# The US Healtcare system



## d12 (Apr 20, 2019)

Not gonna lie, I think the current state of healthcare in the US is kinda fucked. I think that's a pretty safe take to make, the issue seems to be on how to rectify it. Ever since the ACA went down like the Hindenburg it seems this issue is becoming more and more partisan as the days go on. From the Republicans stuffing their ears and saying everything's fine to the Democrats and DSA wanting to tax the privilege out of every cis white male this side of the Danube I'm wondering if any solution will be implemented at all. Are we fated to forever be the land of the free and the home of the six-figure medical bill?


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## Chexxchunk (Apr 20, 2019)

The treatment for lifestyle diseases should be imprisonment with water, saltwater, and a treadmill.
The treatment for terminal diseases near end-of-life should be free heroin or self-administrated euthanasia kits.
Federal student loan programs should be ended so medical schools implode and restructure their curriculums to not cost an arm and a leg and teach so much useless bullshit.
Hypochondriacs who waste doctors time should get a surcharge after the first appointment.
The prices for common services at medical centers should be fixed and public.
Hospitals should be replaced because they're giant breeding centers for superAIDS.


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## A Welsh Cake (Apr 20, 2019)

Just be like us superior euro peons and go on public healthcare.
I mean yes, the NHS is somehow still underfunded and understaffed, and yes there was an issue in the past two years of the heath hospital in cardiff only having 1 bed available in the hospital but those are non issues.
You don't have to pay for surgery, you can just wait for it instead and by the time you actually get the surgery time you might have gotten better!


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## Lopt (Apr 20, 2019)

Just stop being fat lmao


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## MadDamon (Apr 20, 2019)

Well, which country's health care system isn't fucked?


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## Y2K Baby (Apr 20, 2019)

Just about every persisting problem in America's capitalist economy has been indirectly caused by government intervention. No government spending.


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## SmileyTimeDayCare (Apr 20, 2019)

Healthcare like so many industries went to shit when the government got their claws into it.

The only solution is to excise government so that the market can operate freely and push out bad actors, overpricing, and other bullshit but that won't happen.

Bureaucracy is bad and guaranteed money is bad.

People need to stop confusing insurance with gibs. Insurance is you betting something will happen to you and the company betting it won't. The odds of that game change as you age, your lifestyle, and based other factors. Slapping government mandates just ups the fucking minimum bet. ACA was a terrible fucking idea that I swear was built to fail so that HRC could swoop in and install ACA 2.0 that would be even more costly but make people feel like they were getting more.

_Government money_ doesn't belong in the private sector it always ruins everything:

They screw with education now tuition is outrageous.

Federal road subsidies and roads are a mess.

Flood insurance subsidies people develop marsh lands that get washed out when a big hurricane hits.

The Government is not your mom and dad. They aren't your granny. They aren't even your friend. Stop looking to them for help.


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## nonvir_1984 (Apr 20, 2019)

I lived in France for a few years with my work. They have a byzantine system - kind of really confusing in a way that the French have turned into an Olympic sport ... but the dis quietening thing was that whenever you went to a doctor, the first thing they would prescribe was a suppository. Never worked out what it was that made them think that part of any treatment - for a sore throat, a cut finger or what ever, was to shove something up your ass. Odd. Still, they never turned me away for treatment. And I avoided the superiority.
Then I was posted to the wonderful land of Oz. They have a national health system - a bit like the NHS in the UK - that the population like and want but which the conservative governments want to dismantle and go to an American model. WTF. The existing system kind of works, its just under funded. But I have to say that I had to attend hospital a couple of times (spider bites, attack by a dingo, hit by a drop bear, that sort of thing) and well, I was seen and did not pay for anything. They did not want to go near my ass. 
I saw a GP a couple of times. You can pay them (It's about $80 per consult)  - but the govt refunds about $40. Or they just send the bill to the govt; you pay nothing and the govt gives the GP about $40. It seems to work. So, in answer to your question:
The French system if you want treatment and confusion, and things stuffed up your ass;
The Oz system if you want treatment by a bunch of people who are pretty laid back, underfunded and kind of wondering what they did to deserve living in Oz.
There are wait lists for elective surgery as a public patient, and if you have insurance you can get it quicker. But emergency surgey is done right away and they dont give a fuck how much money you have. Most cancer treatment is more or less free. It's a really strange place that breeds a kind of apathy.


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## JektheDumbass (Apr 20, 2019)

I don't believe that unrestricted capitalism would solve anything (the various monopolies would prevent any actual competition from occurring), but the current government only genuinely wants to fix things if it's a problem for rich people.  And the American medical system is the best in the world if you can afford it.

Shits fucked, and I don't have any solutions because real shit is incredible complicated.


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## AF 802 (Apr 20, 2019)

Maybe stop refusing to not cover experimental but potentially life saving procedures for hard to treat conditions? Like, I thought insurance was supposed to keep people healthy, and yet instead of saving people's lives, they just force you into a life of taking medications that may or may not work, usually ending up in the disease becoming horribly untreated. If insurance stopped being so shit, maybe companies could give their employees much better plans instead of doing stuff like.... this.

I don't know how people believe literal retards like AOC who suggest that giving the whole country Medicare would solve the issue. That's just fucking Obamacare repackaged under a new name. Don't kid yourself. We're not Europe where the population is considerably smaller, and we have a massive debt. That will fuck up the economy even more.


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## QI 541 (Apr 20, 2019)

We should just let poor people die because the free market is perfect.  Oh Facebook is banning white nationalists?  Can't allow that, the government should step in and stop them.


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## ICametoLurk (Apr 20, 2019)

raymond said:


> We should just let poor people die because the free market is perfect.  Oh Facebook is banning white nationalists?  Can't allow that, the government should step in and stop them.


PragerU talking about the wonderfulness of Anarcho-Capitalism then getting banned from Youtube and suing them for Youtube making the choice given to them via Private Property is fucking hilarious.


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## Anonymous For This (Apr 20, 2019)

Worked in an ER once.  Half the patients are pill addicts who are allergic to everything except dilaudid and the rest just have the common cold.  The poor are all on state Medicaid and they abuse the fuck out of it.  

I'm for a single payer system, but one that cracks down harshly on the fuckheads who abuse it.  Since this is the US Government we're talking about here, it's going to be fucked.


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## Y2K Baby (Apr 20, 2019)

raymond said:


> We should just let poor people die because the free market is perfect.  Oh Facebook is banning white nationalists?  Can't allow that, the government should step in and stop them.


t.libtard


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## Lopt (Apr 20, 2019)

But for real though we need price caps on medicine and equipment. If a dose of insulin takes 2 bucks to produce it shouldnt cost 200 dollars


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## Y2K Baby (Apr 20, 2019)

Lopt said:


> But for real though we need price caps on medicine and equipment. If a dose of insulin takes 2 bucks to produce it shouldnt cost 200 dollars


If insulin is so cheap to make it, why don't you make it


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## ColtWalker1847 (Apr 20, 2019)

Anonymous For This said:


> Worked in an ER once.  Half the patients are pill addicts who are allergic to everything except dilaudid and the rest just have the common cold.  The poor are all on state Medicaid and they abuse the fuck out of it.
> 
> I'm for a single payer system, but one that cracks down harshly on the fuckheads who abuse it.  Since this is the US Government we're talking about here, it's going to be fucked.


Yeah, if the US gets single payer it will be as fucked as the VA. Nobody wants that. They want fairytale universal MediCare, which would bankrupt the country.

The issue in the US is in many ways like the college tuition problem, escalating costs with lower returns based on massive amounts of "free" money available for the unscrupulous to exploit. 

The way I see it most claims aren't being paid out of people's pockets but out of a big vat of money that the individual doesn't really control and isn't responsible for. Most people don't buy their own health insurance policy it is provided by their employer. The employer just goes with whatever insurance rep gives the sloppiest blowjobs then they write it off.

The insurance company then enters into agreements with care facilities based on how well they get jerked off, then spread the costs out on all their policies.

Then the hospitals get into agreements with pharma based on deep throat skills, then tack the costs on to what they bill out.

Layer after layer of providers not being held accountable for controlling costs because they can just pull more out of the ol' piggybank. With a lack of fiscal accountability like that no wonder costs have spiraled out of control.

My solution is simple, don't let employers write off insurance policies. Encourage people to buy their own coverage. This eliminates the largest vats of money that are being exploited and puts people personally in charge of it. Just like our auto insurance and homeowner policies that haven't gone absolutely haywire in recent years.


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## ICametoLurk (Apr 20, 2019)

ColtWalker1847 said:


> Yeah, if the US gets single payer it will be as fucked as the VA. Nobody wants that. They want fairytale universal MediCare, which would bankrupt the country.


The USA literally has the biggest Armed Forces on the Earth. We can kill anyone who tells us we can't do what we want.


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## Y2K Baby (Apr 20, 2019)

ICametoLurk said:


> The USA literally has the biggest Armed Forces on the Earth. We can kill anyone who tells us we can't do what we want.


India would nuke us with poopoo.


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## ColtWalker1847 (Apr 20, 2019)

ICametoLurk said:


> The USA literally has the biggest Armed Forces on the Earth. We can literally kill anyone who tells us we can't do what we want.


We can't force them to buy our debt with the military.


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## Red Hood (Apr 20, 2019)

The ACA was a fucking joke. The problem is similar to the student loan crisis- you have people entrenched in the current that stand to stop making a lot of money if the current system is changed.


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## Fields Of Rye (Apr 20, 2019)

Chexxchunk said:


> Federal student loan programs should be ended so medical schools implode and restructure their curriculum to not cost an arm and a leg and teach so much useless bullshit.



Can you be more specific? Medical schools teach all this shit because you don't really specialize until you get your residency. They might be expensive as fuck, but the actual money for the surgery is hardly going to the doctors. 

