Insurance. The numbers just. Don't. Work.

February 11, 2012 6:28 PM

Kevin Zelnio is a science writer with a degree in marine biology. He is the father of two children. And, like many in this country, he has no insurance. Earlier this week, his 6 year-old developed pneumonia.This is his account of what happened.
posted by Laminda (201 comments total)

What many people don't realize is that the uninsured are billed at a much higher rate than they charge insurance companies.
posted by Brian B. at 6:42 PM on February 11, 2012 [11 favorites]

I think the really dangerous thing about the health care system is how it makes the idea of going to the hospital even more terrifying than it already is. I learned the hard way that shitty insurance is often worse than normal insurance. In a single year I went to the hospital with my shitty insurance because I collapsed and my mother went to the hospital with no insurance for a broken wrist. We had similar final bills, but she got hers written off through a financial aid program the hospital had. In the meantime, I was appealing to the insurance company and the hospital wouldn't let me apply for aid. It ended up going to collections, which I dodged fearfully for about a year and a half until I got a better job and I managed to haggle it down and get a payment plan.

I think I have decent insurance now, but you know...I'm not sure what would happen if I went to the hospital. It's like a sick form of gambling. I notice that if you take a dog to the dog ER they are very much upfront about costs, which is the opposite of how it is at the normal human hospital. It's like a terrifying possibly life-ruining thing you get in the mail a month later. So yeah, I'm STILL afraid to ever go to a hospital.
posted by melissam at 6:43 PM on February 11, 2012 [15 favorites]

My doctor's office gives a discount to cash payments.

Oh and that kid should have been to the pediatrician way beforehand. Insurance or not.
posted by St. Alia of the Bunnies at 6:45 PM on February 11, 2012 [4 favorites]

Not to say that the system isn't broke because it most assuredly is.
posted by St. Alia of the Bunnies at 6:47 PM on February 11, 2012 [1 favorite]

We're moving back to Canada in a month or so, I've just changed jobs. My current employer, where I've worked for 17 years, made me a counter-offer to move back to the US. We loved lived in the States, but after running the maths, it just didn't make sense even with the higher taxes in Canada. The health insurance costs through my employer's very good plan, were certainly a factor in the calculation. I have a good job, which pays well and I balk at the costs involved. I daren't think about the decision you have to make where you have to "choose" to not have insurance. As the author says, when you can't afford it, the choice is made for you.

I was raised in the UK, where the NHS for all its flaws looks after everyone. We're past the time where the US should do the same. Politicians should take note that many of us will HAPPILY pay more taxes to support a national health service. Paying taxes to support a US version of the NHS will result in cheaper provision for all and overall costs savings for EVERYONE.
posted by arcticseal at 6:55 PM on February 11, 2012 [15 favorites]

Did he actually say that flood and renter insurance was more important than his children's health insurance? I mean shit, my kid's health insurance from United Health is like $110 a month and I guaran-fucking-tee that that bill will be paid. The most I've had to pay at my doctors for him is $35, with most of my visits covered completely. If you can't afford to pay for your kids coverage with your "consultation and writer's" salary, get another career or at least a second job. He seems like a giant ball of bad decisions and poor planning to me.

And the discount that doctors give cash payers is ridiculous, like 10%. When I didn't have health insurance, I paid through the nose. Health insurance has been far more reasonable and easy to keep on top of than the large lump sums that I had to come up with the few times I needed care. I was always getting hurt or needing dental visits around income tax time, luckily.
posted by dozo at 6:55 PM on February 11, 2012 [6 favorites]

Countdown til 'shouldas' arrive - three, t...oh sorry, I didn't see you were already here.
posted by obiwanwasabi at 6:56 PM on February 11, 2012 [27 favorites]

Down in Charlotte I recall seeing a billboard for a hospital advertising a new text-message system that let you find out the real-time wait estimate in the emergency room. Completely backwards.

We have a broken system. We need more pieces like this. Thanks for posting.
posted by odinsdream at 6:56 PM on February 11, 2012 [1 favorite]

Many states have health insurance programs just for kids. Including North Carolina. I haven't read the whole article but it seems like his thought process stopped at "We can't afford it and I didn't think about it that much."
posted by bleep at 6:59 PM on February 11, 2012 [4 favorites]

here are the important paragraphs from the essay:

When I started my family 6 years ago, I was on a path to a career in research and teaching. We had amazing health insurance through my institution and my wife and children-to-be were generously covered, no-questions-asked by the state of Pennsylvania during, and a year after, the pregnancies. We never saw a bill. After I got “real jobs” upon completing my Masters degree, I entered a grey zone of contract teaching and research employment at universities. With a decent, regular salary we were ineligible for state aid, yet didn’t make enough to afford extra costs. Furthermore, the quality of the insurance kept lowering until I wasn’t even sure what I was paying for – even as the premium costs were rising.

It reached rock bottom last Spring when we attempted to actually use our insurance that I bought for $1400 every six months while a contract lecturer and beginning PhD student at a North Carolinian university. My boy was starting Kindergarten and needed to be current on his vaccines. Of course, both kids needed to be current, so we took them in one-by-one, got their shots and check-ups, handed over the insurance information, paid our co-pay and went on our way. Never thinking about it, assuming that insurance would do the job we paid them to do.

Exactly 6 months later we received bills, after I no longer had insurance (I had to leave my phd for variety of reasons), and addressed to our kids’ names and not mine, the policy holder, for substantial amounts. Apparently, my daughter owed over $400 and my son owed over $1600 to the doctor office, which was the net left over after the insurance contributed about $200 for each visit.

If you make too much for federally subsidized insurance i.e. CHIP, aren't covered by your employer, and aren't making a ton of cash, shopping for insurance is a minefield.

Sadly, I can't say that OBAMACARESOCIALISM is going to change his situation. The devil is in the details of what standard of coverage is actually mandated and the very real likelihood that whatever standard is baked into the law (and won't take effect until 2014) will be watered down in pursuit of compromise.
posted by ennui.bz at 7:05 PM on February 11, 2012 [4 favorites]

He should do like Mitt Romney suggests, and fire his health insurance company.
posted by benito.strauss at 7:20 PM on February 11, 2012 [2 favorites]

There are few things as loathsome as a man who through fortune or circumstance has found himself on high ground who will look at another man who through fortune or circumstance finds himself treading water and does not reach down to pull him up; but the one who exceeds that one in loath is the man who looks at another man standing next to him who has stumbled and then pushes him into the water.

That's what it's like being poor in the U.S. You're doing okay, getting by, put enough bread on the table to eat, then you get sick, you go into debt, you lose your job, you can't pay your bills, you wind up in hock, and then you're on the street.

Disgusting.
posted by seanmpuckett at 7:24 PM on February 11, 2012 [66 favorites]

My doc's discount is way more than ten per cent.
posted by St. Alia of the Bunnies at 7:39 PM on February 11, 2012 [1 favorite]

My doctor's cash-up-front discount is 25%.

It’s not overprotection of the children as much as it is the overprotection of the family unit – keeping us and our lifestyle intact.

I'm sorry, I'm uninsured too so I sympathize, but everything about his treatment of his son in this article is making the rest of us look bad. If I had kids I would move heaven and earth to get insurance for them. I mean in what universe is hesitating to take a blue child straight to the ER an "overprotection"? I don't think there's a way to justify that.

If we were able to see a doctor a day earlier, he perhaps could have been treated at home as an outpatient with antibiotics..

Did he actually find out how much a single doctor visit would cost before he ruled it out?
And then this..
My community has income-based charity care which will hopefully reduce our bill to a much more manageable sum.
If he knew this before his son got sick, would he have gambled with an innocent life?

I mean yes the insurance situation in this country really sucks, but there are way more options for kids than there are for adults.
posted by bleep at 7:48 PM on February 11, 2012 [6 favorites]

All I'm saying is if you have uninsured kids you need to be educated in advance about what your options are and put your kids first and put $20 from each pay check into an emergency fund just for them. If you didn't do that then no you can't write an article about how the healthcare in this country sucks because you didn't do your homework and it's someone else's life you're risking, not your own. Wait until something happens to YOU first, because if you're over 18, over the poverty line, and not pregnant or nursing THEN stuff gets fun.
posted by bleep at 7:53 PM on February 11, 2012 [1 favorite]

If you can't afford to pay for your kids coverage with your "consultation and writer's" salary, get another career or at least a second job. He seems like a giant ball of bad decisions and poor planning to me.

With this job market, maybe he couldn't get a job with benefits, and maybe his wife couldn't either. But I find it strange that he never mentions even trying to find one. the fact that many Americans hold the attitudes he expresses in this piece is exactly why our healthcare system is the way it is. "My poor decision-making capabilities in this regard was influenced by my lack of experience with any major disease (I have an immune system of steel, fortified by coffee and whisky)...at least we were all relatively healthy and never seemed to have problems." Health problems only happen to sickly people! I'm healthy as a horse!

I mean yes the insurance situation in this country really sucks, but there are way more options for kids than there are for adults.

Zelnio doesn't give any numbers. Is buying individual coverage for children really that expensive?

If people like Zelnio realized that they can't have their dream lifestyle of being a writer with a (possibly) stay-at-home spouse and provide adequate care for their children, there would
posted by Ralston McTodd at 7:54 PM on February 11, 2012 [2 favorites]

He can't afford health insurance, but he's got hail insurance, life insurance, a kindle fire, and a new set of star wars DVDs to watch.
posted by tylerkaraszewski at 7:54 PM on February 11, 2012 [7 favorites]

I'm very moved by his story and he raises many important issues. But I noticed that he includes a picture drawn by his son on his Kindle Fire. Now a kindle fire is only $200, but there is part of me that feels like if I didn't have insurance for my son, I wouldn't be buying like a kindle fire (especially when it is clear he is connected to the Internet in lots of other ways). This along with other issues other commenters have raised suggests part of his problem might be related to how his family handles their money or prioritizes spending.

I don't think this invalidates his point and it seems like he has learned from this experience. The lesson here could be more than "the current health care model is broken." It also seems to be that Americans have a lot to learn about how to manage money.
posted by imposster at 7:55 PM on February 11, 2012 [5 favorites]

Argh, hit post too soon. I meant to say that there would be more outrage at the injustice of the system if people realized just how much they needed to sacrifice to provide adequate care for themselves and their children BEFORE having a major medical event.
posted by Ralston McTodd at 7:57 PM on February 11, 2012

If people like Zelnio realized that they can't have their dream lifestyle of being a writer with a (possibly) stay-at-home spouse and provide adequate care for their children

He can't afford health insurance, but he's got hail insurance, life insurance, a kindle fire, and a new set of star wars DVDs to watch.


lol suckers. I bet Mr. Zelnio fancied himself a libertarian before this... but there are no libertarians in the emergency room.
posted by ennui.bz at 7:57 PM on February 11, 2012 [4 favorites]

People become bankrupt in this country because they get sick.

Regardless of this guy's personal decisions, the fact that this happens in an ostensibly-developed and civilized country like the US should make everyone here ashamed.
posted by lewedswiver at 8:05 PM on February 11, 2012 [33 favorites]

Did he actually say that flood and renter insurance was more important than his children's health insurance?

It may be a required expense. I have a mortgage, which requires home insurance. Late last year, the new FEMA flood maps went into effect, and now my mortgage holder requires flood insurance. If I don't have either, they'll gladly find policies for me at a increased premium and charge me for it.

If my wife didn't work for a car company with those socialist unions, we'd not be able to afford insurance. Our kids maybe, but not the two of us. I'm not sure if I could get insurance just for my kids through my work, they make it seem like it is an adult plus kids, or nothing.

I work for the local government. My health insurance is from a statewide pool. It is more money and less benefits than what my wife gets. This year I will decline coverage, and go back on my wife's policy.
posted by narcoleptic at 8:05 PM on February 11, 2012 [7 favorites]

It also seems to be that Americans have a lot to learn about how to manage money.

400 Americans have as much wealth as some 150,000,000 of us. I'd say it seems you are right.

Of course, the sort of money management which usually solves this sort of inequality and disparity of wealth is written about in history books for generations afterwards. It usually has a name like, "The Mega-Corporation Burnings of 2012".
posted by Mike Mongo at 8:08 PM on February 11, 2012 [23 favorites]

We pay ~ $1,300 a month for COBRA insurance with a $2,500 a year deductible. It's eating a hole into my life saving but what can I do? We've applied to other insurance companies and been turned down. I have health problems. Going without is not an option. I work a part-time job that doesn't provide benefits for full-time employees until they've worked for the company for a year. It's also 5 minutes away from my son's school. Getting a full-time job is not really an option for me as my son has autism and I need to be able to drop everything at a moment's notice to be there if he needs me. My husband is unemployed. Until he finds a full-time job with benefits, we're fucked.

It feels like our health insurance company's the mob running a protection scheme on us - "Nice life you've got here ... shame if something were to happen to it." I fucking hate the health insurance industry.
posted by echolalia67 at 8:12 PM on February 11, 2012 [41 favorites]

Countdown til 'shouldas' arrive - three, t...oh sorry, I didn't see you were already here.

So it's off limits to comment on THE STORY HE JUST TOLD and see where the situation was made far worse due to his poor fucking choices? I know the system is fucked up but are you kidding me? Let's just ignore the fact that he decided to pay for his trinkets to be insured but not his own children and that deciding that not spending a portion of the $4000 he had saved FOR VACATION to bring his child to the doctor when he had a 104 fever (which his wife self diagnosed as pneumonia after having the exact same illness) wasn't completely selfish and wrong?

God damn obiwanwasabi, I hate the system too but I'll be damned if my precious little boy will be the one bearing the brunt of me cutting corners if I can help it. He depends on me to care for him and I will do whatever it takes to make sure that it happens while working towards changing the rules. It sounds like Kevin didn't have any of this at the top of his priorities and his son almost paid the ultimate price for his dad's shitty planning. Like bleep says, there are plenty of children specific health plans that could have been utilized but whatever, let's not wonder why they apparently chose not to pursue that, right? Why was he saving for vacation but not saving for an emergency situation? Poor Kevin, now he can't go to Sweden because of the insurance companies.

My doc's discount is way more than ten per cent.

That is great! What is it?

The lesson here could be more than "the current health care model is broken." It also seems to be that Americans have a lot to learn about how to manage money.

My point, nearly exactly. Thank you!
posted by dozo at 8:14 PM on February 11, 2012 [10 favorites]

There is exactly one financial priority for me that is higher than health insurance for my family, and it is my mortgage payment. All the other things that he mentions having I would have sacrificed for healthcare if that's what it required.

Our healthcare system *is* broken in this country, but I feel like he's using that as a crutch to excuse his own failing in this situation. He talks about the possibility of losing his life savings. Yes, that would be horrendously difficult, but the life of your son is worth it. If you are risking your son's life for your savings then you are making a bad call. Many people don't have any savings, and I think I'd feel worse for them. But, he waited too long to gamble that his son would be fine, rather than bringing him in before things got really dangerous. You know how much it would have cost for the doctor to look his son over and say, "it's just a flu, he'll be fine"? probably about the cost of a Kindle Fire. That's what he was risking here, because if the doctor *didn't* say he'd be fine, then he'd be in for an expensive bill regardless, and waiting an extra day only made it worse.

