential of much better pay. But I would be leaving my excellent health benefits (thank you Half Price Books) and would need to find my own insurance. No insurer would give me an individual plan that covered anything related to my daughter’s ears. We’re talking denial of services beyond mere lack of support for her cochlear implants: no coverage for ear/nose/throat infections, or problems involving balance, or speech therapy related to her disability. Issues that would be covered in an individual plan had our daughter not received the implants.

I’ve also been told by two insurers that getting into a new group plan through a different employer would be complicated by the implants. I’m still trying to figure out how this works.

I recognize that I’m extremely fortunate in that I have great coverage now, and that I enjoy my current job (thanks again, Half Price Books!) but this job doesn’t pay what we really need to earn and it’s frustrating that I’m essentially locked into it because of otherwise unrelated issues.

On the flip side of that coin, my wife and I figure that our daughter has cost upwards of $250,000 in medical expenses due to her surgeries and hearing-related therapies, so it’s difficult to complain about our situation. But the system truly sucks.

[Sprockets]

@Subway Prophet

I’ve also been told by two insurers that getting into a new group plan through a different employer would be complicated by the implants. I’m still trying to figure out how this works.

Not true and not “complicated.” They can’t turn you away because of a pre-existing condition if you can show a continuity in health care coverage. They can, however, charge you pretty much whatever they want to for coverage, which is in effect denying coverage.

this job doesn’t pay what we really need to earn and it’s frustrating that I’m essentially locked into it because of otherwise unrelated issues.

But it does in fact pay what you “need,” because you need affordable health care coverage. You say you figure your daughter’s care has cost $250,000, so divide that amount by the number of years you’ve had this job and add it to the annual salary. You have to consider the whole picture.

It does seem odd to me that health care coverage is tied to employment. It seems as arbitrary as saying where you live is determined by shoe size. But that’s how it is in this country and until we find a better system (which IMO does not exist) we’re stuck with it.

[lisacurl]

@Shagnasty

Likewise, if you suffer a gunshot wound, New Orleans Charity Hospital is where you want to be regardless of income. Those aren’t rare and serve the poor, the indigent, and everyone else. They tend to have state of the art services although the clientele may make them seem a little gritty.

Of course, it doesn’t exist anymore.

[Sprockets]

@MarcusF

Sprockets, Wikipedia is not the best source. . .

No, there are definitely better sources out there, although (once again) there is no ultimate authority and every source is just someone else’s opinion. This is a “good” source:

http://64.233.167.104/search?q=cache:50gjctZz5tsJ:www.cancer.gov/cancertopics/factsheet/Detection/PSA+PSA+test&hl=en&ct=clnk&cd=1&gl=us

There are certainly false positives and false negatives, and it is also true - as I stated before - that serial PSAs are what doctors mainly pay attention to. As the site above points out, though, doctors still recommend a PSA for any man at age 50 and for men with risk factors at earlier ages. These tests are performed in conjunction with digital exams.

The tests are not perfect, but as the site points out they are currently the most accurate test we have. If I were a man I’d certainly want one on a regular basis.

Here’s a site that details some of the differences between the UK and US health systems:

http://64.233.167.104/search?q=cache:h1uDEmWEMP4J:www.usa-vs-uk.com/healthcare.html+NHS+"preventative+medicine"+UK+US&hl=en&ct=clnk&cd=3&gl=us

And quoting from the above site:

"Preventative medicine is not practiced to ensure the nations overall health "

I’d love to throw more links around, but I have to go let the Canada Geese know they are not welcome on my pond. Geese are extremely slow learners.

[Broomstick]

@Sprockets

Not true and not “complicated.” They can’t turn you away because of a pre-existing condition if you can show a continuity in health care coverage. They can, however, charge you pretty much whatever they want to for coverage, which is in effect denying coverage.