There are fucking chairs in my hospital that cost more than what I make in a year. MDs are a small part of the standby crew. 

Honestly, look, it's the fucking insurance companies and the middle men. I'm not going to go to far into it, but 30 years ago doctors ran their own practices. They purchased their equipment from a few general suppliers or got it custom made. They footed the bill on everything, and they made a total profit, and the sought to reduce costs whenever reasonable.

Now, a doctor doesn't buy the scalpel, needle, thread, disinfectant, drugs, and look to profit from the surgery.

Instead, the scalpel company profits from the scalpel. The needle company from the needle. The thread from the thread. Disinfectant from disinfectant. drugs from drugs, and in a $300,000 surgery the doctor pockets a few thousand. Every fucking step in the process has been bloated to high hell, as at every possible point some motherfucker shoves his tiny dick into the system and demands a prophet. 

How do you think we get $700 advil? The chemical company produces it and sells it for like a cent per pill and they make a profit. 30 years ago the doc would buy it and give it to you for 10c. But now it goes to a supplier for 10c. Which goes to a distributor for $1. They give it to the hospital for $15, and then to you as a specialty drug for 700 because some bullshit decision marks it as a "specialty drug" 

Then it goes to you insurance who says "lel no" and pays 10c. Or it goes to you, and you drop the 700 because you don't have a ton of fuckoff lawyers.


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## Slap47 (Apr 21, 2019)

ICametoLurk said:


> The USA literally has the biggest Armed Forces on the Earth. We can kill anyone who tells us we can't do what we want.



Most American debt is owed to Americans.


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## idosometimes (Apr 22, 2019)

Fields Of Rye said:


> Can you be more specific? Medical schools teach all this [poop] because you don't really specialize until you get your residency. They might be expensive as [weasels], but the actual money for the surgery is hardly going to the doctors.
> 
> There are fucking chairs in my hospital that cost more than what I make in a year. MDs are a small part of the standby crew.
> 
> ...


This is not true.  Providers make much larger profits that insurance.   Insurance is a minimal cost.  Drugs, doctors, and medical supplies/appliances are where the money actually goes.

The doctors are also paid by fee for service model, which means that the patient gets a separate bill for the 3 minute visit from some specialist prior to surgery.   Everyone gets a cut because doctors and medical providers do not are about prices.  Doctors also fail at evidence based medicine.  Doctors favor certain treatments because that is what their professors or hospital does, not because it is necessarily better than alternatives.

The real costs come from inefficiency, unnecessary care, and drugs/supplies being so expensive.  People in US are also really afraid of death, so EOL care costs a bundle of a boatload.


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## eternal dog mongler (Apr 22, 2019)

idosometimes said:


> This is not true.  Providers make much larger profits that insurance.   Insurance is a minimal cost.  Drugs, doctors, and medical supplies/appliances are where the money actually goes.



You're half-right. Insurance has slim margins. But so do providers (unless you consolidate the fuck out of every hospital in a region and can dictate pricing to insurance companies).

The ones with the big margins are pharmaceutical and DME manufacturers. That's our biggest cost sink.

I support single payer but I'm not really going to lie that it will be expensive as fuck and CMS already can't deal with fraud or timely reimbursements as it is so it's going to be a bumpy fucking ride.


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## Webby's Boyfriend (Apr 22, 2019)




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## Slap47 (Apr 22, 2019)

Webby's Boyfriend said:


> View attachment 734918



Americans are fat because of the corn and sugar they eat.


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## Webby's Boyfriend (Apr 22, 2019)

Apoth42 said:


> Americans are fat because of the corn and sugar they eat.


Then they should eat less or the diet version of that.


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## Corbin Dallas Multipass (Apr 22, 2019)

The biggest problem with the US healthcare system currently is the ACA.

However, as someone alluded to above, I have often wondered why, if drugs just are wildly overpriced in the US (You hear of shit that costs 30 a pill in the US costing .50 cents in canada, for example) couldn't someone with some venture capital just start a generic drug company and easily take over the entire market?  Or is there some reason for those extreme high prices in the US that a new company would also be unable to avoid?

The free market is supposed to easily handle outrageous markups with the application of simple greed. Someone else sees the outrageous markups, says "Hey I'd like to make money hand over fist" and charges 2% less than the competition.  I would love to know what is preventing the free market from handling this in the US.


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## ProgKing of the North (Apr 22, 2019)

Webby's Boyfriend said:


> Then they should eat less or the diet version of that.


make me Eurofag


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## mindlessobserver (Apr 22, 2019)

The problem is that a healthcare industry and a system that provides healthcare are mutually exclusive, which is something many free marketeers overlook. An industry needs to turn a profit, and a healthcare system needs to take care of people who can't (by definition) take care of themselves anymore due to illness or injury. Patients are economic net losses on the economy.

Also, in order for a market to be "Free", there needs to be certain factors involved.


Both the seller and the buyer understand the good or service being made, sold, or exchanged.
There is open competition between sellers for the attention of the buyer
The buyer has free choice to obtain (or not obtain) the good or service
All participants in the market function under the same set of rules, and all contracts between the participants are honored.
The Healthcare Industry is fucked because it doesn't follow any of those principles.

Point 1: The buyer often has no idea what they are buying. The doctor has market knowlege that would make a used care salesman blush. "I need to draw blood to do some tests". Test what? How? Do I need to? The buyer has no idea. Worse, the buyer often does not even know how much the test costs! And if they are insured, they may never know as healthcare providors deliberately hide the true cost of everything they do. Oftentimes even the doctor doesn't know either. If people don't even know the price of a service or good, how can they provide market pressure to get prices lowered by favoring more efficient doctors?

Point 2: This means that there is NO competition between providers, beyond outcomes. "The doc made me better, 5 star review on google!" All well and good, but if a doctors only market differentiation to his competitors is outcome, he's going to go the extra (unneccesary) mile to insure he gets those outcomes. He may even pander to an idiot patient who wants an expensive brand name drug rather then equally effective off brand generic. Anything to avoid a dreaded 1 star review. Reputation competition ONLY, which is far more ephemeral then pricing competition. Again to compare to a used care salesman, at the end of the day he has to offer better prices then the other used car salesman across the street if he is going to make the sale. Healthcare providers don't because they don't need too.

Point 3: They don't need to because the market is captive. Nobody goes to a doctor or hospital because they choose too. They go because something has gone terribly wrong or could go wrong, and the thing being sold is quite literally their own lives. People can choose to not buy the car from the used car salesman. There are alternatives. You can uber, take the bus, walk, bike, bum rides off friends, etc. But when it comes to your health there is not alternative. You have to pay. You have no choice, and this can lead to bad market distortions. When you want to buy a car, you want the best you can afford, which means the best car at your ideal lowest price point. Do you want to pay for the cheapest doctor or procedures if its your life on the line? Fuck no. You want the deluxe package. Nothing else will do when its quite literally your own neck at stake. And since it is a matter of life and death both the providors, and the politicians take advantage of it.

Point 4: Which means there are different rules for different people, and since we are a democracy the idea that the government won't be involved is just not going to fly. People always vote for the bread and butter, and nothing is more basic then their own health. This will inevitably lead to rules and regulations imposed by government in much the same way electric and water utilities are regulated. The biggest rule being a hospital cannot refuse to provide necessary life saving treatments to those who need it. Like the hobo on the street suffering an OD on Heroin. This is huge loss for the providers, and as such they need to make it up somewhere, so they build the cost of people who can't pay into the price for those who do pay.

tl;dr, healthcare is not a free market and it never will be.


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## eternal dog mongler (Apr 22, 2019)

Corbin Dallas Multipass said:


> However, as someone alluded to above, I have often wondered why, if drugs just are wildly overpriced in the US (You hear of shit that costs 30 a pill in the US costing .50 cents in canada, for example) couldn't someone with some venture capital just start a generic drug company and easily take over the entire market?  Or is there some reason for those extreme high prices in the US that a new company would also be unable to avoid?



You need to get your generic approved by the FDA which requires an ANDA form and in vivo studies. You can't just start cranking them out.

Which is good because generics need to be bioequivalent based on plasma concentration curves. This is to avoid you taking generic hydrocodone XR and then it fucking all releases at once or something and then you stop breathing.

The in vivo studies are, however, quite expensive for generic manufacturers. It makes it difficult for a new company to enter the market. And also there's an issue of collusion between them right now that's spiking generic drug prices but that's a different matter.

e:



mindlessobserver said:


> Point 3: They don't need to because the market is captive. Nobody goes to a doctor or hospital because they choose too. They go because something has gone terribly wrong or could go wrong, and the thing being sold is quite literally their own lives. People can choose to not buy the car from the used car salesman. There are alternatives. You can uber, take the bus, walk, bike, bum rides off friends, etc. But when it comes to your health there is not alternative. You have to pay. You have no choice, and this can lead to bad market distortions. When you want to buy a car, you want the best you can afford, which means the best car at your ideal lowest price point. Do you want to pay for the cheapest doctor or procedures if its your life on the line? Fuck no. You want the deluxe package. Nothing else will do when its quite literally your own neck at stake. And since it is a matter of life and death both the providors, and the politicians take advantage of it.



Yes, and the idea from some people that healthcare would be improved by free market solutions is bunk. No patient is looking up appendectomy costs at nearby hospitals while they're experiencing severe LLQ pain, nor should they be expected to. There's also no need for patients to question the training of their doctors or wonder if the medicine they're taking is actually what's listed on the label because of, , guess what, regulations.

The libertarian fantasy breaks down when you realize that patients are NOT rational consumers and there really does need to be regulation in this industry or else you get thalidomide babies.


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## Chexxchunk (Apr 22, 2019)

Apoth42 said:


> Americans are fat because of the corn and sugar they eat.


Yes, and designer foods that make you want to eat more food. The secret to losing weight is to not eat or drink things that stimulate appetite. Then it's pretty easy.