Is our healthcare system broken? Yes. Is that an excuse for someone with (even modest) savings and who can afford fancy electronic toys to wait until it's almost to late to take his child to the doctor? No.
posted by tylerkaraszewski at 8:14 PM on February 11, 2012 [8 favorites]

While I agree with others that a parent should be alarmed that his kid has a fever of 104 and seek medical care no matter what, the author's point that the lack of insurance can insidiously affect the decision making process is a well-taken one.
posted by Pantalaimon at 8:23 PM on February 11, 2012 [15 favorites]

I'm glad his son is doing better.
posted by chinston at 8:24 PM on February 11, 2012 [8 favorites]

When I lived in Britain, the NHS sent a doctor to our flat to attend to a roommate who was too sick to check in at the hospital.

Now that I live in the States, I've had a friend drive eight miles to the ER without the gunshot wounds to have a finger lanced and then relanced again two days later when the antibiotics didn't work. She had to phone her parents at midnight both times to get the information to have the ER visits cleared with her (out of state) insurance policies to make sure her visits to the ER for a swollen, discolored, throbbing, infected finger were covered.

Let me be clear: she avoided going to the ER for days and couldn't go to a doctor because her insurance only covers emergency visits in PA, and couldn't afford one out-of-pocket.


Look, it sounds like maybe they could have made better choices, but we don't actually know that, do we? Much insurance is mandated. The Kindle could be a business deduction, or a gift, or a product provided by work...does it matter? Seriously? Our health system, both educationally and fiscally, is broken.
posted by jetlagaddict at 8:28 PM on February 11, 2012 [36 favorites]

Let's just ignore the fact that he decided to pay for his trinkets to be insured but not his own children and that deciding that not spending a portion of the $4000 he had saved FOR VACATION to bring his child to the doctor when he had a 104 fever (which his wife self diagnosed as pneumonia after having the exact same illness) wasn't completely selfish and wrong?

Read it again. From the article:

"Nearly a decade ago when my wife was in constant pain for over a day, and after she could not take it anymore, I rushed her to emergency room. They had no clue, it was a worthless visit. They just looked at us dumbfounded and tried to get her to take antibacterials and be on her way. They even did unnecessary x-rays.

All of that was of course billed to us. We had saved up for 4 years to visit her family in Sweden. Every last cent, about $4000 was wiped clean. "

Yeah, been there, done that (husband was having chest pains), still have the $1,500 ambulance bill that our insurance won't cover because we used an "out of network provider". Fuckers.

At one point last year it looked like our insurance had been cancelled appropos of nothing after my husband had been laid off. As it turns out it was a paperwork glitch, and after a week or two of phone calls we were reinstated. During this time, I ended up cutting myself pretty severely. If you read the thread, you can see that I was so panicked about the potential cost of getting treatment that I was ignoring the very serious potential that I could get a life-threatening staph infection. So fucking what if the guy had a Kindle fire - odds are that even if he cut every non-essential expense right down to the bone, he STILL wouldn't have enough money to cover insurance. It's just that fucked in this country right now.
posted by echolalia67 at 8:31 PM on February 11, 2012 [46 favorites]

So it's off limits to comment on THE STORY HE JUST TOLD and see where the situation was made far worse due to his poor fucking choices?

His poor choices were made because of a poor system that had treated him like gold in one instance and shit like another and already fleeced him of money in another. A previous bill was already in collections because the health insurance he could afford was shitty and only paid 20% of doctor bills for his two kids, which caused him and his kids to get bad credit ratings.

Could he have made better decisions? Sure. But it seems odd to hammer at him for not making the right decision in a system that is so clearly stacked against him.

and that deciding that not spending a portion of the $4000 he had saved FOR VACATION

What are you talking about? The $4000 was when his wife was sick and they were saving to visit her family in Sweden. The hospital didn't help her, but performed all sorts of unnecessary tests, which was common at that particular hospital. Later, he and wife were part of a class action lawsuit against said hospital, because their practice of fleecing the uninsured got so noticeable.

You know how much it would have cost for the doctor to look his son over and say, "it's just a flu, he'll be fine"? probably about the cost of a Kindle Fire.

He paid $1400 insurance every six months. When his kids got vaccines in order to be in school, he was sent a bill for $2,000. This was after having an insurance plan that took care of everything, so he had no real concept of insurance not paying.

A Kindle does not cost $2000, but thank you and everyone else for piling on the poor sucker who wasn't smart enough to navigate a patently unfair system.
posted by Brandon Blatcher at 8:34 PM on February 11, 2012 [79 favorites]

400 Americans have as much wealth as some 150,000,000 of us. I'd say it seems you are right.

I'm part of the 99%, too. I don't have a Kindle because I have to pay for health insurance. I don't have to have 10 million dollars to make sure my family is taken care of first. And I'm not even that great at managing money.

Read it again.
What are you talking about?
Yeah, I read wrong. Sorry.
posted by dozo at 8:36 PM on February 11, 2012 [1 favorite]

Young families get into positions like this in times like these. If they are paying a mortgage, the house and any mandated catastrophic event insurances are bundled into that payment. If they live in an area where an automobile is necessary then they must have automobile insurance, again by law. I think that perhaps the deterioration of the health insurance coverage available to the underemployed and unemployed has not been fully apprehended and I'm not sure this article fully explains that disaster. He had--or thought he had--health insurance.

The last three or four years have been devastating to young families like this one. Maybe he wasn't financially astute enough to use the little bit of money he had in the most advantageous way but that doesn't mean he was valuing something else more than his child's life. Maybe he is an absent minded academic type. There is no way of knowing when and under what circumstances he acquired the KindleFire; it might have been a gift, so that seems an unnecessary criticism.

It is not unusual, either, not to recognize the severity of a young child's illness when it is your first child and you have little experience with sick children. They can get very sick so quickly that it is truly frightening.

Also, the economic dilemma that he is describing can be nearly paralyzing, certainly depressing. He is working and he is not doing nothing. I feel he doesn't altogether deserve a lot of personal criticism, which in any case does nothing to solve the problem which he did not create--he might not have done as well as others might in his circumstances, but he didn't create this horror of a system.

I keep hoping for our society to become civilized in its provisions for those in need--the old, the young, the sick, the homeless, the hungry, and the damaged.
posted by Anitanola at 8:38 PM on February 11, 2012 [13 favorites]

I don't have a Kindle because I have to pay for health insurance.

Getting a Kindle is lot cheaper than getting health insurance.
posted by Brandon Blatcher at 8:41 PM on February 11, 2012 [14 favorites]

If insurance costs $5000/year and he can't afford that, this does not mean that he can't afford a $200 Kindle Fire or $80 DVDs. You can't buy $280 worth of a $5000 health policy. Maybe you can scrape together $500 and have it for a month, once, instead of these things, but they impose waiting periods and unless you can keep paying over and over until these periods are complete, they will cancel your insurance and you would have to start it over again.
posted by aeschenkarnos at 8:44 PM on February 11, 2012 [12 favorites]

But it seems odd to hammer at him for not making the right decision in a system that is so clearly stacked against him.

The child was blue and couldn't breathe. If he thought they were goin to send him home shrugging their shoulders with a $4,000 bill for nothing, and he's a science writer, the problem is just that he's dumb. Which just distracts from the very real healthcare crisis in this country.

I just got into a car accident and refused transport to the hospital because I'm uninsured and I felt fine. If my kid was in the car with me? HELL YES WE'RE GOING TO HOSPITAL, no questions asked. The kid's blue? Why aren't we at the hospital already? Pretty simple.
posted by bleep at 8:48 PM on February 11, 2012 [2 favorites]

I guess what I find irritating about this story is that, while he admits to "poor decision-making capabilities", he's referring only to the fact that he didn't take his son to the doctor soon enough, not that he thought it would be more or less okay to go uninsured because he and his family are such healthy people. (I find it extra disturbing that he believed this even though his wife apparently does have a history of health problems, taking "years to recover her strength and more of her lung capacity" from pneumonia.) Also, his whole problem with the health care system is that it's too expensive. Under a just system, there would be no medical bankruptcies, but there would also be no opting out because you have an iron constitution and don't ever get sick. I don't know what Zelnio's income is, but perhaps under such a system, he would end up paying just as much as it would cost to insure his family now.
posted by Ralston McTodd at 8:48 PM on February 11, 2012 [1 favorite]

If he thought they were goin to send him home shrugging their shoulders with a $4,000 bill for nothing, and he's a science writer, the problem is just that he's dumb.

Ok, let's say you're right, he's dumb. Let's ignore the article he just wrote where he talks about the mindset of being uninsured and it makes one overly caution.

Instead we'll go with "he's dumb" for taking the kid to Urgent Care as opposed to the ER. What is your point? Are you suggesting a particular source of action and if so, what is it?

I guess what I find irritating about this story is that, while he admits to "poor decision-making capabilities", he's referring only to the fact that he didn't take his son to the doctor soon enough, not that he thought it would be more or less okay to go uninsured because he and his family are such healthy people.

The problem is that they make enough money to not qualify for help for themselves or the kids, yet not enough to get decent insurance:

With a decent, regular salary we were ineligible for state aid, yet didn’t make enough to afford extra costs. Furthermore, the quality of the insurance kept lowering until I wasn’t even sure what I was paying for – even as the premium costs were rising.

posted by Brandon Blatcher at 8:58 PM on February 11, 2012 [2 favorites]

My point is that by gambling with his son's life and not using any of the knowledge and resources available to him to get him cared for in a timely manner, he's not making a good case study for the health care crisis in this country.

Being uninsured makes one overly cautious, I get that. But how is letting your son struggle for life being overcautious? I see it as being reckless and ignorant. It's fine to be reckless and ignorant with your own body, when you're the one calling the shots, but to make your child suffer for it is just cruel.
posted by bleep at 9:04 PM on February 11, 2012 [1 favorite]

Anitanola, I want to second your comment.

Insurance companies are some of the biggest scammers around. And after working in a hospital, I can tell you hospitals are some of the next biggest.
posted by BlueHorse at 9:06 PM on February 11, 2012 [6 favorites]

The course of action I'm suggesting is to not try to risk his son's life to save a few bucks and instead make an accurate judgement of an emergency situation and take the hit to ensure his son's survival. If that urgent care clinic was so great why couldn't he have taken him there the day before like he said?

If he makes enough money for entertainment gadgets, he makes enough money to put some aside for his kids well-being and not have to second-guess in emergency situations that were already accurately assessed by his own wife.
posted by bleep at 9:12 PM on February 11, 2012 [1 favorite]

My point is that by gambling with his son's life and not using any of the knowledge and resources available to him to get him cared for in a timely manner, he's not making a good case study for the health care crisis in this country.

So you're choosing to ignore the points he made about job based covered, the variety in quality of health insurance, outright fleecing by a hospital, shitty insurance that gifted him 2,000 in debt, the grey area between having a decent job, yet not being able to get decent coverage and even if he could, the premiums having been rising faster than the cost of living.

Instead you want to say his story isn't a good example of the health care crisis in America. Ok, then what is it an example of?
posted by Brandon Blatcher at 9:12 PM on February 11, 2012 [6 favorites]

dozo: “I mean shit, my kid's health insurance from United Health is like $110 a month and I guaran-fucking-tee that that bill will be paid.”

I have a very hard time believing you; no offense, I just do. Seriously? $110 a month?

If that is true, Florida is nothing like other states I've lived in as far as cost of health insurance. I have never, never been able to find a health insurance plan for myself for less than $300 a month, and I'm a normal functioning adult. His quoted figure in the article – $1400 – is pretty much exactly what I would have expected.
posted by koeselitz at 9:13 PM on February 11, 2012 [3 favorites]

Christ, people are so willing to jump in this guy's shit for the littlest of details. OMG HE HAS A KINDLE. Maybe someone gave it to him for Christmas? You realize how absolutely petty such a snipe about the Kindle sounds?

None of us are saints. None of us make perfect decisions. The takeaway point from this article isn't "let's judge this guy at how he screwed up."
posted by introp at 9:15 PM on February 11, 2012 [26 favorites]

Are we doing the shouldas' here? If so, I've got one : You've got a PhD, quit the broken nation. Canada loves PhDs. He's clearly "gambling with his son's life" by remaining an American.
(We can all play the shouldas game if you really don't want to discuss the mindset issues the article actually raised)
posted by jeffburdges at 9:16 PM on February 11, 2012 [5 favorites]

I am in the 'I have a kindle fire but no health insurance' crowd (well, not literally, but only because I read reviews of things before I buy them). I have an X-Box and a cellphone and a laptop but no health insurance.

For me a single, healthy, young person, a year of health insurance costs the equivalent of 36 X-Box 360s. Now, would it be irresponsible for me to buy 36 X-Box 360s and not buy health insurance? Sure. But that's not a choice I had. I could afford to buy one X-Box, but there's no way I can buy 1/36th of a year's worth of insurance.

I am in a position very similar to the author (though fortunately single and with no kids) in that the numbers just don't make sense for me. Even if I could come up with the monthly payment, the only insurance I can get for that much is a high-deductible plan, under which I would have to pay the first $10,000 of doctors bills every year anyway. I know that if anything major happens to me, I am bankrupt. But that is the case anyway-- If I have a major medical event I'm out $10,000 I can't afford for the deductible, plus the $7000+ I've already paid for the year in premiums. As I get a bit older, I am trying really, really hard to make the numbers work, but as it is, they just don't.
posted by matcha action at 9:16 PM on February 11, 2012 [34 favorites]

$110/month for one child's health insurance sounds employer-subsidized to me.

I can only speak for myself -- but I definitely did not know jack shit about how fucked the system was until I no longer had employer-subsidized health insurance.
posted by gnomeloaf at 9:19 PM on February 11, 2012 [10 favorites]

A Kindle does not cost $2000, but thank you and everyone else for piling on the poor sucker who wasn't smart enough to navigate a patently unfair system.

Nor does a basic visit to urgent care where the doctor examines you, tells you you have something non-serious, and sends you home, possibly with a prescription. It costs about $100 or $150 (ask anyone above who knows exactly what their doctors' cash discounts are). Maybe I missed the part in the story where he called and asked how much it would cost if he brought in his son and it turned out be non-serious, but it seems like he never even tried to check. The fact that he was improperly billed by a (now uninvolved) insurance company for a completely different thing in the past is really not that applicable.
posted by tylerkaraszewski at 9:19 PM on February 11, 2012

I live in Australia. When I was younger (and single) my uncle, an MD, advised me against getting insurance. You see, medical care in Australia is cheap or free. Private hospitals mostly compete by having private rooms and giving the patients a choice of doctors. So my uncle pointed out that critical cases (e.g., road accidents) are generally taken to public hospitals. Most major surgeries take place in public hospitals. Young, healthy people are unlikely to benefit from private health insurance because they're unlikely to need long-term treatment.

Things are different now: I have kids (and family health insurance is a real bargain) and I'm a bit older. I have private health insurance now, for which I pay a bit over three hundred dollars a month. But I don't need to; lots of people don't. My point is that you could do this in the USA. It would probably be a huge benefit to your country: poor people would have fewer amputations, kids would be less likely to lose their hearing, there would be less abuse of emergency rooms, fewer people would live in pain, there would be fewer chronic transmitters of disease.