Uh-huh

I lost my job in November. My employer dumped about 50 people before the holidays in the name of “efficiency” or whatever. We could NOT afford COBRA. By that I mean it would have cost more than our rent, food, and all other expenses combined per month. This is because we had a very, very good policy that cost a lot a money (paid by my employer). You have to pay COBRA on the policy you were already on, you can’t opt for a cheaper policy. So there I was - no income beyond unemployment benefits - 1/4 of my prior income - and we have to dip into savings just to pay the bills. Paying COBRA would - that is, for certain - have bankrupted us in under 4 months (no money left + continuing debt).

So, we’ve had a coverage gap of over 2 months now.

No one ever has to cover anything pre-existing on us ever again.

AND they can charge us whatever they damn well please.

We are even less able to afford coverage now.

To say “I am not happy” would be, needless to say, an understatement. But there’s not a goddamn thing I can do about it.

We have, effectively, been denied coverage. By making it too expensive for us to buy we have been shut out of the system. So don’t bullshit me by saying “you can’t be denied”. Yes, you can, through the legal loopholes in place.

But it does in fact pay what you “need,” because you need affordable health care coverage.

You can’t eat health insurance and it won’t keep the rain off your head or the heat on in the winter. You NEED food, clothing, and housing. Our society, however, has decided that only the people who are either young-and-healthy or rich deserve health insurance.

It does seem odd to me that health care coverage is tied to employment. It seems as arbitrary as saying where you live is determined by shoe size. But that’s how it is in this country and until we find a better system (which IMO does not exist) we’re stuck with it.

Bullshit. There are dozens of countries that manage to cover basic medical needs for ALL their citizens, without bankrupting the ill and disabled. How can you claim our system is better? For the 47 million shut out of the system, and the millions more with only partial access, our system sucks.

[Sprockets]

@Broomstick

Bullshit. There are dozens of countries that manage to cover basic medical needs for ALL their citizens, without bankrupting the ill and disabled. How can you claim our system is better? For the 47 million shut out of the system, and the millions more with only partial access, our system sucks.

Just wait a freaking minute here. I know you’re upset and I understand why. The system does suck and I never said it didn’t. I never claimed our system was better than other systems, and I’d appreciate it if you’d read what I posted before you go off on me. There’s too of that on these boards to begin with without you adding to it.

There is no free lunch, though. If you study other systems you will see there is no “free” health care for anyone. National health care schemes are financed through huge taxes and by rationing care in various ways. It is not uncommon in the UK for an elderly disabled person to wait years for a hip replacement - although the surgery does eventually take place.

As horrible as your current situation is, you are only “shut out” of the system because you didn’t know how the system works. If you had, you would have realized that you needed to take a job - any job with healthcare - as soon as possible after losing your last one, for continuity of coverage. It’s true COBRA is prohibitively expensive, but that’s how it is. We have to work within the system because that’s the system we have, and the fat cats in Washington have no real incentive to change anything.

Don’t flame at me, though. I’m more on your side than you could know. I grew up under military medicine in the US, I was married to a doctor for several years here in the US (so I know how well patients CAN be treated when they’re part of the “in crowd”) and I’ve worked in many medical offices in both the US and the UK. I lived in the UK for several years. I have not seen any system that puts the needs and welfare of the patient first.

[tagos]

@Sprockets

You want links to other people’s opinions? What is it you require? I’m also confused about why others are giving their experiences and opinions but I’m getting the “don’t do it” message from you. Is it what I’m wearing? Am I holding my mouth wrong?

Facts, despite what you seem to think, are not the same as opinions.

FACT: The NHS has many preventative programmes.
OPINION (False and easily checked): The NHS does not have preventative programmes.

You see how the two differ? I know it’s very subtle but if you look long and hard it becomes clear.

[Sprockets]

@tagos

Facts, despite what you seem to think, are not the same as opinions.

That’s very patronizing.

FACT: The NHS has many preventative programmes.
OPINION (False and easily checked): The NHS does not have preventative programmes.

The NHS does indeed have many preventive programs on the books, which may or may not translate into preventive care for the majority of patients. As I said, my experience was that I was denied preventive health care when I asked for it and that no one I knew while I was there had received the most elementary levels of preventive health care. I really don’t feel like belaboring this, because it is so obviously a matter of opinion and experience and it has been pointed out to me that neither of these has the least value, especially for people who desperately need their opinions and experience to be “fact.”