I think sweet beverages (artificial sweeteners and corn syrup) are the worst offenders. Coke will just turn you into a fat fuck outright, Diet Coke spikes your insulin and gives you the megamunchies because body is like "I taste sugar where is sugar??" and then there's a vicious feed cycle.

I switched from Diet Coke to Club Soda with Vinegar and Lemon Juice, and now I feel like I can comfortably fast all day because I just don't feel like eating. It's pretty miraculous feeling after all the other bullshit.  Takes almost no discipline. I'm resigned to not getting away from caffeine, so I also take theanine with my coffee because it's a caffeine antidote and makes everything very smooth.



eternal dog mongler said:


> You need to get your generic approved by the FDA which requires an ANDA form and in vivo studies. You can't just start cranking them out.
> 
> Which is good because generics need to be bioequivalent based on plasma concentration curves. This is to avoid you taking generic hydrocodone XR and then it fucking all releases at once or something and then you stop breathing.
> 
> The in vivo studies are, however, quite expensive for generic manufacturers. It makes it difficult for a new company to enter the market. And also there's an issue of collusion between them right now that's spiking generic drug prices but that's a different matter.


How many drugs are actually really truly beneficial, though? And haven't we discovered most of them and made them generic by this point?


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## eternal dog mongler (Apr 22, 2019)

Chexxchunk said:


> How many drugs are actually really truly beneficial, though? And haven't we discovered most of them and made them generic by this point?



There are a bunch of pointless, expensive drugs on the market right now (Linzess, for example. It makes you poop slightly more and it's like $400/mo, great) but no, there are still useful drugs being developed. MiRNA inhibitors and stuff like that.


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## mindlessobserver (Apr 22, 2019)

eternal dog mongler said:


> You need to get your generic approved by the FDA which requires an ANDA form and in vivo studies. You can't just start cranking them out.
> 
> Which is good because generics need to be bioequivalent based on plasma concentration curves. This is to avoid you taking generic hydrocodone XR and then it fucking all releases at once or something and then you stop breathing.
> 
> ...



Actually the reason there are drug regulations is even more sad then the thalidomide babies. That example gets held up as regulations working because the FDA held up approval for better testing. But the reason there are drug regulations in the first place was because of the Elixir Sulfanimide incident.









						Elixir sulfanilamide - Wikipedia
					






					en.m.wikipedia.org
				




The stuff used what was essentially anti freeze as the medications solvent. The pharmescists at the time were unaware it was poisonous and never did animal testing because the law did not require it. The stuff killed 100 people, including a 6 year old whose letter penned by her mother got national traction. It was not a pleasant death either. Cascading kidney failure. This is pre dialysis and pre painkillers. You died slow and you died painfully. Imagine that happening to a 6 year old girl. Was a huge scandal. One of the doctors suicided.


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## Corbin Dallas Multipass (Apr 23, 2019)

eternal dog mongler said:


> You need to get your generic approved by the FDA which requires an ANDA form and in vivo studies. You can't just start cranking them out.
> 
> Which is good because generics need to be bioequivalent based on plasma concentration curves. This is to avoid you taking generic hydrocodone XR and then it fucking all releases at once or something and then you stop breathing.
> 
> The in vivo studies are, however, quite expensive for generic manufacturers. It makes it difficult for a new company to enter the market. And also there's an issue of collusion between them right now that's spiking generic drug prices but that's a different matter.


Well sure, but other countries also have their own certification agencies, and somehow manage to offer medication at like 1% of the price it is in the US.  

So I guess part of the issue is that each generic is it's own thing, separately patented, everyone doesn't just make the same generic following the same approved formula, so developing a generic version of a drug is almost as expensive as just inventing a new drug.   Do I have that right?


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## Mewtwo_Rain (Apr 23, 2019)

Corbin Dallas Multipass said:


> The biggest problem with the US healthcare system currently is the ACA.
> 
> However, as someone alluded to above, I have often wondered why, if drugs just are wildly overpriced in the US (You hear of shit that costs 30 a pill in the US costing .50 cents in canada, for example) couldn't someone with some venture capital just start a generic drug company and easily take over the entire market?  Or is there some reason for those extreme high prices in the US that a new company would also be unable to avoid?
> 
> The free market is supposed to easily handle outrageous markups with the application of simple greed. Someone else sees the outrageous markups, says "Hey I'd like to make money hand over fist" and charges 2% less than the competition.  I would love to know what is preventing the free market from handling this in the US.


Well the problem really is on the consumers. In capitalism (or "Free Markets") consumers are supposed to avoid making purchases if they are over priced or make smart decisions to avoid leading Capitalism into being corporatism (or just make smart decisions in general). The problem not only shows that consumers are not being intelligent about purchases (See every year where people buy new  Apple phones for instance whether they actually need them or not) and an over regulated system, and we have developed that main specific issue.

Sure, it can be argued that other countries have dumb consumers as well, but those countries trade off the costs of medication for higher taxes, or higher priced goods which are offset when they import from other areas/countries.

The problem with medication costs is not everyone can just quit taking their medication especially if their life depends on it which has created a vicious cycle of the costs, and too many consumers won't stop taking their non-life threatening medication. If enough people did that would drive down profit and companies would be likely to drop costs on drugs/medication to get consumers back.  Most people in America aren't taught this these days about responsibility on their part in free markets, thus we will to continue to suffer such dramatic costs in medications until either people learn this very concept or until (or if) people reject corporatism/over regulation. Both seem very unlikely to happen though.


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## Webby's Boyfriend (Apr 23, 2019)

ProgKing of the North said:


> make me Eurofag


Americans hate Europe for our privileges, out of jeleousity, because ye don't have them.


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## Y2K Baby (Apr 23, 2019)

Webby's Boyfriend said:


> Americans hate Europe for our privileges, out of jeleousity, because ye don't have them.


Lol, I'd rather have freedom than white privilege.


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## mr.moon1488 (Apr 23, 2019)

I wouldn't mind Japan's system, but it would never work the US.  If I recall correctly it's actually a crime there to abuse medical services, regardless of your income, you have to pay at least SOMETHING into either a private, government, or employment service, and their medically related torte laws aren't as idiotic as ours.  This would never work in the US because there's nothing Tyrone loves more than free shit, going to the emergency room for a hangnail, and then suing the doctor because he decided to sell his prescription meds rather than actually using them.


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## ProgKing of the North (Apr 23, 2019)

mr.moon1488 said:


> I wouldn't mind Japan's system, but it would never work the US.  If I recall correctly it's actually a crime there to abuse medical services, regardless of your income, you have to pay at least SOMETHING into either a private, government, or employment service, and their medically related torte laws aren't as idiotic as ours.  This would never work in the US because there's nothing Tyrone loves more than free shit, going to the emergency room for a hangnail, and then suing the doctor because he decided to sell his prescription meds rather than actually using them.


I'd rather have a system that some people abuse than a system that fucks over people that genuinely need it and just can't afford it


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## Y2K Baby (Apr 23, 2019)

ProgKing of the North said:


> I'd rather have a system that some people abuse than a system that fucks over people that genuinely need it and just can't afford it


Sounds like you're a nigger


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## ProgKing of the North (Apr 23, 2019)

Tard Baby said:


> Sounds like you're a nigger


Worse, one of Carl of Swindon's fabled White Niggers


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## eternal dog mongler (Apr 23, 2019)

Corbin Dallas Multipass said:


> Well sure, but other countries also have their own certification agencies, and somehow manage to offer medication at like 1% of the price it is in the US.
> 
> So I guess part of the issue is that each generic is it's own thing, separately patented, everyone doesn't just make the same generic following the same approved formula, so developing a generic version of a drug is almost as expensive as just inventing a new drug.   Do I have that right?



It's much less expensive compared to developing a new drug because you can skip the three-phase clinical trial (you only need to do in vivo testing) but there's still a pretty big cost of entry to begin manufacturing a generic. What some pharmaceutical companies are doing now is manufacturing generics for drugs that are very rarely prescribed and jacking the price up to ludicrous levels. Nobody is going to compete because the sales volume is too low to really make jumping into that drug worth it for another manufacturer, so that's why you see generic drugs that are ridiculously expensive for little discernible reason.

As far as other countries having actually cheap drugs, it's because the government negotiates prices. In the US that's done by pharmaceutical benefit managers rather than the government, and PBMs are honestly in kind of a weird spot. They need to compete with other PBMs on price (or else your insurance company/employer switches to one that is able to get better deals) but they also need to make revenue, too. How a PBM works is extremely complicated but basically their revenue comes from them taking a cut of drug sales, so they need prices to still remain somewhat high in order to get more revenue. Plus PBMs operate mail-order pharmacies so that's another revenue source that benefits from high prices. The system is not working out well compared to what happens in other countries.



Mewtwo_Rain said:


> Well the problem really is on the consumers. In capitalism (or "Free Markets") consumers are supposed to avoid making purchases if they are over priced or make smart decisions to avoid leading Capitalism into being corporatism (or just make smart decisions in general). The problem not only shows that consumers are not being intelligent about purchases (See every year where people buy new  Apple phones for instance whether they actually need them or not) and an over regulated system, and we have developed that main specific issue.



Well, it's also difficult for patients to shop around for different prescription drugs that may be cheaper than what they're on, so patients just get stuck. Doctors have absolutely no idea what you're going to pay for something or if your insurance will even cover it. If you have a really cool doctor you might be able to get him or her to write several scripts for similar drugs, so you can drag them down to the pharmacy and get whatever rings up cheapest. Doctors, obviously, are quite wary about doing this because some idiot is inevitably going to fill them all and wind up on 12 antidepressants at once.


----------



## Y2K Baby (Apr 23, 2019)

ProgKing of the North said:


> Worse, one of Carl of Swindon's fabled White Niggers


You're Irish?