As Australians go I'm pretty right wing, but I'm still astonished that USAns fear universal health care. It's like fearing universal education - and yes, I know that that was once controversial. Universal health care is great: you don't have this omnipresent fear of losing the health insurance that comes with your job, or being cheated by your insurer, or falling between the cracks somehow. The psychic benefits alone make it worthwhile. So yes, I'm sorry for this guy - but I'm also sorry for everyone reading this who has to worry about healthcare. It shouldn't be this way. You deserve better.
posted by Joe in Australia at 9:21 PM on February 11, 2012 [37 favorites]

$110/month for one child's health insurance sounds employer-subsidized to me.

That commenter seems have ignored the fact that the writer bought insurance, paid $1400 for six months coverage and wound up with a $2000 bill for vaccines for the kids, which was mandated in order to get them into school.

Nor does a basic visit to urgent care where the doctor examines you, tells you you have something non-serious, and sends you home, possibly with a prescription. It costs about $100 or $150 (ask anyone above who knows exactly what their doctors' cash discounts are).

How would he know that if the last visit for routine shots wound up costing 2k?

The point of the article was a certain mindset develops when you have no health insurance in America. You take gambles and risks not because you want to, not because you're poor, but because the system is fucked you can't be sure if, how and when how deeply it's going to fuck you.
posted by Brandon Blatcher at 9:25 PM on February 11, 2012 [10 favorites]

My significant other is a doctor, and she tells these stories pretty much every day. Most people don't do the right thing when they don't have insurance. They're scared, and they mess up. As the article points out, this is natural. It's called panicking. And I guarantee you that 90% of people panic and fail to act rationally when their health or (especially) the health of their children is put at risk by shitty economic circumstances.

This thread is basically a microcosm of American society. Those of us who have managed barely to scrape enough together and get by tend to carry with us some bitterness at how difficult it was, so we push that bitterness on those who failed. 'How dare that homeless guy sit there on the corner asking for change? If the rest of us can get a job, so can he! Times are tough all over!'

It's apparent that there are still people around who seem to think that, if you don't happen to be good at thinking in an emergency, if you don't happen to be good at clear-headedness in high-pressure situations, you should be punished, and your children should get sick. Does this really make sense? Are only people with nerves of steel and the metabolism of an EMT allowed to raise kids?

This is not how things should be.
posted by koeselitz at 9:26 PM on February 11, 2012 [62 favorites]

You're going to get financially screwed the second the kid gets sick anyway, regardless of when you take the kid to the hospital. The only difference is if the kid dies or not, I suppose.

I'm just so sick of hearing stories like this and it's never going to get better.
posted by jenfullmoon at 9:31 PM on February 11, 2012 [5 favorites]

dozo: “I mean shit, my kid's health insurance from United Health is like $110 a month and I guaran-fucking-tee that that bill will be paid. The most I've had to pay at my doctors for him is $35, with most of my visits covered completely.”

Actually, according to the generic quote I get from United Health for your area, either (a) you are only covering yourself and one child, which is a completely different situation from this guy, who has two kids and a spouse to cover as well; or (b) you actually have the "short-term value" plan, which is $110, and which covers doctor visits but nothing else.

I suspect it's the latter, in which case you would have been in the same situation as this guy: having to shell out thousands of dollars for shots, being stuck with any and all bills (this plan says that you're left entirely to pay for "medical expenses") and generally not being able to afford care for your kids.

Medical insurance is not care. That's the point.
posted by koeselitz at 9:34 PM on February 11, 2012 [3 favorites]

I have never, never been able to find a health insurance plan for myself for less than $300 a month

You're a male over 30. Insurance costs jump around 30. It happened to me too a couple years ago. A kid would be able to get insurance cheaper... what with not being over 30.

That doesn't have much bearing on this story in general, obviously, but you can't compare the insurance costs for a 32 year old male with insurance costs for a child.
posted by Justinian at 9:34 PM on February 11, 2012

Justinian: &Ldquo;That doesn't have much bearing on this story in general, obviously, but you can't compare the insurance costs for a 32 year old male with insurance costs for a child.”

This includes when I was 27; the cheapest plan I could find was $350 then. Granted, I think Colorado has some ridiculous health insurance rates.
posted by koeselitz at 9:36 PM on February 11, 2012

For reference, here are the various medical/dental plans and income requirements for New Hampshire Healthy Kids (on whom we have relied in the past) [pdf]. It's available even at relatively good incomes, with a premium.
posted by schoolgirl report at 9:36 PM on February 11, 2012 [1 favorite]

I educated and with skills, my former partner is educated too. And it is very hard to land a job with insurance benefits if you're not in the right field.

Without the COBRA coverage that extends a plan negotiated by a previous employer, my insurance options would be expensive and poor quality. As it is, they're expensive and decent quality. We had two COBRA options, but one of the employers went out of business, and their insurance closed down.

Family insurance in my area, on COBRA, is 2/3 the rent of a 2 bedroom apartment.
posted by zippy at 9:46 PM on February 11, 2012 [1 favorite]

I am ...
posted by zippy at 9:47 PM on February 11, 2012

If you make too much for federally subsidized insurance i.e. CHIP, aren't covered by your employer, and aren't making a ton of cash, shopping for insurance is a minefield.

Personal story, i went off my parents insurance shortly after going into the psych ward for a suicide attempt, and looking for insurance was hell. No one would cover me due to "pre-existing conditions". I finally found a state program that i could get (the only one that would cover me, after trying to get it for quite some time), but i lose it if move out of state, and it covers squat. Prescriptions are pretty much not covered, which with psych meds can get up there big time, especially when you have to try different ones and then if the cheap ones don't work. So yeah, finding insurance is hell.
posted by usagizero at 10:17 PM on February 11, 2012 [1 favorite]

Huh, you'd think the US medical system is completely fucked listening to you whiners. It's all very simple. Save up an "emergency fund" -- this should be at least $20000 to protect against an "out of network" emergency visit, more if you have any sort of family history of disease. Ask your parents to chip in, or plan a "healthcare potluck" at your local church. Then, consider taking a yearlong course in medical bill payment. This will allow you to negotiate a fair price (CASH$$$) with the doctor while your child is bleeding from the head (remember to clip coupons in advance, if your doctor offers them in the local circular!). Doctors are always well informed about service costs and will be sure to inform you of less pricey options while your chest cavity is open. It doesn't hurt to ask, and may result in saving a few pennies, despite the eye rolling from nurses asking you who shot the harpoon and is he still on the loose.

And remember the most important rule of all: NO KINDLES!!
posted by benzenedream at 10:23 PM on February 11, 2012 [51 favorites]

Can we even fix this? The assholes who make the laws are all millionaires; the companies that benefit from this situation are all pouring even more money into the millionaires' pockets.

I can't see it ever being fixed.
posted by maxwelton at 10:40 PM on February 11, 2012 [3 favorites]

Joe in Australia wrote: Universal health care is great: you don't have this omnipresent fear of losing the health insurance that comes with your job, or being cheated by your insurer, or falling between the cracks somehow.

See, Joe, the people that run our economy consider these things to be features, rather than bugs. The "omnipresent fear" of poverty and homelessness you speak of is considered to be a unique incentive for American workers to work harder, for less.

Why would our nation's elites agree to a social program which reduces their ability to control the masses?
posted by Avenger at 10:41 PM on February 11, 2012 [15 favorites]

And America's "macho" & "bootstraps!" (bullshit) national psyche doesn't help. (No one gives a shit if you're a "tough guy," but I swear the only reason 3/4 of the idiots who vote for psychotic right-wingers do so because it makes them feel tough.)
posted by maxwelton at 10:43 PM on February 11, 2012 [5 favorites]

Can we even fix this? The assholes who make the laws are all millionaires; the companies that benefit from this situation are all pouring even more money into the millionaires' pockets.

And don't even mention all those morons on Medicare or Medicaid who believe any new gubbermint health care is gonna execute them to save money.
posted by PeterMcDermott at 10:45 PM on February 11, 2012 [2 favorites]

Every time I read about Americans and their healthcare/insurance outrages.... I seriously wonder why there hasn't been a civil war about it. Really. It's the most disgusting, terrible, unjust and plain fucking absurd situation for a "first world" country to be in... and yet.... it seems to be tolerated. They Occupy Wall Street but health insurance gets a whimper????

Pay people properly, tax them accordingly, educate everyone for free, and make it difficult to sack people unless they've actually done something very wrong. Provide universal healthcare for everyone and give vip level to those that want it, but abolish the notion of un-insureable people or conditions.

It can't be that bloody hard if Australia does it, for fncks sake.
posted by taff at 10:48 PM on February 11, 2012 [11 favorites]

Two kids vaccinated, $2400.

Is the cost of insurance the problem? Is it the insurance companies who are gouging people?
posted by fredludd at 10:54 PM on February 11, 2012 [1 favorite]

So it's off limits to comment on THE STORY HE JUST TOLD and see where the situation was made far worse due to his poor fucking choices?

Congratulations - you're smart enough to come along as a casual, disinterested outside observer, apprised of a minor handful of facts, and throw around a bunch of offhand judgments about woulda, coulda, shoulda. You bleat the catch cry of the privileged and the plain lucky - choices, man, it's all about choices. Doing it tough? Well, you must be some kind of idiot, because did I mention choices? You bought those Star Wars DVDs, so it's your fault you kid almost died. Sure, there's a massively inefficient, cruel, perversely structured health industry in that guy's country, and that's the real problem here, but STAR WARS DVDs, everybody!

So no, it's not off limits. It's also not off limits for me to think you're an arsehole for doing it, and saying so.
posted by obiwanwasabi at 11:04 PM on February 11, 2012 [17 favorites]

Is the cost of insurance the problem? Is it the insurance companies who are gouging people?

It's really the whole medical industry that gouges people, for a variety of reasons. There's malpractice insurance at multiple levels, the cost of medical professionals, and the profit motive itself. Medical devices and pharmaceuticals carry a lot of costs in their development, and success isn't always guaranteed. In the US, cost controls don't exist in many areas of the medical industry.
posted by ZeusHumms at 11:10 PM on February 11, 2012 [2 favorites]

Can we even fix this?

The Italian, Spanish, Japanese and Canadian co-operative models for insurance, hospitals and clinics might be possible as it can be formed independently by individuals. The Canadian govt has a nice summary of some models here.

The US also had some co-op insurance in the 30s done through co-ops -- the trick is to not let them become just like private insurance--which means maintaining member control.

It seems to me the co-op model might appeal due to US aversion (among some people) to state control of health care.

I also think it might have some advantages of the privately run clinics (or church run hospitals) in Canada's single payer system (and of course some trade offs as well).
posted by chapps at 11:11 PM on February 11, 2012 [2 favorites]

Every time I read about Americans and their healthcare/insurance outrages.... I seriously wonder why there hasn't been a civil war about it. Really. It's the most disgusting, terrible, unjust and plain fucking absurd situation for a "first world" country to be in... and yet.... it seems to be tolerated. They Occupy Wall Street but health insurance gets a whimper????

Pay people properly, tax them accordingly, educate everyone for free, and make it difficult to sack people unless they've actually done something very wrong. Provide universal healthcare for everyone and give vip level to those that want it, but abolish the notion of un-insureable people or conditions.

It can't be that bloody hard if Australia does it, for fncks sake.
posted by taff at 0:48 on February 12 [+] [!]

The American situation is a little bit like the Red Queen's race from Through The Looking Glass:

"Well, in our country," said Alice, still panting a little, "you'd generally get to somewhere else -- if you ran very fast for a long time, as we've been doing."

"A slow sort of country!" said the Queen. "Now, here, you see, it takes all the running you can do, to keep in the same place. If you want to get somewhere else, you must run at least twice as fast as that!"

Basically, virtually everyone is so tasked to work as hard as they can to stay in place, to not fall behind, and to maintain appearances, that no one really thinks about the consequences of all their hard work not actually getting them ahead.
posted by ZeusHumms at 11:14 PM on February 11, 2012 [18 favorites]

I guess I'm going to be the asshole who mentions the numerous typos / grammar / usage errors that make me wonder who is paying this guy to write for a living, or who at Scientific American can't afford a proofreader's 10-minute run-through to fix the numerous errors.

As for the health insurance... I think he needs to do whatever it takes to get a job with it, even if it's not his life's dream. It's a shitty choice but in this country, at this time, freelance writing with children, and no spouse insurance to cover them, is really playing Russian roulette. I have a boring paper-pushing state job with good health insurance. I don't make much money, though. But it's a great situation for me (I have many doctor visits per year, and extremely expensive medications). Sometimes you gotta take the lesser job for the health insurance.
posted by marble at 12:21 AM on February 12, 2012 [1 favorite]

I was laid off in 2010. I was 41, obese (but was getting better - most recent doctor visit had me at 320, down from nearly 400 the year before), had two minor surgeries (gall bladder and hemorrhoids), and insulin resistance (not full blown diabetes as long as I pay attention).

I had COBRA coverage and subsidy for a year from my previous employer. For that, it was $650/mo, with a $2000 deductible for in-patient doctor care, emergency room care, and the prescription plan.

After that year was up, it went up to $1200/mo. Yes, twelve hundred dollars.

Between things I had to do for job-hunting, paying bills, all of that, the amount I got from unemployment was not going to let me pay the health insurance and any other single major bill. I would have had to move back in with my parents and been unable to even afford things like a monthly bus pass (from where they lived, assuming I could get a ride for the twelve miles to the bus stop in an area where bicycling was suicidal, in backwoods South Jersey).

When I called to talk about what I could do to get a more reasonable rate, the next tier up had a $20,000 deductible (including ER care) and no prescription plan, for $1000 a month.

So there went insurance. But this is just me. If I had a family, I might have tried to get killed so at least they'd have my life insurance money. At least they'd have had something.
posted by mephron at 12:30 AM on February 12, 2012 [4 favorites]

" Sometimes you gotta take the lesser job for the health insurance."

This is the most fncked up, but utterly understandable thing I've read in a long time.


For fnck's sake....War, people, war!!!!
posted by taff at 12:34 AM on February 12, 2012 [3 favorites]

If you can't afford to pay for your kids coverage with your "consultation and writer's" salary, get another career or at least a second job. He seems like a giant ball of bad decisions and poor planning to me.

Wow, you people are fucking ridiculous. If he lived in a sensible country, this wouldn't even be an issue. What is this guy supposed to do go out to the job orchard and just pick one off the job tree that happens to have a good health insurance policy attached?

And also what the fuck is it with this "bad decision" shit or " If he knew this before his son got sick, would he have gambled with an innocent life?" yeah no shit had he known this or that random, un-published factoid maybe he would have made a better choice. But he didn't, so, should his son just die, for the crime of his father not knowing all the details of an insanely Byzantine system as they relate to every medical facility in the area?

This is what I don't get about the "they were" stupid argument when horrible things to happen to people. Do you expect that everyone should be Stephen Hawking and know every detail about everything and if they don't they deserve every horrible unfair thing that happens to them? The world is full of stupid people, the vast majority make stupid mistakes all the time. Why should that be a mortal sin? It's completely ridiculous. In fact if you don't think most people make stupid mistakes all the time you're probably one of the stupider people out there.

So it's off limits to comment on THE STORY HE JUST TOLD and see where the situation was made far worse due to his poor fucking choices? I know the system is fucked up but are you kidding me?

