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

[Rand /pol/]

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

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

LMAO McCain rekt y'all

 

[JosephStalin]

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.

 

[NOT Sword Fighter Super]

Repeal Obamacare.

 

[Gaat]

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.

 

[Ledian]

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.

 

[eternal dog mongler]

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.)

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.

 

[JosephStalin]

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.

 

[Gaat]

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.)



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.

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.

 

[CamelCursive]

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.

 

[Guardian G.I.]

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.

 

[Fek]

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.

 

[Gaat]

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.

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.

 

[eternal dog mongler]

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.

 

[ICametoLurk]

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.

 

[DK 699]

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.

 

[Anonymous For This]

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.

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.

 

[DK 699]

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.

 

[ICametoLurk]

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.

 

[AF 802]

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.