----------



## mr.moon1488 (Apr 23, 2019)

ProgKing of the North said:


> I'd rather have a system that some people abuse than a system that fucks over people that genuinely need it and just can't afford it


"some people abuse."


----------



## ProgKing of the North (Apr 23, 2019)

mr.moon1488 said:


> "some people abuse."
> 
> View attachment 736224


A number of people that is greater than none but less than all. "Some". What would you have preferred I use? 

And if you're trying to make it a race thing I will laugh.


----------



## Y2K Baby (Apr 23, 2019)

ProgKing of the North said:


> A number of people that is greater than none but less than all. "Some". What would you have preferred I use?
> 
> And if you're trying to make it a race thing I will laugh.


Watch out, guys. He might laugh.


----------



## mr.moon1488 (Apr 23, 2019)

ProgKing of the North said:


> A number of people that is greater than none but less than all. "Some". What would you have preferred I use?
> 
> And if you're trying to make it a race thing I will laugh.


To the "some" question, "some" in regards to the US is too damn many.  One of the main reasons health care got so expensive in the US, is people abusing the system.  Even if the plaintiff loses a malpractice lawsuit, it still costs the hospital a small fortune normally.  People going to the emergency room over stupid shit, means rather than needing a couple of ER nurses and a trauma surgeon on call, you instead need a gigantic cluster fuck of doctors triaging patients, which should have just secluded an appointment.  There's no valid reason it shouldn't be a criminal offense if you knowingly, and willfully abuse medical services since this is both directly, and in-directly harmful to others.    

"And if you're trying to make it a race thing I will laugh."
Assuming you live in an urban area, go to your local ER on a Friday, or Saturday night, and ask a doctor about the infamous "sumdude."


----------



## ProgKing of the North (Apr 23, 2019)

and if you go to scattered out rural areas there's a lot of poor white rednecks probably scamming the system too, focusing on one race doing it is retarded


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## mr.moon1488 (Apr 23, 2019)

ProgKing of the North said:


> and if you go to scattered out rural areas there's a lot of poor white rednecks probably scamming the system too, focusing on one race doing it is exceptional


Yes...  I'm sure if you live in an area with only one group of people, that one group of people will be the only ones doing something wrong.  (It's almost like existence is a prerequisite of bad behavior)  Outside of that, that's just a snide way of avoiding proportionality, which is entirely relevant in this context since there is a certain breaking point at which enough abusers can overwhelm the capabilities of the contributors.  Pic related: an example of when you account for proportions.


----------



## ProgKing of the North (Apr 23, 2019)

...the guy with 1488 in his username is autistically obsessed with race, color me shocked.

Yeah, yeah, I get it, blacks murder more proportionately (but prostitution and gambling? Lol, what next, smoking weed and underage drinking?), what does that have to do with abusing the healthcare system? If you've been shot you're not really abusing the system by going to the ER.


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## mr.moon1488 (Apr 23, 2019)

ProgKing of the North said:


> ...the guy with 1488 in his username is autistically obsessed with race, color me shocked.
> 
> Yeah, yeah, I get it, blacks murder more proportionately (but prostitution and gambling? Lol, what next, smoking weed and underage drinking?), what does that have to do with abusing the healthcare system? If you've been shot you're not really abusing the system by going to the ER.


It has nothing to do with the healthcare system.  It has everything to do with proportionality, which is extremely important when considering macro societal questions.  As for the direct relevance to the healthcare system, I don't think there's an actual "ER abuse" statistic, but you'll notice that one group is disproportionately using Medicaid, and one group isn't.  (e.g. Alabama State racial distribution 68.7% white, 26.5% black.  State Medicaid usage 46% white, 44% black)   
"...the guy with 1488 in his username is autistically obsessed with race, color me shocked."
Good job "catching me" I guess?









						Medicaid Enrollment by Race/Ethnicity
					

The Kaiser Family Foundation website provides in-depth information on key health policy issues including Medicaid, Medicare, health reform, global health, HIV/AIDS, health insurance, the uninsured …




					www.kff.org


----------



## queue-anon (Apr 23, 2019)

Mewtwo_Rain said:


> Sure, it can be argued that other countries have dumb consumers as well, but those countries trade off the costs of medication for higher taxes, or higher priced goods which are offset when they import from other areas/countries.



Other countries have dumb consumers, but their health care systems generally don't pander to dumb health care consumers the way the U.S. does.

As an example, if you give birth to a braindead baby in the UK, the hospital is going to let the baby die as God/nature (take your pick) intended. They won't even let you take the braindead baby out of the hospital to send it to the U.S. where there are numerous clinics willing to pat your ass and tell you that braindead baby totally isn't dead.

Those systems are shitlordy about pretty much everything else too. If you go to the doctor with a twisted ankle, they'll dress it and send you home. In the U.S., they'll likely do an X-ray, which isn't necessary like 99 percent of the time, but they're trying to cover their asses legally and keep you from getting mad about blowing you off.

That's the good thing and the bad thing about nationalized health care, doctors go with the most likely scenario and solution, which is more affordable but is also callous to patients who are scared and in pain. This is why I think nationalized health care is likely not going to happen in the U.S., Americans want the best health care, no matter the cost, no matter if they can actually afford it. And this is true on both sides of the political spectrum, it's just that liberals are dumb enough to think that it's at all feasible to provide Cadillac care to all Americans.


----------



## Basic Bleach (Apr 23, 2019)

The whole health insurance thing confuses the shit out of me.  Aside from the fact it's somehow separate from dental and vision, neither of which counts as health somehow.  I got health insurance (through work, because fuck letting the feds get another claw in me) to avoid being penalized for not needing it.

Turned out I needed it this year when a gland decided to go spastic and fuck my life up.

Now I'm getting avalanches of financial assistance offers from the hospital, they never did tell me who exactly to pay, there are numerous different parties charging me for shit...the bulk of the one ER visit isn't even the hospital, it's the ER staff, who only work _at_ the place and not _for_ it.

Goddamn, this is why I prefer to wait till I'm dying and drag myself to the doc in the box and just pay out of pocket.  At least that hit on the chin is honest.  Props to the docs here though for supporting going to get generics at walmart, and to the pharmacist there for pointing out half the stuff in the prescription was OTC and saving me money there.  I'll take $4 of ibuprofen over the $40 same shit that's just marked up because it has the word prescription on it.

And don't get me started on the social security I'll never see a dime of thanks to all the millennials too socially anxious to leave their houses.


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## mr.moon1488 (Apr 23, 2019)

Rogue Boob said:


> The whole health insurance thing confuses the shit out of me.  Aside from the fact it's somehow separate from dental and vision, neither of which counts as health somehow.  I got health insurance (through work, because fuck letting the feds get another claw in me) to avoid being penalized for not needing it.
> 
> Turned out I needed it this year when a gland decided to go spastic and fuck my life up.
> 
> ...


Not exactly to your post, but another problem with the US health care system is that WAY too much shit here in the US is prescription only.  Most notably, some very easy to administer antibiotics like Doxycycline.


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## Basic Bleach (Apr 23, 2019)

mr.moon1488 said:


> Not exactly to your post, but another problem with the US health care system is that WAY too much shit here in the US is prescription only.  Most notably, some very easy to administer antibiotics like Doxycycline.



I suspect it's prescription only because otherwise someone would figure out how to make meth out of it, and it'd be locked away anyways.

I do wish basic antibiotics were OTC, but I do understand some people can be allergic to them and just not know it.  Liability and all that.


----------



## mr.moon1488 (Apr 23, 2019)

Rogue Boob said:


> I suspect it's prescription only because otherwise someone would figure out how to make meth out of it, and it'd be locked away anyways.
> 
> I do wish basic antibiotics were OTC, but I do understand some people can be allergic to them and just not know it.  Liability and all that.


Medication allergies are one thing I'd require to be tested during school were it up to me.  Honestly though, this may sound radical, but were it up to me a lot of the current school curriculum especially during the high school years would be removed, and replaced with at least some medical training.


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## queue-anon (Apr 23, 2019)

Rogue Boob said:


> The whole health insurance thing confuses the shit out of me.  Aside from the fact it's somehow separate from dental and vision, neither of which counts as health somehow.  I got health insurance (through work, because fuck letting the feds get another claw in me) to avoid being penalized for not needing it.
> 
> Turned out I needed it this year when a gland decided to go spastic and fuck my life up.
> 
> ...



The dental thing is especially ridiculous since you can die from dental problems; an infection from an infected tooth can spread to the brain. Things like gum disease can increase your risk of other illnesses, such as heart disease.

Insurance billing makes an already shitty system that much shittier. I have to worry about whatever health problem I have, whether my doctor will take it seriously, whether my insurance will cover the visit/tests/treatment, and whether I can afford whatever's gotten kicked to my coinsurance/deductible.


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## Basic Bleach (Apr 23, 2019)

mr.moon1488 said:


> Medication allergies are one thing I'd require to be tested during school were it up to me.  Honestly though, this may sound radical, but were it up to me a lot of the current school curriculum especially during the high school years would be removed, and replaced with at least some medical training.



Ah, but then who pays the bill for the test, the machines used to do the testing, the supplies, and the people trained to use them, and the people trained to do those tests?

There's another used-car-sized bill to ponder.

Basic first aid and preventative human maintenance get glossed over and show up for about five seconds in health classes, which I doubt are required anymore, and those mostly focus on STDs and safe sex anyway.  You'd be more likely (in my day) to learn those skills from your parents or in girl/boyscouts (I did actually).  Thing is, the rise of education and medicine as an industry promotes specialists of every kind now, so you can't just go to the neighborhood barber to have, say, a bone set or a tooth pulled, which may be a good thing.

I agree with earlier assessments that at this point the issue is largely that there are too many fingers in the cookie jar fishing for profit at every turn.