It's not off limits, the question is why does it matter? Do you honestly belive that the penalty for your parents making a poor decision should be death? Or serious injury due an untreated condition because they're afraid to go to the hospital? Because that's the implication of what you're saying, that people who make 'bad decisions' in respect to a capricious and arbitrary set of bureaucratic rules should die or have their children die. And nothing could possibly be stupider then that?.

Let's just ignore the fact that he decided to pay for his trinkets to be insured but not his own children and that deciding that not spending a portion of the $4000 he had saved FOR VACATION to bring his child to the doctor when he had a 104 fever (which his wife self diagnosed as pneumonia after having the exact same illness) wasn't completely selfish and wrong?

Apparently you can't read either because the $4k was for his wife's pneumonia 10 years prior.

Getting a Kindle is lot cheaper than getting health insurance.

Yeah that's the thing. A kindle fire costs far less then health insurance. It wouldn't have made any practical difference in his ability to pay for insurance.

Are we doing the shouldas' here? If so, I've got one : You've got a PhD, quit the broken nation. Canada loves PhDs. He's clearly "gambling with his son's life" by remaining an American.

Yeah, instead of visiting Sweden, he should have moved there.

Nor does a basic visit to urgent care where the doctor examines you, tells you you have something non-serious, and sends you home, possibly with a prescription. It costs about $100 or $150 (ask anyone above who knows exactly what their doctors' cash discounts are).

Again, did you read the article? That's what he did when his wife was sick, they did nothing and charged him $4000. Which he later got zero dollars for when he won a class action suit against the hospital. If you think a trip to the hospital will only cost $100-$150 is delusional. Like he said, he did that in the past and was billed $4k.

TL;DR: People make mistakes. People make stupid mistakes. If you think, for some reason that we should have a system where a stupid mistakes results in bankruptcy or death then you're a much, much greater idiot then they could possibly be.
posted by delmoi at 12:41 AM on February 12, 2012 [39 favorites]

Wow, I'll stop complaining about the long wait times in Canadian ERs.

I feel for this guy. A similar thing happened to my toddler -- he'd been struggling with what we thought was another daycare cold and then one afternoon he just fell over. Rushed him to ER and discovered he had pneumonia. We were in a Vancouver hospital for five days but it didn't cost us anything.

I know, I know, there's the invisible cost of taxes, but that's spread out across the entire society, so it's just not as noticeable. I'm taking out more than I'm paying in now, but I was fine with paying for more than I used when I was single and childless, so....

My toddler has been in hospital twice now for week-long stays (respiratory issues), and has become a regular at his doctor's office for various daycare plagues -- let me tell you, foot and mouth disease and constipation at the same time is no treat. But we've never spent a dime for any of those visits.

I don't know if this guy made a bad call or not with his kid. I'm glad this isn't even an issue in Canada. Yes, we have problems with wait times compared to the U.S., but we don't usually have to agonize over visits to the doctor or even ER.

My sympathies to all of you who have to live in this madness. I hope it gets better for all of you soon.
posted by showmethecalvino at 12:51 AM on February 12, 2012 [4 favorites]

Are we doing the shouldas' here? If so, I've got one : You've got a PhD, quit the broken nation. Canada loves PhDs. He's clearly "gambling with his son's life" by remaining an American.

He mentions that his wife is Swedish. He can escape the US if he wants. I don't know why he continues to endanger his children's lives by staying.
posted by Jehan at 12:57 AM on February 12, 2012 [8 favorites]

I pay $10 a month. I see a doctor whenever I want; with a short wait. I'm Canadian. I'm very fucking lucky.
There must be a way this can be changed for you. Imagine how your country would change for the good if the common good were a base part of the U.S. constitution. Silly little well-wisher.
posted by qinn at 1:00 AM on February 12, 2012 [1 favorite]

Oh jesus christ! You all smart asses have everything figured out, don't you? Every one of you has a bulletproof health insurance policy, right? You all think your insurance company won't ever fuck you over in your greatest hour of need? No one has any financial troubles? You all think it's perfectly normal that a university-educated, working family has to forgo vacations, all but the most necessary consumer goods, choose a career based not on what they like or have trained for, but on where the best health coverage is, and have to choose between fire and health insurance in order not to be financially ruined by a 19th century disease? That in a self-nominated teh best, most developed country on earth?!
It boggles my mind, with all that sage advice you guys can dispense based on even the tiniest shred of information and 3rd grade reading comprehension skills (the $4000 question above), with your ability to make sound financial decisions, how the hell the economy is the way it is? Must be because of all those god damn Kindles, and spelling mistakes, right?
posted by c13 at 1:35 AM on February 12, 2012 [30 favorites]

Imagine how your country would change for the good if the common good were a base part of the U.S. constitution. Silly little well-wisher.

Oh, it is.
posted by Philosopher Dirtbike at 1:37 AM on February 12, 2012 [2 favorites]

I read here how stupid the guy is. OK. But why stop here? Doesn't his stupidity go much further? After all, he knew he was not a millionaire, and therefore it would be super risky to have kids at all? You may have a good job now, but is it guaranteed? The moment you lose that job - and it is a foreseeable risk which it would be irresponsible to not account for - your kids are in trouble.

The only responsible, non-stupid thing to do, for the 99%, is to not have children in the first place. Yeah, go ahead and laugh. But tell me exactly why that is wrong? You say he did x, y, and z things that were stupid - let me tell you, it was stupid to have children given your financial status, much stupider than buying a kindle.

And as you laugh, please remember that this is not exactly satire. I know of couples who delayed, or forwent having children altogether because they didn't think they could afford them. He was a moron to think that he'd always have a job that had good insurance - that was plainly unrealistic and I'm here to tell you, that unless you stay in the military or a few other unique situations, there are no guarantees wrt. health insurance.

Ergo, the 99% are idiots for ever having kids. Fucking morons. And we, the taxpayers have to support their lazy irresponsible welfare sucking no-good asses. So cut our taxes already.
posted by VikingSword at 1:43 AM on February 12, 2012 [4 favorites]

I guess I'm going to be the asshole who mentions the numerous typos / grammar / usage errors that make me wonder who is paying this guy to write for a living, or who at Scientific American can't afford a proofreader's 10-minute run-through to fix the numerous errors.

As for the health insurance... I think he needs to do whatever it takes to get a job with it, even if it's not his life's dream. It's a shitty choice but in this country, at this time, freelance writing with children, and no spouse insurance to cover them, is really playing Russian roulette. I have a boring paper-pushing state job with good health insurance. I don't make much money, though. But it's a great situation for me

No. Mentioning typos is just petty. But bragging about you got other taxpayers to subsidize your health care by getting a worthless job with the government that runs trillion dollar-a-year deficits (to be paid off by the children of the people you're fleecing now) is pretty assholish.
posted by c13 at 1:46 AM on February 12, 2012 [5 favorites]

The conservative trope is, as we see in this thread, that bad outcomes are all about bad choices. The liberal response to this is "So what?" People make bad choices. Welcome to the real world. It is arguable in this case whether bad decisions were made - I suppose you can second guess him from across the internet in hindsight, if you like, but that just makes you look like an ass. But let's just say, for the sake of argument, that a bad choice was made here. Who cares? Should his child die because of that?

Conservative public policy, with its devotion to "personal responsibility," seems to be designed to govern some kind of weird, totally rational, fictional automaton - or at least, to try to bring these automatons into existence through a cruel Darwinian experiment. WE DON'T LIVE IN THAT WORLD. We live in a world where mistakes are made and money is wasted. If you can't see that we need public policy that allows real people to live in the real world with a minimum of suffering, please, please let the rest of us solve social problems. Because you've only got solutions to fictional problems in a fictional society.
posted by Philosopher Dirtbike at 1:48 AM on February 12, 2012 [11 favorites]

On preview
And we, the taxpayers have to support their lazy irresponsible welfare sucking no-good asses.

Heh. And paper pushers in the government that are there only for the insurance....
posted by c13 at 1:48 AM on February 12, 2012 [1 favorite]

So I had my gall bladder removed recently (early December) at a public hospital here in Brisbane, Australia. I was on the waiting list for about two months, which I guess isn't bad. In fact it's fucking excellent because I was told it could be anywhere up to two years. Anyway, before I ended up in the public hospital I had presented myself to a private hospital because the gastro doctor said "This needs to be done immediately, go downstairs and check yourself in for day surgery." At this point I had private health insurance through Medibank Priority. The level of cover was MyOptions Executive (or something like that). It was presented to me via my job as a civil servant, and we were told it covered hospital, emergency, and even extras. Nice! Sixty bucks a month which I paid without question (because it was automatically taken out of my bank account) for about two years.

I admit I didn't read the ninety-seven brochures I was given with my membership card, so it's really my fault, but still, I was assured by the Medibank representative that it was "a comprehensive level of cover" and I handed my card over to the admitting nurse at the hospital (doubled over in agony, I might add). She kind of smiled sadly and said "You know, we've had doctors come in here with this exact level of cover, hoping to get operated on, but I have to tell you it's useless and doesn't cover anything." She told me it was good for acupuncture and sports injuries (but only sports injuries to the lower part of the leg, or something) and a little bit of dental. "Okay," I said, and out of desperation asked what I could be expecting to pay for a surgery of this nature.

"Well, it's about $5,000 a day, you can probably expect to be out in two days."

That's actually a fair price. I'm down with that. You've got doctors and nurses and medicine and a bed and the actual operating room filled with the surgical team. Five grand a day is very fair. Of course, I don't have that sort of money, so I said thanks and left. On my way home I called Medibank and cancelled my membership.

Hung around for a few months in non-stop pain (gallstones caused by rapid weight loss, apparently, which tore up the inside of my gallbladder) and ended up in public hospital for a six hour surgery (it should take two at the most but my gallbladder was so badly fucked that it had fused to the organs surrounding it) and then in hospital for a week in the absolute worst pain I have ever felt (surgical complications and my tube wasn't draining properly. I remember at one stage it had this long ropey bit of yellow stuff in it that I used to manipulate through the tube) in my entire life. So many lovely drugs (that actually don't do fuck all, because the majority of the pain you get from abdominal surgery is caused by the gas they pump into you to open up the cavities and make it easier to get to stuff, and the gas gets trapped and OH GOD IT HURTS but you've not experienced true pleasure until you've been in pain like that and then got in the shower and had boiling water coursing over your back for an hour at a time). I cost the taxpayers a small fortune, I'm sure, what with the little packets of biscuits and the pear juice (because I was constipated for four days). (I even got a private room - yes, my own private room, at a public hospital - for three days of my stay.)

But, y'know, that's okay. Because I've been paying my tax for fifteen years for exactly that reason. And not just for me, I'm paying for everybody else. And my parents and brothers and sisters and nephews and nieces, they've all busted their asses and they paid for my surgery too. I was lucky as hell to get in for elective surgery that quickly, and others aren't. So I'm grateful for the system. I'm grateful I'm not twenty-five thousand dollars out of pocket for something I really had no control over. I mean, that's what tax is for, right? It's for hospitals and roads and welfare and police and fire brigade and ambulances and parks and conservation. It's the price you pay for living in modern society. Sure, you get shitty when you look at your pay packet and, Fuck, look at all this tax!, but then you think about what it's for, and you sort of go Well, I guess I understand it.

If it was JUST ME paying all the tax in the nation I'd probably be pretty upset. But it's everybody. Everybody paid for me, and I'm happy to pay for everybody. And private health insurance can go fuck itself in the face inside of its own ass.
posted by tumid dahlia at 2:56 AM on February 12, 2012 [31 favorites]

Zelnio is moving to Sweden
posted by vacapinta at 3:05 AM on February 12, 2012 [11 favorites]

something something 'kindle fire' ehehehehehehe

jesus
posted by This, of course, alludes to you at 3:09 AM on February 12, 2012 [1 favorite]

I am a 24yo quadriplegic grad student. I own an iPod I bought myself. I can afford to have a nice cell phone. I can afford to buy the occasional new hardcover and put gas in my car. I am excruciatingly fortunate in that my dad has a government job, so I'm still covered by his insurance, because with my health issues there's no fucking way I'd be able to afford the premiums to get my own policy, much less pay off the $1,000,000+ bill (that my dad's insurance covered, thank god) from the hospital stay after my accident.

It's sad that I don't even have to wonder what would've happened if I hadn't had the insurance. I've met people who didn't, who were hung out to dry because insurance costs too much and covers too little so you go uninsured and it's all good until the day you get hit by a car, and then you're screwed seven ways from Sunday because suddenly you're paying out the nose and not even getting all the care and/or hugely expensive medical equipment you now need. The system is broken. It's so broken I can't even express how fucking broken it is.
posted by clavier at 3:10 AM on February 12, 2012 [8 favorites]

I mean shit, my kid's health insurance from United Health is like $110 a month and I guaran-fucking-tee that that bill will be paid. The most I've had to pay at my doctors for him is $35, with most of my visits covered completely.

If I had a kid his health insurance would be nothing and the most I would have to pay at my doctor's for him would be nothing.
posted by tumid dahlia at 3:22 AM on February 12, 2012 [4 favorites]

I mean in what universe is hesitating to take a blue child straight to the ER an "overprotection"?

Because imagine how fucking awesome would it be if the child turned blue but was otherwise perfectly okay?
posted by tumid dahlia at 3:25 AM on February 12, 2012 [2 favorites]

To be selfish about this, my default reaction to these sort of horrible news stories about the awful state of healthcare in the US has changed over the last few years from "Americans are sure stupid, how can they put up with this" to "pleasepleaseplease don't let this happen here".

Because over the last decade succesive governments in .nl have been slowly chipping away at the idea of free/affordable healthcare and insurance.

First the system under which you got healthcare has been changed, from partially government run for the lower paid to a privatised system in which a certain basic amount of healthcare is available and mandatory for all and everything else has to be bought commercially. So you don't have to worry about life threatening illnesses or accidents bankrupting you, but by the same token some more mundane healthcare options are only available if you can afford to pay for them (the majority of dental work for example).

Second, the things that are covered under basic healthcare are looked at year by year and are slowly chipped away at by government review -- birth control being the latest battlefront -- while the premiums have consistently gone up as well as have the copays and own risk.

What I'm worried about now is that the universitality of this healthcare will be the next to be abandoned. Currently insurers cannot refuse to sell you the mandatory package, even if you can't pay or suffer from pre-existing conditions. On both there's some pushback where either people who sponge of the taxpayer should be refused entry or forced to pay their insurance, or people who make unhealthy lifestyle choices should need to pay more.

What I'm worried about then is that as bad as the American example is, this is still what we're slowly marching towards, as politicians worried about costs and insurance companies wanting to up their profit margins conspire to slash at the idea of universal healthcare, with the best of intentions and never admitting to even themselves that this is what they're doing.
posted by MartinWisse at 3:30 AM on February 12, 2012 [6 favorites]

But bragging about you got other taxpayers to subsidize your health care by getting a worthless job with the government that runs trillion dollar-a-year deficits (to be paid off by the children of the people you're fleecing now) is pretty assholish.
posted by c13

As an aside, the person you responded to is a state, not a federal worker.