[Broomstick]

@Sprockets

JThere is no free lunch, though. If you study other systems you will see there is no “free” health care for anyone. National health care schemes are financed through huge taxes and by rationing care in various ways. It is not uncommon in the UK for an elderly disabled person to wait years for a hip replacement - although the surgery does eventually take place.

Spiffy. I pay taxes right now and I don’t have health care insurance. Rationing? Waiting lines? Do you understand I can’t even get into line? I have no health care - RATIONED health care would be an improvement on my situation. Do you not understand that?

My husband needs surgery for carpal tunnel syndrome. We found that out just a month before I lost my job. Sure, in the UK or Canada he might wait a few months or years - but under our system he will NEVER get that surgery! How can you claim that our “system” is even as good as UK, Canada, Australia, various European systems…?

As horrible as your current situation is, you are only “shut out” of the system because you didn’t know how the system works.

I worked for a health insurance company for 13 years. I am well aware of how the system works, thank you very much.

If you had, you would have realized that you needed to take a job - any job with healthcare - as soon as possible after losing your last one, for continuity of coverage.

How nice of you to suggest that. Perhaps I could could go to Wal Mart and buy a job? No?

I have been averaging 2-3 job interviews per week since I lost my job. I have not been hired. WTF do you suggest? No one is hiring At least no one offering benefits. Nor am I limiting myself to just one area. I have applied for every job I could find that I am even remotely qualified to do. I have picked up some work to bring in money but nothing with benefits of any sort. Do you not realize how stupid, immoral, and EVIL a system is when a person can work and work hard and STILL not get needed medical treatment?

I can hunt for jobs, submit resumes, go on interviews (I have yet another one this afternoon) but I do not make the hiring decision - someone else does. I have contacted two employment agencies and although I am highly qualified both have told me that there are lots of OTHER highly qualified people who have lost jobs in the past few months and very few companies hiring. Have you never been unemployed before? Perhaps you’ve noticed the economy is not doing well right now? Seasonal work over the holidays, yes - but no benefits. Part time work - but no benefits. Quite a few full- time jobs - but no benefits.

It’s true COBRA is prohibitively expensive, but that’s how it is. We have to work within the system because that’s the system we have

I understand that. However, it really grates on me that if I lived in almost any other civilized nation in the world this would not even be an issue.

Don’t flame at me, though. I’m more on your side than you could know. I grew up under military medicine in the US, I was married to a doctor for several years here in the US (so I know how well patients CAN be treated when they’re part of the “in crowd”) and I’ve worked in many medical offices in both the US and the UK. I lived in the UK for several years. I have not seen any system that puts the needs and welfare of the patient first.

Ah, but under OUR system my husband and I aren’t even allowed to BE patients - we are shut out entirely unless we are actively dying of something - at which point we will receive just enough to keep us alive and a bankruptcy.

YES, I would rather pay higher taxes and live under a single-payer system with lines and rationing because that’s more than I have right now.

[alphaboi867]

@Diomedes

Your ‘personal physician’ likely is a private doctor who is not an employee of the hospital. The hospital can’t write his bills off in the way they can other costs. And if the doctor doesn’t charge for his services, he doesn’t eat.

You received free care other than the bill from the physician? And you’re rolling our eyes? Ingrate.

I’m rolling my eyes because in the five years since he technically became my personal physician I’ve never met him. Not once. The 4 times I visited his office in that time I was seen by his PA. I didn’t even see him in the hospital. The closest I came was speaking to him on the phone last night to get discharged because he was too busy to some upstairs. He appears to have done nothing more that review information collected by hospital staff and write my a prescription for antibiotics which a staff physician could easliy have done.