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## kira-kun (Apr 25, 2019)

Insurance and pharmacies suck.
Pharmacy gets Rx
Insurance won't fill because it's "too soon", regardless of medication. Could be your fucking heart pills. Nope, nope, nope, you only get this much every month, and if you go over, you gotta pay.
Have to go through the cheap meds first before they'll pay for ones that actually work
Won't pay for brand-name meds even if there is no generic option. You have to send that shit through a second time before they'll pay for it, regardless of medication. Again, could be your fucking heart pills.

I don't really know about how difficult it is to get insurance... I mean the majority of jobs I've worked have had benefits, and all I have is a HS diploma. They've been shitty benefits - BlueCross BlueShield, Walmart Vision, and no drug or dental, but they were benefits. The no drug is not such a big deal since Walmart fills generics for like 4 bucks and most doctors will give out a free prescription card (I forget what it's called, but they're bright yellow) that will link with an app on your phone to help find really cheap prescription prices. Some docs will even hook you up with a mail-order pharmacy. The major thing is the dental, since as far as I know, once you're 18 in the US you're fucked. CHIP is the only state-sponsored dental insurance, and that ends the day you turn 18. I may be wrong though.


----------



## cuddle striker (Apr 25, 2019)

I don't "trust _any_ government agency" with this, but single payer yes. let the AMA oversee it.

you like the free market version? check out the thread on drinking turpentine and doing bleach enemas. that's where it ends up, unregulated bullshit sawdust pills.

there's no freedom of choice in medicine. the patients are not able to make decisions at the time they need the service.


----------



## mindlessobserver (Apr 25, 2019)

Since we are telling crazy insurance stories. I recently picked up dental insurance after ignoring it for a while (because fuck extra costs). Go to dentist for first time in 4 years, expecting to be told I got cavities. Mouth had been uncomfortable. Nothing big but still enough to convince me to break down and get dental again.

No cavities! But my gums and roots were fucked. The discomfort I was feeling were abscess pockets of plaque below the gum line. Doc just had to poke to cause bleeding. He wanted to do a scaling right then and there, but insurance would not cover a periodontal procedure on the first visit. So they could not call it a scaling. Instead he called it a root cleaning in the presence of inflammation. Which apparently was covered and was close enough to what he needed to do to not matter.


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## cuddle striker (Apr 25, 2019)

mindlessobserver said:


> Since we are telling crazy insurance stories. I recently picked up dental insurance after ignoring it for a while (because fuck extra costs). Go to dentist for first time in 4 years, expecting to be told I got cavities. Mouth had been uncomfortable. Nothing big but still enough to convince me to break down and get dental again.
> 
> No cavities! But my gums and roots were fucked. The discomfort I was feeling were abscess pockets of plaque below the gum line. Doc just had to poke to cause bleeding. He wanted to do a scaling right then and there, but insurance would not cover a periodontal procedure on the first visit. So they could not call it a scaling. Instead he called it a root cleaning in the presence of inflammation. Which apparently was covered and was close enough to what he needed to do to not matter.


when we see something needs to be done, we *find* a way to finagle it done, insurance companies be damned.


----------



## Mewtwo_Rain (Apr 25, 2019)

queue-anon said:


> Other countries have dumb consumers, but their health care systems generally don't pander to dumb health care consumers the way the U.S. does.
> 
> As an example, if you give birth to a braindead baby in the UK, the hospital is going to let the baby die as God/nature (take your pick) intended. They won't even let you take the braindead baby out of the hospital to send it to the U.S. where there are numerous clinics willing to pat your ass and tell you that braindead baby totally isn't dead.
> 
> ...


I have to agree, although I'd argue it's more corruption within the health care system (see your twisted ankle example) than anything. It's the same reason Opioids are such a issue currently. There isn't enough ramifications for doctors acting inappropriately often time, or being corrected via over watch.  I agree with your analysis though for the most part.


----------



## eternal dog mongler (Apr 30, 2019)

queue-anon said:


> That's the good thing and the bad thing about nationalized health care, doctors go with the most likely scenario and solution, which is more affordable but is also callous to patients who are scared and in pain. This is why I think nationalized health care is likely not going to happen in the U.S., Americans want the best health care, no matter the cost, no matter if they can actually afford it. And this is true on both sides of the political spectrum, it's just that liberals are dumb enough to think that it's at all feasible to provide Cadillac care to all Americans.



In most cases it's not even the best care, just the most expensive care. Cardiac surgery (coronary artery bypass graft, angioplasty with stents) is nearly the first-line treatment after a heart attack in the US but it's incredibly rare in Canada. They ration their money more wisely due to being on a nationalized system.

Tossing statins at a patient and calling it a day is about as effective as most cardiac surgeries performed in the US. One's just a wee little bit more $$$ than the other though so guess what providers do.

Many people have been told a lie in the US that nationalized systems provide you with worse care. Maybe, if you're used to the insanity that is the US system where pointless things happen all the time for cash. It's not actually true in practice though.


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## JosephStalin (Apr 30, 2019)

Ideally, would like to see some version of the military's Tricare system for everyone.  Believe it or not, Tricare works pretty well.  Military contracts administration out.  Claims handled quickly.  Referrals and authorizations also handled quickly, if needed within a few hours.

In a nutshell, you pay $X as a single person (military retiree, active duty and their families pay no premium), $2X for a family of any size.  Copays are low, limited vision coverage, prescription coverage, mental health coverage.   NO deductibles, least in the Tricare we use.  No problem with pre-existing conditions.  Vaccinations, tests, imagery of any type are free.  Just show up with lab slip for tests/imagery.  One big benefit...providers who are in the Tricare network cannot "balance bill".  Once you've paid your copay, you're done.  Sometimes providers attempt to balance bill, but they are reminded, and then see the light.  Has been a huge benefit to our family.  As long as you follow some simple Tricare rules, your out-of-pocket, even for major illnesses/surgeries, can be very low.

Tricare is a HMO-type organization.  You have a primary care manager who arranges for specialist care when needed.   Network of providers is pretty good, not much problem finding a specialist. 

My variant would be funded with all the money spent on Medicare, Medicaid, VA health care, the Indian Health System, and any other applicable Federal funding, plus user premiums.  The military health system is excluded due to operational needs.   If a family is on welfare or unemployed they pay no premiums, reduced/no copays.   Guess this would be single-payer, unless people wanted to go the "concierge medicine" route. 

This system would need to pay providers more than Tricare presently does.  Tricare's payments are based on Medicare payments.   But overall believe something like this might work.


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## eternal dog mongler (Apr 30, 2019)

JosephStalin said:


> This system would need to pay providers more than Tricare presently does.  Tricare's payments are based on Medicare payments.   But overall believe something like this might work.



TRICARE reimbursement rates are the same as Medicaid where they keep SCHs/CAHs afloat through generous reimbursement rates but fuck you if you're not treating hillbillies.

There's a pretty big disconnect between payers and providers in the US. Hospitals gotta pay their bills and decentralization of care (medical imaging and ambulatory surgery centers) have pretty much made hospitals into big fucking expensive patient warehouses where profits go to die.

And private health insurance reimbursement rates for ED care is even lower so lol


----------



## JosephStalin (Apr 30, 2019)

eternal dog mongler said:


> TRICARE reimbursement rates are the same as Medicaid where they keep SCHs/CAHs afloat through generous reimbursement rates but fuck you if you're not treating hillbillies.
> 
> There's a pretty big disconnect between payers and providers in the US. Hospitals gotta pay their bills and decentralization of care (medical imaging and ambulatory surgery centers) have pretty much made hospitals into big fucking expensive patient warehouses where profits go to die.
> 
> And private health insurance reimbursement rates for ED care is even lower so lol



You just raised an interesting point.

In our area there's a chain of surgery centers.  Primary owners are a group of doctors who operate there, but the local hospital owns 30%.  Wouldn't be surprised to see such a setup in many places.  

As a side note, our local "non-profit" hospital has been Hoovering up all the medical practices they can, solo and group, then making the doctors employees.   Some doctors have left, not liking the work-life balance.   They've also set up "wellness centers", including acute care clinics.


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## soft kitty (May 1, 2019)

None of these options seems like a good idea, but if I had to pick one it would be just get a job that offers you an employee sponsored health plan. 

That's the most realistic I guess.  Ideally, we'd burn the entire system to the ground and start over. Econ 101 says if you want lower prices you need more competition and supply. How do we do that? We could start by deregulating, and break-up existing oligopolies on health insurance. One idea that has been floated by the right is to open up the market so you can buy insurance across state lines. That sounds like that might help.


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## eternal dog mongler (May 1, 2019)

dinoman said:


> That's the most realistic I guess.  Ideally, we'd burn the entire system to the ground and start over. Econ 101 says if you want lower prices you need more competition and supply. How do we do that? We could start by deregulating, and break-up existing oligopolies on health insurance. One idea that has been floated by the right is to open up the market so you can buy insurance across state lines. That sounds like that might help.



Actually you can get that right now since the individual mandate doesn't exist anymore.

So enjoy your "insurance" which will not pay for anything.


----------



## soft kitty (May 1, 2019)

eternal dog mongler said:


> Actually you can get that right now since the individual mandate doesn't exist anymore.
> 
> So enjoy your "insurance" which will not pay for anything.


Well, like I said, it's far from ideal, but it's better than nothing. And I know because I AM on an employer sponsored plan. It's not THAT bad.


----------



## Kiwi Lime Pie (May 1, 2019)

In short the system sucks and is in need of major overhauls.

While the ACA might have been well-intended, it ended up being a big disaster even before Trump took office. Just as the Democrats took George Bush to task for his "Read my lips: no new taxes" statement. Obama and the Dems need to be treated similarly for his "If you like your existing plan you can keep it" promise when ACA was ready to launch. Every year since, ACA plan premiums have increased dramatically and have nearly doubled because there is no cap for them like there is for group plans that aren't supposed to exceed 9.5% of one's adjusted gross income. If it wasn't for the ACA subsidies that still exist, many people that had coverage pre-ACA would likely have nothing or barely afford coverage now.