I originally started this reply with two words, the second of which was "you." Hi. I'm one of those worthless government job holders, currently doing 3 people's work since in 2008 the city I work for cut our departmental budget by 84% (that's not a typo), and laid off most of its employees. We got famous for a while when we started turning off streetlights to save money. We hit the news again not long ago because the streetlights were turned back on. Nobody mentioned it's because we slashed public transportation to uselessness and stopped replacing workers who quit or retired. You and your future fleeced children are fucking welcome for the useless public services we're still managing to provide.

I have a degree. I make a hair over $17,000 a year and receive no benefits at all - not vacation time, not sick leave, and certainly not health insurance. After taxes and making my (mandated by law) contribution to my retirement account, I net a little over $1000 a month. Did I mention the raise freeze? There have been no raises for several years now, and that is unlikely to change for the foreseeable future. The public doesn't think we useless paper-pushing public servants should have it too cushy.


To further depress myself, I went to the United Healthcare site mentioned upthread and pulled the following numbers based on what was asked - my zip code, my age and whether or not I smoke. There were no questions about any pre-existing conditions (of which I have several), so I shudder to think what my premiums would actually be.

Saver80 - $10,000 deductible - lowest premium plan that provides coverage for hospital confinements, surgery, and the more costly outpatient tests. $169.31/month

Plan 100 - $10,000 deductible - A high deductible plan that provides 100% for covered expenses after the deductible. $253.68/month

HSA 70 - $5,000 deductible - Helps you take control of your health care expenses with a tax-favored savings account and quality medical coverage. $343.21/month

Copay Select - $10,000 deductible - A comprehensive plan with a $35 copay for doctor office visits. $245.37/month

HSA 100 - $5,000 deductible - Helps you take control of your health care expenses with a tax-favored savings account and quality medical coverage. $355.15/month

Do I need a job that provides health insurance and other benefits? Damn right I do - but apparently some people are not living in the same economy I am, because jobs with benefits are not all that easy to find...I know, I've been looking for 2 years now.

Take a look at my annual income again, and tell me how I can afford these premiums. I live in a 600 sq foot studio apartment on the poor side of town. I drive a 14 year old car on its last legs. I have school loans I'm still paying off. With the exception of underwear and socks, I buy my clothing at thrift stores. I don't eat out, ever, although I do admit to eating...maybe I could give that up to afford heath insurance. You might though that the $169/month policy doesn't actually cover a visit to the doctor.

One serious illness or hospitalization will sink me, and as I get older, it's only a matter of time before something does. Right now I do what MILLIONS of Americans do, which is simply hope I don't get sick.

P.S.: I was given a Kindle for Christmas. Thanks to all those who explained why that means I don't deserve health insurance.
posted by faineant at 3:34 AM on February 12, 2012 [49 favorites]

^You might *notice* though, that the $169/mo policy, etc.
posted by faineant at 3:39 AM on February 12, 2012

So fucking what if the guy had a Kindle fire - odds are that even if he cut every non-essential expense right down to the bone, he STILL wouldn't have enough money to cover insurance. It's just that fucked in this country right now.

SERIOUSLY.

I married my husband for his health insurance. I mean, I loved him and we were committed to spending the rest of our lives together, but I married him for his insurance. We made the decision to get pregnant and then once we did, we looked into the costs for the birth based on his insurance and mine. Mine had a very high deductible and we could have been on the hook for thousands of dollars. His covered the whole birth, no matter what. And indeed they did. (Had we had to pay out of pocket, the birth - vaginal birth with epidural - would have cost us $15k.)

Before that, I had insurance. I bought it myself. I work in childcare and even full-time positions in preschools very rarely come with benefits. I have epilepsy and need to see specialists and get medications to stay conscious. I've gone without health insurance and racked up thousands of dollars in medical bills. So, when I could afford to buy insurance - I did.

And the only reason I could afford it is that I moved in with my then-boyfriend-now-husband and didn't have to pay rent. What I was paying for health insurance is more than what my rent had been in a 2BR apartment on the "Well, it's not the ghetto, but seriously - lock your doors" side of town. I could only afford insurance - which was over half of my month's salary - because it was my only major expense. I had car insurance, phone bills, student loans, and credit card bills to pay - but without a car payment or rent, I could manage.

Before that - when I was still paying rent - I couldn't have afforded insurance even if I'd sold the iMac that I owned at the time or the iPod (this was in the days pre-iPhone) or any of my other possessions. There is simply no way I would have been able to come up with that much money month after month no matter what I did without otherwise. Granted, I also didn't have kids - but I've been there where the medical bills rack up and there's not much you can do about it because you simply can't afford to get insurance - which, especially with a preexisting condition - is not a trivial expense.

Anyhow. We got married so my husband's insurance would cover our son's birth and we can now afford to put aside money to save rather than shoveling it into the gaping maw of whatever insurance company will deign to sell you coverage with a preexisting condition.

We recently had to take our son to urgent care while we were visiting family in Portugal and man, is that ever a very, very different scene where parents take their kids in early because they're not worried about the bill. (Which, yeah, our pediatrician advises bringing a kiddo in to get checked on right away if a fever goes higher than 103 - but y'know, we also have insurance so...) Another factor in this that's important to bear in mind is that a lot of his story takes place over a weekend wherein an ER would have been his only option - which is, of course, what happened anyway because he tried to avoid it. A simple doctor's visit on Friday would have helped - but on Saturday or Sunday, he would have been screwed no matter what.
posted by sonika at 4:32 AM on February 12, 2012 [3 favorites]

I was diagnosed with cancer and had to be out of work this past summer for a few months. My husband and daughter were on my insurance, which my employer stopped paying its percentage of during that period. It was very expensive. I was lucky enough to receive help from my family, and our day-care provider reduced our costs as well, as I was also not receiving any pay. That's luck. Our system shouldn't be based on whether you have such assets as a more affluent stepmother who's generous or a day care provider that respects your circumstances.

I can't point fingers at anyone on this stuff. Insurance costs tons and people have to make their best decisions.
posted by miss tea at 4:47 AM on February 12, 2012 [3 favorites]

I'd agree that a Kindle sounds like poor decision making because clearly he should've save $50 buying a no name brand ebook reader that handles ebook piracy better. Isn't it obvious that, if your child is sick, then buying books from publishers is immoral when you could download them for free!  I'm doing these shouldas' so well, man!
posted by jeffburdges at 5:30 AM on February 12, 2012 [3 favorites]

Faineant, I'm not really sure what or why you're telling me this. I'm afraid it might be another case of $4000 question.

I guess I'm going to be the asshole who mentions the numerous typos / grammar / usage errors that make me wonder who is paying this guy to write for a living, or who at Scientific American can't afford a proofreader's 10-minute run-through to fix the numerous errors.

As for the health insurance... I think he needs to do whatever it takes to get a job with it, even if it's not his life's dream. It's a shitty choice but in this country, at this time, freelance writing with children, and no spouse insurance to cover them, is really playing Russian roulette. I have a boring paper-pushing state job with good health insurance. I don't make much money, though. But it's a great situation for me (I have many doctor visits per year, and extremely expensive medications). Sometimes you gotta take the lesser job for the health insurance.

Yeah, I think it's pretty assholish thing to say. Also very stupid. If for no other reason than the fact that we ALL can't be paperpushers with good health insurance. Neither at federal, nor at the state level.
posted by c13 at 5:44 AM on February 12, 2012

As long as we're sharing war stories, last month I filled two cavities in my teeth by myself. Bought the tools and the filing material on ebay. Already had a Dremel. So two fillings cost me $50 compared to $180 per filling at going rates locally and I'll be damned if I'll pay that much for a 15 min job. I have two university degrees and an MD. I'm waiting for the residency position so meanwhile no insurance. Not for myself, not for my wife and not for my 4 year old.
But I do have not only Kindle Fire, but also an iPad AND a laptop. I guess I should go sell them and check out openings at the local DMV...
posted by c13 at 6:00 AM on February 12, 2012 [5 favorites]

For whatever it's worth, the author of the linked article, Kevin Zelnio, has seen this thread.

So if anyone else would like to criticize him or his decisions, you can bask in the fact that he'll hear it.
posted by Brandon Blatcher at 6:05 AM on February 12, 2012 [10 favorites]

I noticed that he includes a picture drawn by his son on his Kindle Fire. Now a kindle fire is only $200, but there is part of me that feels like if I didn't have insurance for my son, I wouldn't be buying like a kindle fire

No matter how many times this kind of stuff appears on the internet it remains so astonishingly rude and stupid in its assumptions I find myself boggling each time I see it.
posted by mediareport at 6:07 AM on February 12, 2012 [7 favorites]

And as you laugh, please remember that this is not exactly satire. I know of couples who delayed, or forwent having children altogether because they didn't think they could afford them. He was a moron to think that he'd always have a job that had good insurance - that was plainly unrealistic and I'm here to tell you, that unless you stay in the military or a few other unique situations, there are no guarantees wrt. health insurance.

It staggers me that in America this is considered logical thinking. Forgo having kids? Might as well forgo living; if he took his family and drove off a cliff, then they would no longer have to worry about health insurance, correct? Better do that right away!

I live in Canada, and believe me, I find these kind of discussions even worse that morally appalling; I find them close to insane in their wrongness and in the degree of suffering caused. I can't imagine the degradation involved in having to put off taking a sick child to the doctor because you're worried about what it's going to cost. Good god. You call this a society? You call that a moral choice?
posted by jokeefe at 6:14 AM on February 12, 2012 [7 favorites]

It staggers me that in America this is considered logical thinking. Forgo having kids?

VikingSword was being satirical.
posted by Brandon Blatcher at 6:18 AM on February 12, 2012 [1 favorite]

Brandon, this is why I quoted this bit:

And as you laugh, please remember that this is not exactly satire.
posted by jokeefe at 6:24 AM on February 12, 2012 [1 favorite]

You know, I've been to urgent care clinics here -- when my doctor was on vacation, and it wasn't serious enough for an ER, and though waiting in line to see the receptionist is first come first served, that line is short, and then they do this medical thing called "triage". Is it really different in the US, and they just neglect to do triage? That seems doubtful.

It sounds like he's both irresponsible (for not bringing his kid in after his wife had almost died from pneumonia and recognised the symptoms) and unable to afford insurance which may or may not cover anything if they get sick. If I had an experience where I was insured and still had to pay 2000$ for standard vaccinations for my kids, I'm pretty sure I'd also agree that there's no point in buying insurance which doesn't actually cover anything.

(I also don't really understand how he's paid to write, unless he just threw that one out without editing it. It looks like a first draft.)
posted by jeather at 6:28 AM on February 12, 2012 [1 favorite]

Attributing misfortunes of others to their bad decisions is our way of feeling immune. It's like hearing someone was raped and questioning the neighborhood she was in, her choice of clothes or the time of night she was out.
posted by Obscure Reference at 6:29 AM on February 12, 2012 [14 favorites]

He can't afford health insurance, but he's got hail insurance, life insurance, a kindle fire, and a new set of star wars DVDs to watch.

He also lost his life savings ten years earlier from an ER visit for his wife -- which is also what probably made him a little more reluctant to go to the ER rather than wait-and-see for his kid.

Or was I the only one who wasn't too busy trying to find fault with him and caught that part?
posted by EmpressCallipygos at 6:30 AM on February 12, 2012 [10 favorites]

So if anyone else would like to criticize him or his decisions, you can bask in the fact that he'll hear it.

My intent wasn't so much to criticize his actions (the Kindle Fire is really a nonissue) but a certain kind of unrealistic attitude. I've seen it on Ask Metafilter. "I have a decent office job, but it's kind of boring and I think I'm going to quit and fulfill my dream of running a gallery. Where should I start looking for insurance? Oh, I have diabetes and Crohn's disease, my kid has asthma, and my wife is pregnant." And people have to give this person a reality check. No, you simply can't leave the office job. You are uninsurable, and one medical problem will bankrupt you.

As long as insured and/or healthy people think that this is the kind of society where people are basically free to pursue their dreams, we will continue to have the healthcare system that we have. Another effect: people who do stick with the safe job are derided as unambitious, unentrepreneurial losers.
posted by Ralston McTodd at 6:30 AM on February 12, 2012 [1 favorite]

I live in Canada, and believe me, I find these kind of discussions even worse that morally appalling; I find them close to insane in their wrongness and in the degree of suffering caused.

Yeah, me too. If I fear for my child's health I take them to see a professional, point, end of sentence. Shit gets done, it gets done by professionals, and at the end of the day I have a roof over my head and clean water coming out of the taps, whether my kid needed a full spectrum, aggressive antibiotic regime or a bandaid.

And I'm an entrepreneur; I left my old job to try to start a business, something I could never ever have done if it meant leaving my family's health insurance at the same time. That's the #1 reason that the number of first-time entrepreneurs in the U.S. who aren't under-35-year-old men is close enough to zero to make no difference. This no-national-health-insurance problem doesn't just grind the poor, it's actually crippling the growth of your economy.

You what's even better than not living in fear? Not living in a country where very nearly everyone is living in fear. We're not done, Canada's not a perfect country, but relative to what's available, let me tell you: it is fucking great.

Get your shit together, America, debates like this just don't exist on the inside edges of civilization.
posted by mhoye at 6:32 AM on February 12, 2012 [16 favorites]

My health insurance is the single most expensive payment I have. I insure my wife and myself and my daughter, through my employer. The monthly payment is over a thousand dollars -- that's *after* my employer's contributions -- and is more than a third of my paycheck. I've looked at changing jobs, but it's hard to figure out if its a step up because potential employers don't generally put in the ad whether their insurance costs $500 or $1000 a month, because that's a huge impact on the actual take-home pay. For the people arguing that "just get a job with insurance and everything's good" -- when the cost of insurance has a more effect on take-home pay than the advertised hourly rate, something is heavily lop-sided in our country's priorities. If I didn't have insurance to pay, I could buy five freaking Kindle Fire's a month, every month, and still live my life of luxury.

Another story, which I think I've told here before: Three years ago, shortly after our one-year pre-existing conditions waiting period, wifey, daughter, and I went in and got our shots updated.

For wife and daughter, insurance covers one annual checkup. I'm a guy, and I didn't realize I don't get any checkups covered -- as a guy, my doctor visits needed to be medically necessary. Doctor coded it as "wellness" visit. I was saddled with the entire cost of a checkup and two or three shots, and a bloodtest which said my cholesterol was high.

Three years later, after spending a year unsuccessfully going through proper channels to dispute the "medical necessity" issue and the "wellness" code that caused the insurance to decline, after facing down a judgement and wage garnishment and having made numerous small payments totalling around $150, I settled for $600. Settled: the total bill was near $900. Yes, I got my tetanus and a couple other shots updated, and it cost me over $500, and even with insurance my wife and daughter's visits still cost over a hundred each. Just to get our shots updated, much like the guy in the original post.

I used to work for one of the Blues; one day, at break, the VP of marketing (my boss) was sitting with us, and somebody mentioned universal health, back when it was a discussion point in the late 90s; I, probably unwisely, chimed in that I thought it was a good idea. The VP asked, "well, who do you think is going to pay for it?" Answering that raising taxes didn't go over well. The VP had, for decades, been getting his health insurance entirely free; he'd have to pay more, and pay for other people's insurance, which didn't sit well with him. Of course, without recognizing that the premiums of all our insureds were essentially paying for him to get free insurance, but he wasn't willing to see such incongruity.