[DrDeth]

@carlotta

There must be a lot of people who

are too young and not disabled enough for Medicare

do not have and cannot get a job that provides health insurance (possibly because they are disabled enough to make this difficult)

have some health condition that makes insurers who provide individual insurance avoid them like cooties(like diabetes or past history of cancer)

I imagine that such folks

A)spend a huge amount of their income (if any) on health care
B)live under the threat of financial ruin in case of big time health crisis
C)don’t live so long because they can’t afford A

Are there any solutions for such people? Don’t some states require that you cannot turn anyone down? So you could at least move to one of those states?

Ok, if they are legally disabled, they are on Medicare, so that’s not an issue.
If they are very poor, they are OK, “County” hospitals, ER’s and other social programs will take care of them, as Diomedes said.

So that leaves the lower middle class and the middle class.

They have several solutions:

1. Get insurance from family member. Happens pretty often. I know some families where Dad has a nice contracting job with no benefits, so Mom works at some sort of low end job that does have benefits. Suprising to many, quite a few retail jobs do have benefits- See’s, Borders, Target, etc. Even for PTers.

2 A .Don’t get so sick you have to go to the hospital. This of course is the real answer- most of us never get so sick they have to go into a Hospital. Well, until you are old, in which case there’s Medicare. Pary nothing really bad happens.

2 B. If the sickness is mild, like the flu- tough it out.

2 C If it’s something like Strep throat, there’s Urgent Care centers with a fixed and moderately reasonable charge for a doctors visit.

The about three are what generally healthy dudes who dont have insurance usually do. It’s not so bad. I went through a period of my life without insuance, it worked.

3. Go ahead and pay for Health insurance. Pretty expensive, but doable if you don;t have any pre-existing conditions, etc.

4. Some, like Subway Prophet just stick to or get a poorer paying job in order to get health insurance.

What is fucked is when you have a long term illness/condition, where you really need insurance but the premiums shoot out of sight for you.

The Them: Generally, the Stautue of Limitations of debts is 7 years. Check your local state laws, or start a thread asking about your debts. You will need to say what state you are in.

[MLS]

@Queen Bruin

When I had my car accident, the ER where I was being treated sent a billing guy 'round. He gave me some forms to fill out and I had to send in all my bills and whatnot, but charity picked up my $3k hospital bill. I had to pay the Dr., X-Ray techs, and ambulance out of pocket however. Also since I could not afford to see a hand specialist rather than the county ortho, I have permanent disability in my left (non-dominant) hand. I DO have insurance now and have seen a nice ortho. He said to fix it now would require some gnarly surgery. So I keep my funky knuckle.

I realize that I am very lucky in how this was handled.

If it was a car accident, doesn’t auto insurance in CA cover medical costs? It does here.

[msmith537]

@groo

I’ll be the first to explicitly draw fire: we need universal health care, or socialized medicine, or whatever you want to call it. Libertarians and Republicans (and, sadly, many Democrats) seem to think that the only concern is “market efficiency” and that it would be less economically efficient or result in patients overusing medical resources because they’d be too removed from the actual costs. But you know what? Fuck that. I’m a human being and live in a world with other human beings, and market efficiency is not anything that humans should care about when considering medical coverage for poor people.

Well, you will care about market efficiency when everyone has the same level of shitty care as our shitty public school systems. People complain about economics or “market efficiency” when they have no idea what they are talking about and assume that everything would be better if people just weren’t so greedy.

Now I don’t believe in universal health care because I believe competition drives down prices and improves service. Unfortunately you don’t have market efficiencies with the current system either. You are basically forced into whatever health care your employer has (or doesn’t have) with limited options. Hospitals, doctors and patients are under no incentive to improve efficiency as everything is covered by the insurance company.

What I would like is the ability to pick and choose insurance companies instead of having to rely on a single employer. Kind of like how car insurance is.

[Antinor01]

@MLS

If it was a car accident, doesn’t auto insurance in CA cover medical costs? It does here.

Most of the time, but say the person carried minimum limits which are 15K for an individual’s medical costs. A major accident can easily go over that.

New Jersey has PIP (personal injury protection) as a required coverage that can help (minimum 15K), but it is optional in CA and not everyone offers it.