Unfortunately, I'm not sure what can be done in terms of solutions. Previous kiwis have already posted replys with some of the stuff I might otherwise suggest. The biggest problem, however, is drug companies, the drug patent process, and all the different hands in the till that expect to make money on prescriptions by just passing on their costs and revenue shares to the end users. Worse, these groups and the drug lobbyists are quick to object to any type of reform that would make prescriptions (or healthcare in general) cheaper and provide less revenue for their interests - even if it meant more people could afford the drugs that they may be presently going without simply because of cost.

"Medicare for all" (MFA) is something that sounds interesting in theory. Unfortunately, those promoting it are either unwilling or unable to discuss how we as a country would pay for this in terms of premiums or higher taxes and how premiums under MFA would compare to the existing premiums people pay. It's hard to support MFA when the people advocating it wave their hands as they say, "Just trust me; it will be better" when pressed for specifics. I think the most I've heard is Democratic presidential candidates saying more taxes on the rich/1% could or would bankroll this, but I'm skeptical as to how effective that would be in practice.

As others have posted, ER and other procedures can be confusing because of all the bills one receives. Besides the hospital sending a bill for services, it's not unusual to receive a bill from a separate entity representing the ER doctors for the doctor's services that is totally separate from what the hospital charges. And because every entity is separate, independent, and doesn't communicate with each other, the idea of one single bill/statement to simplify the billing and collections process probably makes too much sense to be done. Worse, the average person sees all these bills and wonders, "Gee, didn't I already pay for my procedure?" not knowing just how many different people and entities get involved in the billing process - even for something simple or routine.



kira-kun said:


> Walmart fills generics for like 4 bucks and most doctors will give out a free prescription card (I forget what it's called, but they're bright yellow) that will link with an app on your phone to help find really cheap prescription prices.



You might mean GoodRx. While it's generally helpful, it might not always provide big savings depending on the drug and whether  most insurances would pay for it otherwise. If insurance companies won't cover it, the savings can be very minimal. Still, some savings beats none for those without coverage or medications insurance won't or don't cover.

Prescriptions and how they're covered can be baffling as well. Originally, I had a prescription that had two active medications in it and my insurance would pay very little towards it. Even GoodRX wasn't much help because that only reduced the price by less than 10%. However, If I had my doctor write two separate prescriptions - one for each medication individually - my insurance would then cover approximately 80% of the combined price of the two. It makes no sense that insurance would make it cheaper to take more prescriptions instead of less, but it shows that people should try to find out how their insurance works, if they can, and use the system to their advantage.

E: Typos, clarity, and an additional thought.


----------



## eternal dog mongler (May 2, 2019)

Kiwi Lime Pie said:


> In short the system sucks and is in need of major overhauls.
> 
> While the ACA might have been well-intended, it ended up being a big disaster even before Trump took office. Just as the Democrats took George Bush to task for his "Read my lips: no new taxes" statement. Obama and the Dems need to be treated similarly for his "If you like your existing plan you can keep it" promise when ACA was ready to launch. Every year since, ACA plan premiums have increased dramatically and have nearly doubled because there is no cap for them like there is for group plans that aren't supposed to exceed 9.5% of one's adjusted gross income. If it wasn't for the ACA subsidies that still exist, many people that had coverage pre-ACA would likely have nothing or barely afford coverage now.
> 
> Unfortunately, I'm not sure what can be done in terms of solutions. Previous kiwis have already posted replys with some of the stuff I might otherwise suggest. The biggest problem, however, is drug companies, the drug patent process, and all the different hands in the till that expect to make money on prescriptions by just passing on their costs and revenue shares to the end users. Worse, these groups and the drug lobbyists are quick to object to any type of reform that would make prescriptions (or healthcare in general) cheaper and provide less revenue for their interests - even if it meant more people could afford the drugs that they may be presently going without simply because of cost.



ACA would have worked a whole lot better if the GOP wasn't trying to break its kneecaps at every turn. Risk corridors, CSRs, etc. Whole bunch of carriers took a bath on the marketplace and now they're leaving.

Prescription drug prices can be easily fixed and it has a whole lot of support from voters but it's not happening due to PhRMA lobbying. That's a small component of overall healthcare spend, though, so even if it _was_ fixed it would do little overall.


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## Haesindang Park (May 2, 2019)

Sometimes, I just think the feds need to completely fuck off from the American healthcare system and allow the states to develop their own healthcare systems instead. America is a federal country after all. We all know how shitty the VA system can be.


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## kira-kun (May 2, 2019)

Kiwi Lime Pie said:


> Prescriptions and how they're covered can be baffling as well. Originally, I had a prescription that had two active medications in it and my insurance would pay very little towards it. Even GoodRX wasn't much help because that only reduced the price by less than 10%. However, If I had my doctor write two separate prescriptions - one for each medication individually - my insurance would then cover approximately 80% of the combined price of the two. It makes no sense that insurance would make it cheaper to take more prescriptions instead of less, but it shows that people should try to find out how their insurance works, if they can, and use the system to their advantage.
> 
> E: Typos, clarity, and an additional thought.



The separate drug thing usually has to do with a patent. A company will usually find drugs like cholesterol meds and blood thinners that treat things that often occur in the same patient and combine it into one pill to extend a patent. You also see this with "extended release" and dissolving versions of pills/tablets. It's just a way for the pharmaceutical company to hang onto the patent for another 10 years.


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## eternal dog mongler (May 2, 2019)

Haesindang Park said:


> Sometimes, I just think the feds need to completely fuck off from the American healthcare system and allow the states to develop their own healthcare systems instead. America is a federal country after all. We all know how shitty the VA system can be.



Make diethlystilbestrol babies great again!



kira-kun said:


> The separate drug thing usually has to do with a patent. A company will usually find drugs like cholesterol meds and blood thinners that treat things that often occur in the same patient and combine it into one pill to extend a patent. You also see this with "extended release" and dissolving versions of pills/tablets. It's just a way for the pharmaceutical company to hang onto the patent for another 10 years.



There's all kinds of stupid fucking shit going on with pharmaceutical companies but they have a really strong lobbying arm with PhRMA so welp.

Ugh, how do I even begin.

So you can get a patent extension technically if you find another on-label use for your drug but it's limited to rx for that use. So you have weird situations where there's a generic on the market but, uh, you weren't prescribed that. You were rxed the brand so you need to buy the brand.

And then you have a whole weird situation with Purdue somehow convincing PBMs they need to cover brand oxy and not generic because they rammed through a clinical study showing oxy XR was slightly better than generic hydrocodone XR at pain management. great.


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## Hellbound Hellhound (May 5, 2019)

I've never once met an American expat who thinks that the US healthcare system is preferable to what they have in their country of residence. Anecdotal though this may be, I think it speaks volumes.

From my own standpoint, there's a very good reason why most countries don't leave healthcare entirely to market forces, and it's because market forces are generally ineffective at catering to most people's healthcare needs. There are lots of complex reasons for this, but the one I'll focus on here is a concept known as inelastic demand. Essentially, as a healthcare consumer, you don't really have the luxury of refusing treatment if you find the price to be uncompetitive, because the consequence of doing so could be fatal. Everyone who is economically invested in the situation knows this, and hence: it's pretty much entirely a seller's market.

I'd be interested to see supporters of a market-driven healthcare system try to explain how consumers are supposed to exert pressure on prices when the demand is heavily fixed. Any takers?


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## Guts Gets Some (May 7, 2019)

Still waiting and hoping for Trump to repeal fucking ACA before his time is up.


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## ProgKing of the North (May 7, 2019)

Guts Gets Some said:


> Still waiting and hoping for Trump to repeal fucking ACA before his time is up.


He tried, but the congressional Republicans didn't have anything to replace it with that wasn't even worse

It was like they stripped out the only parts people liked and just kept all the shitty parts that were giveaways to insurance companies


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## Rand /pol/ (May 19, 2019)

We should just expand Medicaid and Medicare further, a total overhaul would be too much IMO.


Guts Gets Some said:


> Still waiting and hoping for Trump to repeal fucking ACA before his time is up.





ProgKing of the North said:


> He tried, but the congressional Republicans didn't have anything to replace it with that wasn't even worse
> 
> It was like they stripped out the only parts people liked and just kept all the shitty parts that were giveaways to insurance companies


LMAO McCain rekt y'all


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## JosephStalin (May 21, 2019)

First, agree the VA medical system is just fucked.   Close it down, except maybe for VA nursing homes.  Use the money saved, and it would be a great deal, to fund care downtown for qualified vets.  There is no injury or illness a vet can suffer that cannot be treated successfully downtown.  And hospitals downtown treat all patients the same.  Have heard horror stories out of VA hospitals.  

While the VA medical system is indeed fucked, amazingly, the military's Tricare medical insurance system works very well.  It's administered by contractors.  You pay a small premium monthly.  With some flavors of Tricare there are no deductibles.  Pre-existing conditions, no sweat.  Low copayments.  Labs, imaging, vaccinations, mammograms, and other preventive care are free.  Tricare is an HMO.  You have a primary care manager, who would arrange for specialist care.  Authorizations tend to come quickly, sometimes in a couple of hours depending on circumstances.  Prescriptions covered.  Limited vision coverage.  Many health care providers take Tricare.  Oh, and once you pay your copay to a Tricare provider, they cannot come back to you for a cent - no balance billing.  

Believe some variant of Tricare could work nationally.  We'd take all the money spent on Medicare, Medicaid, the VA Health System, the Indian Health System, and any other applicable Federal funding to pay for it.    