Wifey and I recently had a windfall, which we're leveraging to try and eliminate our living expenses in a few years by buying a house. If we can't cut the 1/3-of-my-income insurance expense, the next available one is to cut the 1/4-of-my-income housing expense. Then we might be able to save for the "someday" when one of us needs something more than a shot or two and our medical costs risk bankrupting us. Wifey and I, jokingly, have talked about using our windfall to move to Canada, but that'd be crazy...right?
posted by AzraelBrown at 6:34 AM on February 12, 2012 [3 favorites]

TL;DR. Can't he express this in terms of a sheet of A11with just the bullet points, held up to the camera while he looks glumly into the lens?
posted by Infinity_8 at 6:37 AM on February 12, 2012 [2 favorites]

I noticed that he includes a picture drawn by his son on his Kindle Fire. Now a kindle fire is only $200, but there is part of me that feels like if I didn't have insurance for my son, I wouldn't be buying like a kindle fire

If you (and all the others expressing similar sentiments) think buying or not buying a Kindle has anything to do at all with being able to afford health insurance in america then you are much worse at managing personal finance than the guy from the story. You are likely just lucky that your ignorance hasn't cause you similar or worse situations.

Let's hope that when the time comes that your demonstrated ineptitude in financial matters puts you in a situation like this the people around you won't react like smug assholes and tell you "well, you shouldn't have xxxxx".
posted by patrick54 at 6:46 AM on February 12, 2012 [4 favorites]

I would like to propose a new general rule for all threads dealing with health insurance in the US. To wit:

If you have health insurance provided through your employer, you may not state your cost for said coverage as if it were the entire cost of the policy. All declarations of employer-provided insurance pricing must be inclusive of both employer and employee costs.
posted by Thorzdad at 6:51 AM on February 12, 2012 [6 favorites]

Heartbreaking that a country would rather measure its freedom by how quickly one can purchase firearms than by how many can afford to be healthy and educated.
posted by ttyn at 6:57 AM on February 12, 2012 [10 favorites]

I just got health insurance for the first time in maybe seven years through my girlfriend's job. I'm a full-time student these days and otherwise wouldn't have been able to afford it on my own, but her benefits are fairly generous and I'll be paying roughly a fifth of what I'd pay if I were insured through a different channel. I have a few ongoing medical issues and this is a total godsend.

What I'm leaving behind from my life as one of the uninsured: well more than $60,000 in unpaid medical debt, a number that I ran up as slowly as I possibly could. A lot of that was for emergency treatments that ended up necessary because I'd let things go for too long until I was so sick I had no other options. Some of it's from a multi-day hospital stay this time last year from an abscess on my hand that developed from a spiderbite. It could've been treated had I got it taken care of when it first started looking weird. Instead, I just kind of hoped it'd clear up on its own so that I could avoid shelling out the money to the doctor - money I absolutely didn't have at the time - so I ended up under the knife twice, had the infection spread throughout my body, and topped it all off with a nice case of blood poisoning.

I'm doing just fine financially right now, save for that medical debt dangling over my head. It's not going anywhere anytime soon, though. I receive somewhere in the neighborhood of 6 calls a day from various debt collectors, often more but seldom less. Eventually, I'll take care of it. My girlfriend's aunt is an attorney who deals in financial matters and has offered to help me when I'm ready.

I don't really have a point relevant to the topic on hand, by the way. I just needed to vent a little bit.
posted by item at 7:10 AM on February 12, 2012 [4 favorites]

And I'm an entrepreneur; I left my old job to try to start a business, something I could never ever have done if it meant leaving my family's health insurance at the same time. That's the #1 reason that the number of first-time entrepreneurs in the U.S. who aren't under-35-year-old men is close enough to zero to make no difference. This no-national-health-insurance problem doesn't just grind the poor, it's actually crippling the growth of your economy.

This is key. The takehome from this story should not be that the system is broken—everybody knows that, even if they refuse to acknowledge it—but that his family is emigrating because of this. While nobody should expect masses of healthcare refugees in the near future, it will play on those who have the choice of where to live and a desire for betterment. The poorest will stay stuck, the financially secure won't mind, but the stretched middle will take it into calculation. The US healthcare crisis will be a tax on their economy, and a small but telling drain on their population.
posted by Jehan at 7:20 AM on February 12, 2012 [9 favorites]

Countdown til 'shouldas' arrive - three, t...oh sorry, I didn't see you were already here.

I think examining how the writer manages his money and makes priorities is fair game. I'm self-employed at the moment, and while I live in Canada and have no worries about health insurance, I don't have the kinds of extended insurance coverage that I enjoyed while working in government, such as dental and disability insurance.

I never paid disability insurance too much thought until recently, when it turns out that there may a real chance that I will be unable to work at least temporarily, or even permanently (I'm the sole provider for my family). So, yeah, the shoulda, woulda and coulda's are all running through my head.
posted by KokuRyu at 7:42 AM on February 12, 2012

This is key. The takehome from this story should not be that the system is broken—everybody knows that, even if they refuse to acknowledge it—but that his family is emigrating because of this. While nobody should expect masses of healthcare refugees in the near future, it will play on those who have the choice of where to live and a desire for betterment. The poorest will stay stuck, the financially secure won't mind, but the stretched middle will take it into calculation. The US healthcare crisis will be a tax on their economy, and a small but telling drain on their population.

Every single western country and quite a few non-western countries are looking towards some grave problems because of rising costs of health-care, but in the US, this issue is larger and worse by an order of magnitudes. When people were blaming the president for focusing on health-care "instead of the economy" they were being extremely short-sighted. focusing on health-care is focusing on the economy. If the America doesn't fix the system, the system will "fix" America. Not only because of the growing economic burden in itself, but also because businesses will find it increasingly difficult to operate, and already now, entrepreneurship has bad conditions.
posted by mumimor at 7:55 AM on February 12, 2012 [4 favorites]

Proper grammar and editing for typos would be, I'm sure, foremost on my mind if my son was in the hospital.

15 minutes ago:
Due to complications of fluid around the lungs, we've transfered to great children's hospital 1.5hrs away in Greenville for the best care
posted by qnarf at 8:27 AM on February 12, 2012 [5 favorites]

Oh dear - poor boy, I hope all will be good soon for Kevins son and the entire family
posted by mumimor at 8:31 AM on February 12, 2012 [1 favorite]

The attitudes displayed in this thread? That's why Americans can't have any of the nice things. It's an unhappy, declining, dog-eat-dog nation of citizens brainwashed to think they have it best, when the reality is that its damn near a third-world nation if you're not in the top ten percent. Fuck.
posted by five fresh fish at 8:41 AM on February 12, 2012 [23 favorites]

The attitudes displayed in this thread? That's why Americans can't have any of the nice things.

Maybe Americans can't have 'nice' things because of the lack of thinking skills displayed in this comment:

when the reality is that its damn near a third-world nation if you're not in the top ten percent. Fuck.

Really? That's the 'reality'? We can safely assume you've never been to the third world, but you must have seen a news report one time? Fuck.
posted by amorphatist at 9:03 AM on February 12, 2012

I'm a scientist. Some years ago, my wife had a "cold" for a few days. On the fourth of July, we went to a concert and she said she felt worse. I took her to the ER, thinking it was a waste of time. She had pneumonia, spent days in the hospital, was discharged, got worse again, had to go back to the hospital, finally got better. If we didn't have great insurance, I'm *sure* we never would have gone to the hospital until something really bad happened.
posted by lukemeister at 9:30 AM on February 12, 2012 [1 favorite]

I have been in several third world countries, and it is actually safe to say that some parts of the US, specially in the South, resemble the third world. Not refugee camps in Sudan or the slums of Lagos, but the whole huge "normal" parts of the third world, where most people have some access to services and basic needs are met, but ordinary people are doomed if a tiny little thing goes wrong. And rich people live in gated communities. The difference is, all the countries I have visited have better access to healthcare for those ordinary people than the US.
In the media, the third world - whatever that is today - is always presented as somewhere totally deprived of resources, inhabited by Aids-patients and children with flies in their eyes. This is not the case.
Also, the American poor aren't exactly visible where most Americans live and work. Maybe it is you, amorphatist, who has not been to (all of) America?
posted by mumimor at 9:35 AM on February 12, 2012 [14 favorites]

I'm an American, I have employer subsidized health insurance, and five fresh fish is dead nuts right.

Oh, and I've been to the third world too. In rural Mexico, my wife's birth control pills, which were $40 a month plus a mandatory checkup to get the prescription each year, were OTC and USD$2.50 for a month's supply. In Costa Rica, they have universal health care.
posted by localroger at 9:39 AM on February 12, 2012 [2 favorites]

If we didn't have great insurance, I'm *sure* we never would have gone to the hospital until something really bad happened.

Even if you do have insurance, you will still do that risk/benefit calculation, depending on your overall financial situation, fully aware that you are balancing the health of a loved one with the financial stability of the family as a whole. High deductibles (as well as separate out-of-pocket schedules for uncovered expenses) have a way of influencing you into putting-off medical care unless it's simply unavoidable.
posted by Thorzdad at 9:40 AM on February 12, 2012 [1 favorite]

I am disgusted with the comments made by some ignorant individuals in this thread "blaming the victim". This is a tactic used by know-nothings as a subversive attempt to divert the thread from an intelligent discussion on health care in the US into a barroom brawl. Fox news??

Health care falls under Maslows hierarchy of needs for safety and security. We all have made a social contract with our governments to provide for our basic needs and those of the vulnerable and needy, in order to be in good physical and psychological condition to contribute to our dog eat dog society. In return for these basic needs being met, we pay taxes, obey the laws and go to work each day to support the machine. If there is time and money left over , we can pursue our liberty and happiness.

Societies who have Universal Healthcare view healthcare as a right not a privilege. So why is healthcare not deemed a "right" in US society as education, housing, infrastructure and policing are?
posted by smudgedlens at 10:05 AM on February 12, 2012 [1 favorite]

smudgedlens,

A lot of Americans don't view any of the things you listed except policing as rights.
posted by lukemeister at 10:08 AM on February 12, 2012 [1 favorite]

This thread makes such depressing reading. I think it's a wise move for the guy to move to Sweden.

It really reinforces my opposition to the UK government's attack on the NHS. In England, the only cost is £7.80 per prescription item, and in Scotland, Wales and Northern Ireland even that is free.

Best thing about the UK by a long way.
posted by knapah at 10:15 AM on February 12, 2012 [4 favorites]

Those of you mentioning the ER wait times in Canada: paying for it in the US doesn't get you in any faster. I've had to wait hours to see a doctor in an ER. This was for a head injury. Another time my wife was having a miscarriage. She was doubled over in pain, passing clots and the hospital was more worried about the cleanliness of the floor than getting her admitted. During the ordeal, I was told to keep her quiet as she was disturbing the other patients. This was in the ER. I had to get her vomit bowls. I had to go and ask for everything she needed. They would not give her any pain medication until her doctor showed up, which was two hours. He then proceeded to tell her it really didn't hurt that much, and she was making a big deal out of nothing. Fuck you Baylor Medical Center in Grapevine.

This is one of the things that kills me, we're paying through the nose and get poor care.
posted by narcoleptic at 10:44 AM on February 12, 2012 [9 favorites]

Really? That's the 'reality'? We can safely assume you've never been to the third world, but you must have seen a news report one time? Fuck.

When my wife was pregnant, we were living in one of the little Caribbean countries. Now then, my wife has a Ukranian citizenship, so we were trying to figure out where to go to actually give birth. Well, I had my mom to check up on how much it would be to give birth at Vanderbilt (simply since both she and I worked there). Long story short: Vandy - $18000 just for the birth, assuming no complications and no prenatal visits. 80% of this had to be paid upfront. My wife had insurance, but giving birth was interestingly not covered.
In that tiny 3rd world nation, my wife received weekly ultrasound examinations that started about halfway through her pregnancy (due to a measuring error there was some concern of IGR, which was later proven to be not true). When it was actually time, she was placed in a single room, the nurse that cared for her had only one more patient to look after. In the labor suite, it was only my wife, myself and the nurse present. They only call the doc if they need him. I've done two OB/GYN rotations in the States, so I know how labor tends to happen here. Let me tell you, if we ever have another kid, we're either having labor at home or going back there... For her whole pregnancy, from the very first OB/GYN visit to taking the baby home, my bill was $2300.
My wife's sister had her first one a year earlier. She still lives in Ukraine. Not only was her whole prenatal and perinatal care free, but she also got ~$1500 assistance from the state. That money has to be spent on the child and she must show proof of some sort, but whatever.
So if you were a women, would you rather have a baby in a "first world", "greatest and richest" country on earth, where your health insurance does not cover your most important biological function, and you have to choose between having a baby, putting up a downpayment on a house or getting a college education (well, at least at the time I was in college, $18000 would just about cover it).

A friend of mine from medschool routinely flies to her native Poland for anything from dental care to her heart condition treatment because even with the cost of travel she still ends up paying less than she would here. Oh, and she does have a pretty decent insurance here. Certainly better than what we had..

Oh, and one more funny story. Last time we were visiting the inlaws, my wife went for a dental checkup and cleaning to here regular dentist. She got the guy to check up on me while we were there as well. The guy owns and runs the place, so he got all of his assistants to come and take a look at my teeth. Because they are fairly young and have never seen an actual amalgam filling. They've been using ceramics for years and years, apparently.. Our combined bill (two cleanings and a filling for my wife) -- $100. That's in a pretty high end clinic with plasma TV's and crappy paintings everywhere.
posted by c13 at 10:53 AM on February 12, 2012 [10 favorites]

The difference is, all the [third world] countries I have visited have better access to healthcare for those ordinary people than the US.

mumimor, well, the third world must have improved dramatically since I was last a visitin' two years ago. Which countries did you visit? Why don't the slums of Lagos count? And care to produce any data to back that? Your statement doesn't seem to match publicly available data, but maybe you mean just your subjective impression of the situation?

when the reality is that its damn near a third-world nation if you're not in the top ten percent. Fuck.

And this statement, which you figured you need to jump in to defend, is still absurd.

Maybe it is you, amorphatist, who has not been to (all of) America?

Who has been to "(all of) America"? What does that even mean? Every county? Every post-office?
posted by amorphatist at 10:53 AM on February 12, 2012

For whatever it's worth, the author of the linked article, Kevin Zelnio, has seen this thread.

Awww, and he called us hipsters!

I'll just be over here, waiting for the inevitable rage implosion. I have the "rage supernova preparedness kit*" and I know how to use it.

*It's actually just a gallon of vodka.

PS: The rage I referred to was on behalf of the MeFi members being called "hipsters" and how fond they are of that label, not any rage being felt by Mr. Zelnio - though I'll be happy to share the vodka if he likes.
posted by sonika at 10:58 AM on February 12, 2012

Kevin Zelnio didn't call us hipsters. The guy who alerted him to this thread did.
posted by lukemeister at 10:59 AM on February 12, 2012 [1 favorite]

I'm an American in Germany, and its tragic to watch how some people, when faced with an absolutely horrific situation, instead of trying to fix the situation go to great lengths to demand absolutely heroic feats of themselves and others. As if the horrific situation is normal and the heroic feats are to be expected.