[Bridget_Burke]

@Shagnasty

It is actually much better if you are truly poor in these situations than if you are anywhere from lower middle-class to upper-middle class and don’t have insurance. There are plenty of programs to help the poor. Most states have state research hospitals and charity hospitals that cater towards the poor and give excellent care. The TV series ER is set in Cook County General Hospital which is a cutting edge teaching/research hospital and gives a fairly accurate depiction of the care the emergency patients receive. Likewise, if you suffer a gunshot wound, New Orleans Charity Hospital is where you want to be regardless of income. Those aren’t rare and serve the poor, the indigent, and everyone else. They tend to have state of the art services although the clientele may make them seem a little gritty.

There also plenty of facilities like nursing homes, cancer treatment centers, and hospices that are run by the state and will take care of the poor until they die no matter how long that is. There are also world-class private charity hospitals like St. Judes and the Shriners Hospitals that care for very sick kids no matter what their parents can afford.

The gap comes if you are middle-class and have anywhere from a moderate to catastrophic clinical loss. You really are screwed then. My wife and I are 34 and we are pushing about half a million in claims over the past 5 years mainly because of the loss of an infant daughter and I am not sure what would have happened if we didn’t have top notch insurance.

The problem has to be described correctly because the truly poor do quite well under the U.S. system because they can’t be turned away and they have nothing to lose.

Someone who can prove they are destitute can, in fact, get into some very good cancer hospitals. But, if they haven’t been having regular checkups, they may only get treatment after the disease is far advanced.

“nothing to lose”???

[Sprockets]

Whether you realize it or not, it sounds like you’re screaming.

@Broomstick

Spiffy. I pay taxes right now and I don’t have health care insurance. Rationing? Waiting lines? Do you understand I can’t even get into line? I have no health care - RATIONED health care would be an improvement on my situation. Do you not understand that?

I understand you don’t have health care, because we’ve been talking about that fact. I lived without insurance for many years so I know how it feels. I was talking about the relative merits of the systems, not about your particular situation.

How can you claim that our “system” is even as good as UK, Canada, Australia, various European systems…?

Once again you’re misquoting me. I never said our system was “as good as” anything, did I? I said there is no free lunch or perfect system.

How nice of you to suggest that. Perhaps I could could go to Wal Mart and buy a job? No?

Buy a job? What are you talking about?

Do you not realize how stupid, immoral, and EVIL a system is when a person can work and work hard and STILL not get needed medical treatment?

No, I don’t realize that. Many people work very hard and still don’t get what they need or want on many levels.

Have you never been unemployed before?

Oh yes I’ve been unemployed. I’ve been disabled. I’ve been on food stamps. Don’t assume you know my experiences.

Ah, but under OUR system my husband and I aren’t even allowed to BE patients - we are shut out entirely unless we are actively dying of something - at which point we will receive just enough to keep us alive and a bankruptcy.

Oh good grief. Of course you’re allowed to be patients. You just don’t have the money or the insurance to pay for the care. That isn’t anyone’s fault.

YES, I would rather pay higher taxes and live under a single-payer system with lines and rationing because that’s more than I have right now.

It’s also so much less than you have right now, in so many subtle and important ways, but until you’ve experienced the alternatives you can’t know it.

Please stop being angry at the wrong people and use that energy to move forward.

[Shagnasty]

@Bridget Burke

Someone who can prove they are destitute can, in fact, get into some very good cancer hospitals. But, if they haven’t been having regular checkups, they may only get treatment after the disease is far advanced.

“nothing to lose”???

Nothing to lose means that the truly poor can explore avenue after avenue of care without worrying about the financing. In the most simple sense, this may mean just going to the emergency room when they think they need to. It could also mean finding a specialist who does some pro bono work This applies mainly in the early stages of disease.

I grew up in a very poor rural area and knew a number of people with chronic and terminal conditions like cancer. The state teaching hospital always took care of them and there was even some experimental care. The biggest problem was finding someone to drive them there X times a week but it wasn’t a true issue of money.

[Broomstick]

@Sprockets

Whether you realize it or not, it sounds like you’re screaming.