A little powerlevel - believe the US healthcare system works very well.  Wouldn't be here otherwise.  And Tricare did  its' job well.  My out-of-pocket for some major-league stuff was minimal.


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## NOT Sword Fighter Super (May 21, 2019)

Repeal Obamacare.


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## Gaat (May 23, 2019)

Sword Fighter Super said:


> Repeal Obamacare.



Sure but at what cost? 

The tax penalty for not having insurance, I'd like to see just how much tax it's actually recovered to be honest. 

Keeping kids on parent's plan is great but what if your 25 year old child gets pregnant and delivers? You're not having your baby covered under this plan. 

I mean, honestly, we shifted to ICD-10-CM (Coding system to explain just how fucking exceptional you were/are when you go to the doctor. Ranges from your annual 'turn your head and cough' to 'Holy shit don't shoot..you shot me in the fucking gut'.) mid 2015. Caught up with the world. Problem? World uses only 17-21000 codes. We're using triple that because the insurance companies sperged out over how detailed this shit is.

Now? Now Centers for Medicare and Medicaid Services are enforcing a MACRA/MIPS program which both encourages doctors to affiliate with a hospital and to work and be concerned over patient satisfaction. Those who didn't opt out of this and who don't participate where CMS reviews your shit and tells you if you're doing your job right lose -4% total Medicare Reimbursement.

You want change? Some ideas: 

Bitch at congress to: 
*Remove most of the fucking VA healthcare. Put them on Tricare which follows Medicare payment and guidelines, even the HMO plans.
*Penalize states which cut the Medicaid shekels so that some local senator can pay his mistress to have an abortion.
*Break up your five or six companies which own the other insurances
*Penalize the insurance companies which import customer service call centers offshore. You'll generate more jobs stateside and you won't have someone who doesn't know what the fuck they're doing delaying and denying claims so they can get their shekels.


There's more shit to do to fix this shit (Doctor and Nurse Education needs to improve to start with) but those are some major steps. 

Sorry for bitching but I've been at this for six. fucking. years. and I'm amazed at the level of stupid I see every damn day.


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## Ledian (May 25, 2019)

My thought on healthcare is simple. No federal level healthcare system. Defund Medicare and Medicaid and use that money to subsidize state-level healthcare systems instead. From there, it's on every state to provide healthcare whether for free in an single-payer system or privatize everything. 
I see it as the best of all worlds because if you really need healthcare, instead of paying an arm and a leg for a treatment, you can pay for a parcel of land in a state with good healthcare that single-payer for instance, because you have to be a resident of said state to get it all paid through the state, and utilize that instead of paying through the nose for insurance.
You still have to pay taxes on the land you bought so the state government wins in the end. There's no burden on the taxpayer when you have to be a taxpayer to access it in the first place. I'd say a requirement of you being a resident in whatever state for 2 years is a good minimum to insure people don't just abuse it.
This idea of mine isn't close to perfect, there really is not perfect solution for the US because it's a goddamn mess but it solves the whole "it's not a Constitutional right!" because it is: explicitly through the 10th amendment, the right to healthcare should be a power of the state, not the federal government.


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## eternal dog mongler (May 25, 2019)

JosephStalin said:


> Many health care providers take Tricare.  Oh, and once you pay your copay to a Tricare provider, they cannot come back to you for a cent - no balance billing.
> 
> Believe some variant of Tricare could work nationally.  We'd take all the money spent on Medicare, Medicaid, the VA Health System, the Indian Health System, and any other applicable Federal funding to pay for it.



Many private insurers prohibit balance billing as well. Insurers don't really know whether or not a provider is trying to balance bill you unless you call and report them. It's up to the patient (who often don't know wtf balance billing even is) to report it, so providers often get away with it.

I agree that TRICARE is the best system to base nationalized healthcare on, although I'm not sure they could keep costs so low if they broadened the networks (TRICARE has pretty thin networks overall, but most members don't encounter this problem since there's very good access near bases.)



Gaat said:


> Now? Now Centers for Medicare and Medicaid Services are enforcing a MACRA/MIPS program which both encourages doctors to affiliate with a hospital and to work and be concerned over patient satisfaction. Those who didn't opt out of this and who don't participate where CMS reviews your shit and tells you if you're doing your job right lose -4% total Medicare Reimbursement.



MIPS is a mess. Patient satisfaction should not be a metric. Only primary and secondary outcomes. Plus I'm not sure where they're pulling their data from but they're very optimistic about patient outcomes in general. E.g., every CHF patient is like a ticking time bomb for hospitals because CMS assumes their readmission rates should be _much _lower than they are in reality.

It also suffers from the same problem as education funding. Hospitals/schools get low scores, so their funding gets cut. Which helps them improve...how? There are a few hospitals in my area death spiraling because they couldn't get ahead of the curve.


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## JosephStalin (May 25, 2019)

eternal dog mongler said:


> Many private insurers prohibit balance billing as well. Insurers don't really know whether or not a provider is trying to balance bill you unless you call and report them. It's up to the patient (who often don't know wtf balance billing even is) to report it, so providers often get away with it.
> 
> I agree that TRICARE is the best system to base nationalized healthcare on, although I'm not sure they could keep costs so low if they broadened the networks (TRICARE has pretty thin networks overall, but most members don't encounter this problem since there's very good access near bases.)



Yeah, that's why I believe a variant of Tricare could work, with the addition of the other Federal monies.   Premiums could be higher.  Would need to do an analysis to see  for sure.

Good point re the Tricare network overall.  Indeed, haven't encountered the problem because I live near two bases, and the few places I visit have bases in the vicinity.  Before traveling I check which acute care places/hospitals take Tricare, just in case.


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## Gaat (May 29, 2019)

eternal dog mongler said:


> Many private insurers prohibit balance billing as well. Insurers don't really know whether or not a provider is trying to balance bill you unless you call and report them. It's up to the patient (who often don't know wtf balance billing even is) to report it, so providers often get away with it.
> 
> I agree that TRICARE is the best system to base nationalized healthcare on, although I'm not sure they could keep costs so low if they broadened the networks (TRICARE has pretty thin networks overall, but most members don't encounter this problem since there's very good access near bases.)
> 
> ...




It's a start. This time at least CMS is aware of how things need to improve. How long did they have patients use their SSN as their Medicare ID, placing them at risk for healthcare fraud? 

IMO the purpose of MIPS is both to see patient satisfaction and to see whether or not the physicians are treating the damn disease. Most just slap the person on the ass and tell them to get.  The Hospitals/Teaching Hospitals needed to have either filed for an extension or pony up with someone else. The problem? 

Doctors are as bad as lawyers (Read the Weeb Wars thread) in regards to technology and changes. The hospital I work at 'now' had to fill out forms to get to Win10 and they're still using the wrong damn tech for patient chart. 

The last bit, my opinion here, to fix the US Healthcare system is to remind nurses they are not doctors, and their prejudice harms patients. I've had to fill out my own statements where nurses make assumptions on patient care (including my mother who has a tumor the size of a fist on a pancreas the size of a thumb - Hyperbole but comparison accurate - and dumbasses who swear she doesn't take her insulin when I've moved her home to guarantee her health is looked after)


@JosephStalin  you have a valid point as well. Most insured are not aware of their rights and responsibilities concerinng health insurance, including being sure that they go to a physician or hospital which is in network (Or both. Can't tell you how many hospitals have providers who are not in network) 
Most are not aware seeing someone who's out of network will cause problems in the long run including out of network. 

Honestly, a single payer health system with massive overhaul (SuperMedicare) would be better in the long run and would fix problems including patients drowning in medical debt as well as shitty serice.
The problem is that you have people who want their shekels and will pay the senators and congressmen to make laws favorable to them. 

When I'm home if you want I can break this point down even more.


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## CamelCursive (May 29, 2019)

No Socialized healthcare.  If people were taxed to have Socialized car insurance, you'd be shrieking if you saw people getting DUI's an driving like absolute maniac.  Healthcare is the same way.  Living like an absolute slob shouldn't have a free safety net.  If they can't afford the consequences of self-induced stupidity, then I'm sure we've got room in the potter's fields.


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## Guardian G.I. (May 29, 2019)

Every time I read these kinds of discussions, I have a feeling that in America there's only space for either public or private system, not both. This is weird.



Spoiler: Healthcare system as I know it



My post-Soviet homeland has that evil socialist public healthcare - the remnant of the Soviet system. At the same time, we also have a parallel layer of healthcare - private clinics and hospitals. State-run healthcare is free, private is obviously expensive af. Private clinics are generally for the rich - most people only go there if they need to get a check-up/get tested *right now *without delay, though almost everyone prefers private dentists over state polyclinics. However, if you need to pass medical check-ups for things like applying to a job or getting a driving licence, you're required to go to state-run healthcare service, as they are the only one authorized to do that under our laws. Hardly anyone has health insurance, because hardly anyone has any insurance in general. Some private businesses like big foreign-owned factories has their own doctors - service is obviously limited to employees.

Public healthcare is very much plagued by queues - you can generally get an appointment only at very inconvenient times. If you're working full time, you'll have to take a leave just to go to the clinic. Most people in queues are either pensioners or people applying for jobs/driving licences. Doctors are often overworked and their pay is not as good as it should be. The level of equipment depends on the place. Some recently renovated polyclinics are very nice and have things like appointments via Internet and electronic queue systems, like a bank. Some look like they haven't been touched by renovation since the 1970s. It depends on how lucky you are - you're assigned to a particular public polyclinic according to your place of residence, and then to a particular GP according to the street you live at. A person living in the town of Examplegrad in Leninsky District at Red October Street goes to a check-up in polyclinic #1, to area 15's GP doctor I.I. Gulagovich, who then appoints treatments and sends them to specialized doctors, if necessary.