I'm writing in the hope that, as jeffburdges mentioned upthread, more people vote with their feet and decide that, instead of attempting all these heroic measures simply move to a country that doesn't so miserably fail its people and misallocate its resources. If you're educated, you can go anywhere.
posted by tempythethird at 11:01 AM on February 12, 2012 [4 favorites]

tempythethird,

I'd like to think I could go anywhere, but I don't think many countries will allow me to move there and work just because I want to.
posted by lukemeister at 11:03 AM on February 12, 2012 [2 favorites]

If you're educated, you can go anywhere.

Leaving the US is so alien to most of us until we take a leap. My biggest regret is that I did not move my family out of the country years ago; now I have grandchildren and their parents are enmeshed in the work-sacrifice-risk cycle of life in the US ... but ... I still hope to lure them away when I leave next year. Health care is so good in Turkey that it is one of the major 'health tourism' destinations now.
posted by Surfurrus at 11:09 AM on February 12, 2012 [2 favorites]

Let me tell you, if we ever have another kid, we're either having labor at home or going back there... For her whole pregnancy, from the very first OB/GYN visit to taking the baby home, my bill was $2300.

I know of American women who have gone to Mexico to give birth for exactly this reason. They received much better and more personal care for much, MUCH less money. If you look at the infant mortality rate in the US (we're #34! Below every conceivable "first world" country and also, Cuba. And Brunei. And others.)... and with c-section rates rising above 30% in a lot of hospitals... there's very, very little about how the American system handles birth that's worth recommending.

I have an aunt who is a midwife and has worked in Haiti and prefers caring for labor&delivery patients there as women get excellent nursing care and a woman who actually *needs* an emergency c-section can get one in six minutes start to finish because they're not clogging up the operating room with elective c-sections.
posted by sonika at 11:11 AM on February 12, 2012 [3 favorites]

For her whole pregnancy, from the very first OB/GYN visit to taking the baby home, my bill was $2300.

That is beyond the means of the vast vast majority of 'third world' families. I'd wager the infant mortality rate is much higher there too (Are you talking about Haiti (even though it's not tiny), not too many other 'third world' nations in the Caribbean).
posted by amorphatist at 11:12 AM on February 12, 2012

I wonder if it would be possible to get a bill passed which would strip all elected officials of their gold-plated health care coverage, and force them to pay out-of-pocket for it.
posted by maxwelton at 11:14 AM on February 12, 2012 [3 favorites]

I'll just be over here, waiting for the inevitable rage implosion. I have the "rage supernova preparedness kit*" and I know how to use it.

You may have to wait a while as the guy's kid just got worse. Or didn't you notice someone say that in the thread?

Or were you too busy trying to think how to look all cool and shit because you didn't want to let on that you were pissed that someone called you a hipster?

Jesus. Sometimes people really suck.
posted by EmpressCallipygos at 11:20 AM on February 12, 2012 [4 favorites]

lukemeister

Over 6 million Americans have somehow managed, so it can't be that hard.

Educated/skilled labor is in demand all over the place. If you have a graduate degree, even better. Find a job, go to University and then get a job, whatever. I know plenty of people who have done it, and I've done it myself.

Admittedly, if you don't have a University education, then it becomes brutally difficult, and that sucks. But I think an exodus of the educated could potentially be a productive shock to the American political system.
posted by tempythethird at 11:22 AM on February 12, 2012

tempythethird,

I have a Ph.D., but I think my wife and I are old enough that we would soon be financial drains on countries willing to have it. Thanks for the link. Maybe I'm too pessimistic.
posted by lukemeister at 11:25 AM on February 12, 2012

Or were you too busy trying to think how to look all cool and shit because you didn't want to let on that you were pissed that someone called you a hipster?

Read the rest of their comment. ;)
posted by kavasa at 11:25 AM on February 12, 2012

Here in the Dallas area, we've seen a number of patients die in ER waiting rooms, before they've ever seen a doctor. If you ever see a medical professional, the nightmare of insurance has only just begun.

Last time I needed emergency care, I called my insurance company to find out which hospital I should.be taken to. Once there, I verified that the hospital was a preferred provider. After 4 hours, I saw a doctor for 5 minutes, who dozed me full of morphine and told me to see an orthopaedic surgeon, and then released me to drive home w/ severed ACL tendons...and a big ol dose of narcotics in my system. Turns out the *doctor* wasn't a preferred provider, so I got a bill for $1800 for his 5 minutes.

Oh Baylor, your suck is legendary.
posted by dejah420 at 11:25 AM on February 12, 2012 [3 favorites]

That is beyond the means of the vast vast majority of 'third world' families

Indeed it is. That's why for the locals the care is free and they get after birth financial assistance. Since I was a rich foreigner, I got "fleeced".
posted by c13 at 11:26 AM on February 12, 2012 [2 favorites]

amorphatist, since my post there have been several excellent examples, which you seem to have ignored. Mexico? Costa Rica? Little Caribbean Country? Turkey as a destiny for health care? Sonika's post above has a nice link.
Neither Poland nor Ukraine are places you'd like to compare with otherwise, but again excellent healthcare.

But you really don't get it, do you? We have to pay for healthcare in other countries, but for the citizens it is payed for either over taxes or strictly cost-controlled insurance systems. Your problem seems to be that you simply can't imagine a society where the moderately well-off and the rich contribute their fair share to secure a proper system of healthcare for everyone.

I've been to a number of countries, for instance Cuba, Mexico (where I have family), Brazil, Iran, Morocco (which is an extremely poor country, if not as poor as some parts of sub-saharan Africa), Egypt, and many more. I haven't yet been to Asia or Subsaharan Africa, but I have a multitude of friends in both regions, who all assure me my impression is valid those places too.

I'm not taking Lagos out of the equation. I'm just saying that "third world poverty" is not all Lagos, and comparing Alabama or the poor areas of Houston to Lagos won't make sense. But the poor areas of Houston look a lot like those in Tehran, and rural Alabama looks a lot like rural Mexico or Morocco. Where the significant difference is that however much they want to, the governments in those countries can't change the lives of the poor, but they still provide medical care. USA has the resources and the knowledge to change things, but doesn't even provide medical care.
posted by mumimor at 11:29 AM on February 12, 2012 [13 favorites]

I think I've mentioned on the blue or green previously about how I won the lottery. The health care lottery. Because you can have good employer provided health insurance and still end up bankrupt because of medical bills.

I have had health insurance through various jobs for the last 15 years. But I never had any exceptional health issues until 2008, when I was diagnosed with thyroid cancer. That's when I found out to my great joy that my current insurance plan covers 100% of hospitalization, with a co-pay of $50. The job I was at just one year earlier only cover 80% of hospitalization (which I think is still considered pretty generous by most standards). Had I been on my previous insurance plan I would have ended up paying around $12,000 for my thyroidectomy, which would have been a set back, but not ruinous to me financially.

In 2009, I started having common gyno problems (fibroids) that were advanced enough to need treatment. Then I had two major and rare complications from the routine treatment, and over the course of two months I was hospitalized 5 times for a total of 3 weeks, and had 7 surgeries. Six months later I ended up having a hysterectomy and was in the hospital for another week. The total cost of those adventures were somewhere in the neighborhood of $800,000. I had to pay about $3000 out of pocket with my current insurance. But if this had happened at my last job, I would have been responsible for upwards of $150k. Even having "good" insurance coverage.

If you are someone with employee provided healthcare, and you don't feel that the current health care debate really effects you, I encourage you to look at your plan and see how well you would fair in the case of a $500k hospitalization. Because it can happen, and doesn't have to be something like leukemia or open-heart surgery. All it takes is a routine health issue, and a some bad luck. I could have been bankrupted, and it's only by chance that I wasn't.
posted by kimdog at 11:33 AM on February 12, 2012 [8 favorites]

Or were you too busy trying to think how to look all cool and shit because you didn't want to let on that you were pissed that someone called you a hipster?

Jesus. Sometimes people really suck.

I think you misread me entirely. I was kidding. I also don't care about being called a "hipster" and was referencing what happens on the site whenever the word was brought up, not my own feelings.

Also, if you'll read my previous comments, never did I express any sort of victim-blaming or glee at the kid being sick - to imply that I would is not only a pretty hyperbolic mischaracterization of my comments here, but also something that I would classify under the heading of "Sometimes people really suck."
posted by sonika at 11:34 AM on February 12, 2012 [3 favorites]

Oh, and let me tell you how we paid the bill. So it's about 1130 on the day after the delivery, the baby has been checked out, all the shots and stuff given, paperwork done. Nurses tell us bye bye and leave the room. I have to go after them to ask where I need to go to pay the bill. They don't really know, so after a while they finally tell us that there is a window by the ER, I should go there and talk to someone. So I do. The dude behind the glass looks up from his food and says that yeah, I can pay there, but it's no hurry, I can come back any time and do it later. For some stupid reason I insist on paying right then, so he sighs, looks for a napkin and swipes my card through the reader.
Oh, and those weekly ultrasounds were supposedly had to be paid for also, but since the OB/GYN did it right in his office, we haven't paid a single time...
posted by c13 at 11:34 AM on February 12, 2012

I forgot the link! This doesn't compare the US to the third world, I'm sorry. I know I've seen those graphs somewhere, but it'll take a while before I find them. What it does is use strict evidence to examine the quality of healthcare in the US.
posted by mumimor at 11:37 AM on February 12, 2012

lukemeister

You have a phd. Is it for something that's in demand? Do you have another productive decade ahead of you? Then you'd be fine. Two of my good friends are a married couple in their early sixties. They're nuclear engineers and have been living abroad for ages, they recently moved from Austria to new employment in Japan.

I think its just the first step that's hard. And admittedly its harder as one gets older. But I hope my generation, which is currently being shafted especially hard, leaves. Certainly a lot of my friends have, and generally those that have left are having a much easier time meeting the basic requirements of life than those that are still in the US.
posted by tempythethird at 11:38 AM on February 12, 2012 [2 favorites]

Oh yes , infant mortality rate is a good measure. Lets look at that: Wikipedia OK, this is so strange. Where is the US on this chart? Oh yes right behind Cuba, at no. 34. Now if this is the level of ambition for the nation that put men on the moon, because "freedom" is more important than health, I think everyone needs to have an informed conversation.
Specially if one looks at the rate of change: Croatia, a country first beset by a communist dictatorship, then engaged in a crazy civil war, and finally riddled by corruption has nether the less managed to move from a child mortality rate of 108.40 to one of 6.66. Not much, but still comfortably above the US rate of 7.07. Which again has some distance to the top achiever here: Singapore, with an infant mortality rate of 2.60.
Singapore is not a Scandinavian socialist country, but it does provide healthcare to its citizens...
posted by mumimor at 12:24 PM on February 12, 2012 [5 favorites]

And an infant mortality rate is also an indicator of maternal health, of course. Which is partly why the US's rate is so poor: uninsured pregnant women don't get the care they need.
posted by jokeefe at 12:34 PM on February 12, 2012 [1 favorite]

I wonder, what in the model "getting most money out of you while giving you the least possible value per dollar" isn't clear, evident, obvious? It's a Las Vegas game!

You bet the amount you pay for insurance against a contract, but:

1- Will you have enough money to fight in court if the contract isn't respected by the insurance company?

2- Will you die, or suffer mistreatement while the company fights hard not to pay you?

3- Do you know enough about medicine to ascertain wheter the treatement you have received is at least correct or the best possible?

4-How do you know the private company isn't giving 90% less of what you have paid for? Do you think balance sheets always "tell the truth" yet for some reason there's always money for top management and bank, but never enough for you?

5-Do you know why healthcare cost have skyrocketed, yet there's still no definitive cure diabetes, let alone cancer and other of the nastiest deadly stuff?

6-How in the hell do you know you will always enough money to pay for insurance premiums and not find yourself in a middle of street crying for help when they will not listen?

I know why: because you never had some serious health problem, or you are awash with money (for now, who knows what the future holds).
posted by elpapacito at 12:36 PM on February 12, 2012

Really? That's the 'reality'?

Yes, that is the reality. By many metrics, many areas of the USA rank with third-world countries. Some at a state level, others at a community level. That is the sad and frightening reality.

It is a pity you don't know it.
posted by five fresh fish at 12:38 PM on February 12, 2012 [2 favorites]

And an infant mortality rate is also an indicator of maternal health, of course. Which is partly why the US's rate is so poor: uninsured pregnant women don't get the care they need.

To balance it out, on the other end of the scale - insured pregnant women get overcompensated with testing that they probably don't need, endless interventions in the hospital leading to a skyrocketing c-section rate. I had excellent pre-natal care, but I also declined quite a lot of testing and screening and chose to see a midwife rather than an OB because I wanted to focus on staying healthy not on obsessively monitoring the fetus. (The minimally monitored fetus was just fine and actually suffered a bit from the one intervention - placing me on a restricted diet - that I was prescribed. Poor peanut was tiny at birth and had a hell of a time staying warm due to lack of pudge. Nothing serious and we're all fine and healthy now.)

I have heard of oh so many "emergency" c-sections that were the result of pitocin and other interventions in labor that could have been avoided if the mom had been allowed to labor on her own naturally and not placed on a timetable of "must deliver within x hours." I have also heard stories of truly heroic c-sections that saved mom and baby's lives, but those are (thankfully!) fewer and farther between and I'm not sure they were necessarily triumphs of the American system specifically or if they were just evidence of talented medical staff in general.

Our maternal health system is a pretty good indicator of the fuck-itude of the system at large in that it is well and TRULY fucked.
posted by sonika at 12:53 PM on February 12, 2012 [1 favorite]

c13:Just out of curiosity, what country did this take place in?
posted by billyfleetwood at 12:54 PM on February 12, 2012

In all likelihood I have an autoimmune condition, Hashimoto's Thyroiditis. Treating this most likely would require only a daily dose of synthetic hormone. This condition is rampant in my family, including but not limited to a paternal aunt and my younger sister. There is an outside chance, as ever, that this could be cancer or something else. It's also possible that my thyroid is so damaged that removing it would be a good idea. In other family members, discovery of this disease led doctors to be amazed that they could function in any way.

My yearly exam was done at Planned Parenthood this year because that's what unisured, employed 18 hours a week me could scrape up enough cash for. I mentioned all of the problems I'm having (weight gain, dry skin, depression, tired all the time, a long long list.). The NP said she was sorry, but is not permitted to order the tests you would need, which is an antibody detection. She could order the basic thyroid test, but my physical presentation "suggests" I haven't sustained "enough" damage to my thyroid to show up on that test. I need the diagnostic big guns. I still have "some" hair left on my outer eyebrows. My unexplained weight gain has brought me up to just about inside the normal range for my height. I can, you know, walk and stuff. If these symptoms were more severe, she might be able to do something. But anyway, she's not really qualified to treat the problem. Especially, she said, if it's cancer.

I found a way to order the lab tests online without seeing a doc first. So I'll be able to bring the results in for my first visit. This will, theoretically save me an office visit, the attendant exhaustion of a day on public transportation (I'm not irresponsible enough to be trying to keep up with a car, or making a choice between groceries and car insurance payments), and of course, a doctor bill. I'm waiting to find a doctor that I can afford, which is really tough. Most medical folks won't (can't) tell anyone over the phone how much anything costs, because if you need something more serious then you might sqwauk about the increase, also so the above about uninsured paying more, generally, than insurance companies pay. It's called "rack rate" and I'm not even kidding, insurance companies negotiate this, or rather, they send the doctor a list and say, this is all we'll reimburse, and you can only send a bill to your patients for $xx over what we'll pay. So, if the procedure takes $1,000 worth of doc resources, and the office can only get $550 from the ins company + patient, of course they're going to look for that money....from other patients. I get that. I really do. But yes, the insurance system is well and truly fucked.)

