The US Healtcare system - AKA Hospitals are broke, no one does preventative care, and Insurance is asking for both kidneys and your firstborn

[kira-kun]

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]

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]

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.

 

[cuddle striker]

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]

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.

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]

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.

 

[JosephStalin]

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.

 

[eternal dog mongler]

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]

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.

 

[soft kitty]

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.

 

[eternal dog mongler]

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]

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]

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.

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]

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.

 

[Haesindang Park]

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.

 

[kira-kun]

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.

 

[eternal dog mongler]

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!

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.

 

[Hellbound Hellhound]

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?

 

[Guts Gets Some]

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

 

[ProgKing of the North]

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