Private clinics look more like their Western counterparts. They adhere to the same regulations by the Ministry of Healthcare, but since they are for-profit institutions, they can spend that extra money on top of the line medical equipment and better pay for doctors. Thus, the quality of service is obviously better, but even a simple check-up is costly. On the other hand, no queues - the service is too expensive for most people.

But there's a very big catch. Even if you go to a state-run polyclinics, the attendance is free and the therapy is free... but *the prescribed medications you get at the pharmacy are not!*  They weren't free _even in the Soviet Union_, except when you were hospitalized (not sure if that still applies today). Some basic medications like aspirin, activated charcoal, certain flu and heart medications and some antibiotics are manufactured locally and are heavily subsidized, but the absolute majority of medications are imported. They cost an arm and a leg, because you get Big Pharma's greed + customs dues at the Schengen Area border + the markup of  pharmacies themselves (most of them are private-run). Vaccines are imported - either from the EU or Russia. If you are an old person with hypertension, for example, you can't live without a device for measuring blood pressure... which are also imported from abroad! Thus, this paragon of socialism is not as free-of-charge as you might assume.

Oh, and neither public nor private hospitals can cure many extremely rare illnesses, particularly nasty genetic disorders. If your child has one, heaven help you. Hospitals in Germany or Israel demand astronomical amounts of money for treating such stuff - as a result we have _a lot_ of charity drive ads on TV like "Insertnamehere was diagnosed with insertdiseasehere at age 3. Doctors at home were helpless. Doctors in Germany can treat them, but the cost is 500 000 EUR - more than the parents can afford. Please help them save Insertnamehere by sending an SMS to the following number..."

What does this have to do with America?
I don't know why you can't have both public healthcare (federal-run, state-run, whatever) and private healthcare systems at the same time. It'll still fulfil important American traditions like screwing over poor people, benefiting the rich and lining up the pockets of (pharmaceutical) corporations without any disruption to everyday life or political system. With the amount of money in US budget, I'm sure America can create a public healthcare service no worse than ours even without health insurance. And I seriously doubt the federal government would railroad people to visit public clinics like our government does, which means you get to choose where to go. Why haven't America just cut the knot already, I have no idea.


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## Fek (May 29, 2019)

CamelCursive said:


> No Socialized healthcare.  If people were taxed to have Socialized car insurance, you'd be shrieking if you saw people getting DUI's an driving like absolute maniac.  Healthcare is the same way.  Living like an absolute slob shouldn't have a free safety net.  If they can't afford the consequences of self-induced stupidity, then I'm sure we've got room in the potter's fields.



The only caveat I've ever had for such a system is pre-existing conditions causing refusal of service, though I think a few hundred too many things can fall into that category in the first place (being born with hemophilia, for example, is not remotely the same as ending up with type FAT diabetes through your shit diet). Otherwise, yeah..fuck people deliberately trying to drive themselves into an early grave and thinking anyone else needs to pay for that shit.


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## Gaat (May 29, 2019)

CamelCursive said:


> No Socialized healthcare.  If people were taxed to have Socialized car insurance, you'd be shrieking if you saw people getting DUI's an driving like absolute maniac.  Healthcare is the same way.  Living like an absolute slob shouldn't have a free safety net.  If they can't afford the consequences of self-induced stupidity, then I'm sure we've got room in the potter's fields.





Fek said:


> The only caveat I've ever had for such a system is pre-existing conditions causing refusal of service, though I think a few hundred too many things can fall into that category in the first place (being born with hemophilia, for example, is not remotely the same as ending up with type FAT diabetes through your shit diet). Otherwise, yeah..fuck people deliberately trying to drive themselves into an early grave and thinking anyone else needs to pay for that shit.



Thing neither of y'all get? 

If it isn't a medical emergency the person pays out the nose. 
If it's a medical emergency (I'm pre-diabetic. Parents were. I have occasional hypoglycemia though I'm diet controlled and exercise regularly. Also had a stroke.) person pays little to limited amount. 

Example: 
Hospitalized recently (Luckily where I worked). Complained of Chest Pain. Labs revealed D-Dimer Enzyme. That shit's not nice.  Spent two days to be sure I didn't throw a fucking clot. 

That? Would be considered reduced rate because it was a medical emergency. 

I enter because I binge on sugary shit and my blood sugar's 675? I should pay out my nose.


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## eternal dog mongler (May 29, 2019)

Fek said:


> The only caveat I've ever had for such a system is pre-existing conditions causing refusal of service, though I think a few hundred too many things can fall into that category in the first place (being born with hemophilia, for example, is not remotely the same as ending up with type FAT diabetes through your shit diet). Otherwise, yeah..fuck people deliberately trying to drive themselves into an early grave and thinking anyone else needs to pay for that shit.



Nobody wants to go down this particular rabbit hole.

I work in public health with all low-SES patients and I'd probably estimate that 80% of their conditions are caused by lifestyle.

Look at a bag of Cheetos. The majority of the ingredients used to make them have farm subsidies attached. That's why they're so cheap. We're subsidizing getting patients into their problems but no money is going towards getting them out.

Now would it be better to subsidize healthy food instead of junk food? Or would it be better to shove money into an overinflated healthcare system that tries to treat patients who are slowly killing themselves. Almost nobody even bothers to address this issue.


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## ICametoLurk (Jun 18, 2019)

You could have viable Universal Health Care, but they would call you a Fascist for what would be needed. No more smoking or really any kind of recreational drug use. No more eating what you want. Mandatory exercise. Mandatory abortions of fetuses with severe or costly defects via prenatal screening.

Nobody wants to pay for you. Just themselves and their family.


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## DK 699 (Jun 18, 2019)

Anonymous For This said:


> Worked in an ER once.  Half the patients are pill addicts who are allergic to everything except dilaudid and the rest just have the common cold.  The poor are all on state Medicaid and they abuse the fuck out of it.
> 
> I'm for a single payer system, but one that cracks down harshly on the fuckheads who abuse it.  Since this is the US Government we're talking about here, it's going to be fucked.


I know someone who used to work as a doctor in a big city. They told me that pill heads are a massive fucking problem. I'm veering into the opiod epidemic here, but doctors are overworked and giving in to these addicts is the easiest way for them to get back to their job. None of their higher ups care, because (I might be wrong with this) the hospital gets some money if these people get their pills and their doctors are less stressed if they just give in. Less stressed doctors = higher efficiency. Finally none of the politician want to do anything, because big pharma has lobbyists. It's not that the foot soldiers have a problem. The privates, the NCOs, the generals; the entire army has a problem.


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## Anonymous For This (Jun 18, 2019)

tsundereaddict said:


> I know someone who used to work as a doctor in a big city. They told me that pill heads are a massive fucking problem. I'm veering into the opiod epidemic here, but doctors are overworked and giving in to these addicts is the easiest way for them to get back to their job. None of their higher ups care, because (I might be wrong with this) the hospital gets some money if these people get their pills and their doctors are less stressed if they just give in. Less stressed doctors = higher efficiency. Finally none of the politician want to do anything, because big pharma has lobbyists. It's not that the foot soldiers have a problem. The privates, the NCOs, the generals; the entire army has a problem.



Most states have a mandatory reporting system for narcotics.  Theoretically doctors are supposed to check it before writing narcotics scripts.  You'll get some doctors who run it religiously.  Those are the ones that print out the report, then throw it (literally) at the patient telling them to get out of their ER.  Then you have the doctors who can't be fucking bothered and write scripts for stupid shit while the nursing staff lose their minds. 

Doctor #1 is faaaaaarrrrrr more common, though.  Most doctors generally won't play with that shit, because those state reports list the physician that prescribed the narcotic.  You don't want a bunch of bad boy points on those lists.  If you get caught writing dogshit scripts, at best you lose your license, at worst you go to jail. 



Gaat said:


> Bitch at congress to:
> 
> *Penalize the insurance companies which import customer service call centers offshore. You'll generate more jobs stateside and you won't have someone who doesn't know what the fuck they're doing delaying and denying claims so they can get their shekels.



Only change I would make there is to require any CSR working in a health insurance company that provides any sort of changes or advice has to be an insurance agent licensed for health.  You see this stupid shit in both Health and P&C where companies are finding loopholes to allow both foreign call centers and people in the US (Making $9 an hour) who don't have licenses to make transactions on policies.  It's so fucking maddening, because the reps they hire shouldn't be let within spitting distance of an insurance policy.


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## DK 699 (Jun 18, 2019)

Anonymous For This said:


> Most states have a mandatory reporting system for narcotics.  Theoretically doctors are supposed to check it before writing narcotics scripts.  You'll get some doctors who run it religiously.  Those are the ones that print out the report, then throw it (literally) at the patient telling them to get out of their ER.  Then you have the doctors who can't be fucking bothered and write scripts for stupid shit while the nursing staff lose their minds.
> 
> Doctor #1 is faaaaaarrrrrr more common, though.  Most doctors generally won't play with that shit, because those state reports list the physician that prescribed the narcotic.  You don't want a bunch of bad boy points on those lists.  If you get caught writing dogshit scripts, at best you lose your license, at worst you go to jail.


I'm only remembering this off the top of my head, but I think they told me that the people were asking them for small amounts of the drugs and they (my friend) were in their residency at the time, so the records would say that it was the hospital giving out the medication, not a particular doctor. I'm not in the medical profession in any way, so I might be talking out of my ass right now.


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## ICametoLurk (Jun 20, 2019)

The US spends too damn much money on defense blah, blah blah. Well, you are fine with paying taxes for defense? Why does universal healthcare bother you? Basically, people want the same entity that mismanaged every single war since Korea to now manage their healthcare... Now I love me some military industrial complex, but this argument only works if you hold US defense spending up as the paradigm of fiscal efficiency.


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## AF 802 (Jun 20, 2019)

Make everything illegal. That should take care of it, everyone dying off quick from food and water being illegal, or getting shot with illegal firearms.


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