Whether you realize it or not, you’re coming off really condescending.

Buy a job? What are you talking about?

You said it was my fault I didn’t get a job with health benefits IMMEDIATELY after losing the one I had. My point - which appears to have sailed over your head - is that acquiring a job is not like making a purchase. I have been trying my best for over two months to get a job and I have not been hired. Well, the two-month gap has occurred and we are screwed. You said I didn’t know how the system worked. I do, in fact know how the system works, but the problem is I could not obtain a new job fast enough no matter what I did. We are screwed, but hey, it’s OK because it’s “nobody’s fault” - except, perhaps, for mine for not getting a new job immediately despite my efforts to do so. I am saying no, it is NOT OK that this can be the result of our current system.

Don’t assume you know my experiences.

And yet you blithely assumed I don’t know how the system works despite years of working for the insurance industry. If you can make assumptions about me, I can make them about you.

Of course you’re allowed to be patients. You just don’t have the money or the insurance to pay for the care. That isn’t anyone’s fault.

Right - so my husband has to live with nearly useless hands and daily pain - but hey, it’s OK because it’s nobody’s fault. My husband has diabetes that requires daily maintenance. It’s f’ing hard to pay for his testing supplies and medications, not to mention regular testing but hey, if we can’t afford it that’s just peachy. I mean, it doesn’t matter if he goes blind or his limbs go numb or whatever, it’s OK because it’s nobody’s fault. Sure, we have access if he’s in a coma but if he’s just debilitated and blind that’s OK because we somehow don’t deserve the same treatment as someone else. We just poor, evil, lazy people who deserve to suffer and live in pain despite the fact we know damn well that the treatments to ease our maladies DO exist.

Or, a little less stridently - someone in chronic pain who can be helped by surgery will get that surgery if insured in the US, will get that surgery (with some wait, possibly) in Europe or Australia, but in the US if someone doesn’t have insurance they will NEVER get that surgery, they will “merely” live in pain every day of their lives, possibly for decades. But hey, it’s OK because it’s nobody’s fault.

Let me tell you something, Sprockets, it IS someone’s fault - collectively, it’s ALL our fault because we COULD provide basic care for all but we don’t.

It’s also so much less than you have right now, in so many subtle and important ways, but until you’ve experienced the alternatives you can’t know it.

How is “I’m sorry but you’ll have to wait six months (or a year)” worse than “I’m sorry, you can never have it.”?

Please stop being angry at the wrong people and use that energy to move forward.

Oh, Mr. Condescending again - and when I told you just a few hours ago I am going on yet another job interview! WTF do you THINK I am doing? Despite the fact you seem to think I’m sitting at home going boo-hoo-hoo I am most certainly not! So sorry if my participating in this discussion based on my own experiences causes you distress. Yes, I am angry at people like you who really don’t give a damn about the suffering of others, or who will be condescending when someone comes to a different conclusion than you. This so-called system we have destroys people as often as it saves them. Modern medical care is USELESS if you can’t access the care you need. It is wrong that people suffer daily pain and permanent but preventable damage when we can do something about it.

[Sprockets]

[QUOTE=Broomstick]
Whether you realize it or not, you’re coming off really condescending.

Well how’s this? I’m sick to death of you taking out your anger at your situation on me, and of your WTFs directed at me. I have also been appalled at the way you’ve misread my messages and misquoted me consistently.

You’re reading “condescending,” but nothing I say is condescending and I certainly don’t feel that way. In fact, what I am writing has as close to no emotional content as I can manage, now and always. I’m not here to flame, but to try to have intelligent discussions.

Bye bye and good luck.

[Frylock]

@alphaboi867

I just spent the last two days in hospital with no health insurance. The hospital social worker just had me fill out some forms and told that my bill will be sent to the county and if the county doesn’t pay the hospital will discount it 100% (essentially eating the costs). This includes treatment by staff doctors, but not by my so called “personal physician” :rolleyes: .

This is similar to something that happened to me, for the record. Why were you and I not fucked?*

-FrL-

*So often uttered as a genuine complaint, but not this time…