If this is "just" Hashimoto's, I'll start on the medication and all will move along merrily and maybe my horrible horrible depression will begin to dissolve. If it's cancer (sure, it's probably not, everybody keeps saying), I've lost a year because the weight gain was 12 pounds in a month, well, a year ago despite no change in my lifestyle/diet/exercise etc. Sure, Turning 29 might have done it. So sure, it's probably not cancer. But I hate living in a country where I have to keep telling myself that. I don't work enough hours to qualify for any of the state aid that I might get if I just quit my job and let my friends or the food pantry feed me, but then where would I live if I couldn't pay my tiny rent? As it is, I've chosen to spend a load on psychiatry and medication for severe depression because that shit could kill me much faster.

Count me among the number that would absolutely take a full time health insurance job if I could find one, despite that I am so depressed I can hardly drag myself out of bed on work days, and often don't bother on not-work days. I'm not sure I could keep such a job for the (usually) year long "trial period" that precedes benefits, but dammit I would try.
posted by tulip-socks at 1:22 PM on February 12, 2012 [6 favorites]

Billyleetwood, it was in St. Maarten. The island is divided in two parts, one side is French, the other Dutch. We lived about half a mile from the "border", on the Dutch side. But for labor we went to the French side, because children born there can get French (and EU) citizenship if they want when they turn 13. The thing is, anyone that lives on the French side is eligible for free care at the hospital and then financial assistance after the baby is born. We didn't know about it at first, so we named our correct address and ended up having to pay for some of the care. But in reality, we could've said whatever, no one checked anything. Besides, they know right off the bat that we were foreigners. BUT, and that is what kills me, even the foreigners living on French side receive free care. And this is in a place where the locals live pretty much by 3rd world standards.
We were half joking about next time spending the 3rd trimester on the island. Even living in a hotel will still cost less than having a baby here. But as I mentioned above, after spending 6 weeks in a Chicago and NY OB wards, I'm pretty sure we're going to end up doing something like that.
posted by c13 at 1:26 PM on February 12, 2012

I found a way to order the lab tests online without seeing a doc first. So I'll be able to bring the results in for my first visit. This will, theoretically save me an office visit, the attendant exhaustion of a day on public transportation (I'm not irresponsible enough to be trying to keep up with a car, or making a choice between groceries and car insurance payments), and of course, a doctor bill. I'm waiting to find a doctor that I can afford, which is really tough. Most medical folks won't (can't) tell anyone over the phone how much anything costs, because if you need something more serious then you might sqwauk about the increase, also so the above about uninsured paying more, generally, than insurance companies pay.

I saw a whole thread on Facebook recently which consisted of my underemployed/unemployed friends talking about ordering tests for themselves because they can't afford physicals. From what I've heard, these DIY test places are a growth industry because of people like you. It's cool because I know so many people who have benefitted, people who might just not have seen a doctor because they were afraid, but it's also kind of scary. I moderate a health Q&A community and I'm constantly having to delete potentially unsafe DIY medicine stuff.
posted by melissam at 1:38 PM on February 12, 2012 [2 favorites]

[Please feel free to go to MetaTalk if you'd like to complain about moderation or defend your right to call people assholes.]
posted by jessamyn at 1:38 PM on February 12, 2012

This has been posted before, but is always relevant - Hans Rosling on "The Developing World"
Naturally, if you don't think USA has development issues, it won't be interesting
posted by mumimor at 1:39 PM on February 12, 2012

I remember when I picked up an infection in Nepal and by the time I got to Thailand I was wheezing and bringing up great gobs of green mucus. I went to Bumrungrad (*) hospital and got a complete checkup plus chest x-ray for $20. And before you start thinking that it was some sort of grass-thatched third-world barefoot clinic, let me say that the foyer was like a nice hotel, the building was massive, and the equipment I could see was easily advanced as a US or Australian hospital. I had nurses fluttering around me and everyone I met spoke English. So that was $20 for a walk-up patient. I didn't even bother claiming it on my insurance.

In contrast, I pay hundreds of dollars for travel insurance when my family visits the USA, I have a co-pay of hundreds more, and I still don't know how to get seen by a GP if anyone in my family is unwell. The last time I tried I was reluctantly given an appointment some days in the future and advised to visit the ER if it got more serious. Did you know that travel insurance is priced according to the country you're visiting? Travel insurance for the USA is enormously more expensive than for anywhere else. It's not because you guys get better health care.

(*) The taxi driver pronounced it "bum lung lad". Best possible name for someone in my condition at the time.
posted by Joe in Australia at 1:53 PM on February 12, 2012 [3 favorites]

What a lot of people don't understand is that getting medical care is not like going to the store and buying donuts. We're not talking about the difference between Entenmann's and Tim Horton's or generic Wal*Mart brand donuts. Medicine is an industry where business acumen, office staff, and all kinds of connections affect a doctor's ability or willingness to negotiate better health insurance payments for themselves. There may be a different rate for every single procedure for every single payor. And I don't just mean, "I have United, what's my copay."

No. I mean, every insured group is also negotiating (or not) with the insurer for the "best" available "plan" so some groups (larger group/younger members/better connected) have better rates, smaller copays, less out of pocket cost permitted than smaller/sicker/older groups. So stories about "I have United through work and they are awesome" may conflict with "well, I have United through work and they never pay anything and my deductible is $25,000 and even then they only pay 25%." Insurance companies (I know, I'm a total broken record on this here) do not make profits by paying claims.

So of course you can't call an office and say, "how much is a well baby visit?" Or, "my kid is coughing and saying it hurts to breathe. If I bring him in, how much is that going to cost me?" Because not only do they need to assess your kid to figure out why it's difficult to breathe (swollen throat? fluid in lungs? lots of mucus in the sinuses? something else?) and then what kinds of tests might be necessary to confirm a choice of treatment. The person answering the phone has no idea.
posted by bilabial at 2:07 PM on February 12, 2012 [3 favorites]

Really? That's the 'reality'?

Yes, that is the reality.

Stats please?
posted by amorphatist at 2:24 PM on February 12, 2012

But you really don't get it, do you? We have to pay for healthcare in other countries, but for the citizens it is payed for either over taxes or strictly cost-controlled insurance systems. Your problem seems to be that you simply can't imagine a society where the moderately well-off and the rich contribute their fair share to secure a proper system of healthcare for everyone.

My problem is with false assertions along the lines of: "when the reality is that its damn near a third-world nation if you're not in the top ten percent."

This is complete bullshit. Take somebody in, say, the 85th percentile here, and compare their access to health care with the third world. Data will resolve this issue. As for the above mudslinging ("can't imagine a society...") not only can I imagine such a society, I lived in one for decades, and it was good. I also advocate cost-controlled universal healthcare for all in the US, with the wealthier contributing more via progressive taxes.

But don't let the fact that you're full of shite on the actual assertion we're discussing stop you from slinging that mud.
posted by amorphatist at 2:33 PM on February 12, 2012

No matter how many times this kind of stuff appears on the internet it remains so astonishingly rude and stupid in its assumptions I find myself boggling each time I see it.

Jesus, seriously. It puts me in mind of a period of unemployment I went through. People threw tantrums because I had things like a computer and an iPod and we have a decent car. All things I was in possession of BEFORE I lost my job. Broke-assed people can't ever have nice things, you have to get rid of them the second you become broke-ass! Fuck me sideways, some people.

I've been in a position similar to Zelnio's. I'm profoundly grateful that my kid's issue wasn't life threatening, but it was still pretty scary and ended up costing a bundle. Selling my iPod and computer wouldn't have even spit in the general direction of paying the ER bill, let alone affording even crappy insurance coverage for the 6 months we went without it.
posted by MissySedai at 2:41 PM on February 12, 2012 [6 favorites]

And by 'third world', I don't mean Cuba. I mean what is commonly meant by that term, the least developed nations in the world. Compare the 85th percentile here with folks in Bangladesh, Sudan, Somalia, Ethiopia, Congo etc, and tell us with a straight face if they have the same access to health care as the 85th percentile American.
posted by amorphatist at 2:42 PM on February 12, 2012

Amorphatist, OK, dude. We get your point. We don't have starved two year olds laying in the street being eaten by vultures. Things are not quite that bad.
But do you get the point that just the fact that we're arguing over where exactly among 3rd world countries citizens of self proclaimed richest, most powerful, most free, most righteous country in the world is fucked up?
posted by c13 at 3:04 PM on February 12, 2012 [3 favorites]

America! Fuck yeah! Where, if you're in the 85th percentile, it is totally not fair to compare your conditions to the third world!

America! Fuck yeah!
posted by secretseasons at 3:09 PM on February 12, 2012

Heh.. The world's gonna hear the roar of our engines as we rocket past Costa Ricka and Dominica in WHO Health system ratings. Eeeehaaaow!
posted by c13 at 3:13 PM on February 12, 2012 [2 favorites]

armorphatist, you are now officially on the edge of your argument. You are changing the definition of the third world to the level of Fox News, and by doing so, you are lowering the level of argument to something like: US healthcare is excellent because it is better than in Bangladesh. Wow, yes. US healthcare is better than in Bangladesh, but as stated above, the quality of healthcare has improved less in the US over fifty years than it has in Croatia. Actually, if you measure by improvement of infant mortality, healthcare in Bangladesh has improved more than in the US.

"Third world" is a strange term, and it has in many ways lost its meaning since the end of the cold war. But within this debate it is very interesting to see how many third world countries have improved the conditions of life for their citizens during the last 20 years, while US citizens have seen a steady decline. In that context, I can understand why one would like to redefine the term. Now "Third World" can't include Cuba or Brazil, because these countries have healthcare-systems that are being studied across the globe. In Brazil, the improvement of healthcare, education and social security has resulted in an explosive overall growth.

Do you really want the US to be compared with Bangladesh and Somalia, rather than Singapore and Canada? Is it acceptable that Mexicans have better access to healthcare than Americans?

To get back to the point: you don't seem to realize that in some parts of America, there is extreme poverty: here are some charts. In these areas, vultures may not be picking the dead babies, but people are dying from third world ailments like hunger, cold, simple infections, childbirth etc. Officially, the people here have access to healthcare, but that is not how practice works.
Because practice is what Kevin Zelnio described: a world of fear and hesitation and lack of knowledge. And anyway, the healthcare provided for the poorest Americans is nothing close to what is happening at the other end of the scale. After accumulating a load of debts going through medical school, doctors will naturally compete for the best jobs. Look at the stories up-thread of doctors who misread symptoms.

The stupid thing is, the US would be right up with the best, if it took care of its weakest. A lot of the extra costs of healthcare in America can be attributed to the fundamental unwillingness to accept the reality of cost-sharing. American taxpayers pay a lot for people who turn up uninsured at ERs and never pay for whatever treatment.

Now you say you have lived in a country with universal healthcare and that you support that system in the US. So actually, we agree. What we don't agree upon is the state of poverty in the US. And here, I must return to my original statement - maybe you need a road trip or several. That was how I learnt it, and I was shocked. I had no idea.

In the same vein, when I read Mr. Zelnio's story, I was shocked by how close the middle class is to this state of poverty. I had no idea. I believe his and several other posters statement that it is impossible to pay rent and be insured at the same time. I can check the insurers' websites as well as anyone. I can see what a young academic's salary is. This is fundamentally wrong
posted by mumimor at 3:29 PM on February 12, 2012 [10 favorites]

To get back to the point: you don't seem to realize that in some parts of America, there is extreme poverty

You didn't come to that conclusion based upon anything I wrote. I am fully aware that there is abject poverty in large swathes of this country: For eight years I was a Big Brother to a kid with a schizophrenic mother with six children by six fathers, four of whom were in jail, so I'm more aware than most how bad things are for the less fortunate amongst us.

Putting on my Captain Obvious hat... when making arguments for change, we undermine our case when we use hyperbole to the point of absurdity. If the numbers had been reversed, and the assertion that for the bottom 10%, the situation is comparable to the third world, fine, roll with that. But it's simply not the case for the bottom 90%.

This is fundamentally wrong

I completely agree. I'm all for all the things you want for this healthcare system here, including progressive taxation to pay for it.
posted by amorphatist at 3:59 PM on February 12, 2012

Maybe you confused me with someone else. I would never claim the proverbial 99% or even 90% were in a third world state. The number of poor in America is something between 8% and 14%, depending on which parameters you select by. Which in my view is an horrendous number.
I wonder why you threw yourself into this argument. Of course some emotional people will exaggerate in a discussion like this, and you are right that in some circumstances it will undermine the argument for change. I just have the feeling that Metafilter ins't really a hotbed of liberal Republicans or conservative Democrats, which are the people who could potentially be influenced by this discussion. The crazy libertarians here will use your valid critique to argue that poverty doesn't exist in the US, and the marxists will see you as a bourgois do-gooder.
Most people with just see you as a person who lacks empathy. I certainly did, and though I have now changed my mind, I'd suggest that your style of debating isn't exactly heartwarming. But who am I to judge? I can be harsh most days, too
posted by mumimor at 4:16 PM on February 12, 2012

when we use hyperbole to the point of absurdity

Except that it isn't absurdity to compare large swaths of America today to the third world. It's not. It's just not. Get that through your fucking skull. I live in New Orleans and travel a lot in the South. I've also visited just about every country in Central America, and my wife has visited sub-Saharan Africa several times and even Madagascar in her birding hobby. We're not Kenya or Madagascar, true, but Mexico and Costa Rica are better than us at providing basic healthcare. That is a fact. Unless you want to make the case that Mexico and Costa Rica aren't third-world countries, your argument is shit.
posted by localroger at 4:26 PM on February 12, 2012 [1 favorite]

Maybe you confused me with someone else.

Mumimor, my original post in this thread was directed at this comment:

The attitudes displayed in this thread? That's why Americans can't have any of the nice things. It's an unhappy, declining, dog-eat-dog nation of citizens brainwashed to think they have it best, when the reality is that its damn near a third-world nation if you're not in the top ten percent. Fuck.
posted by five fresh fish at 8:41 AM on February 12

Maybe I'm a little harsh with garbage assertions: they hurt everyone in the long run, including the progressive cause. This one was utter nonsense, and deserved a slap down. And admittedly, I hadn't had my coffee yet. But still, why let something like that slide, whether it's by Dennis Kucinich or Sarah Palin or anybody in-between?

Of course some emotional people will exaggerate in a discussion like this, and you are right that in some circumstances it will undermine the argument for change. I just have the feeling that Metafilter ins't really a hotbed of liberal Republicans or conservative Democrats, which are the people who could potentially be influenced by this discussion. The crazy libertarians here will use your valid critique to argue that poverty doesn't exist in the US, and the marxists will see you as a bourgois do-gooder.


I hear what you're saying, but I think exaggeration, hyperbole, garbage data, are always harmful, slippery slope, citation needed, etc, etc.. You wouldn't get away with that stuff in a high-school report, why should it be let slide on the blue? There are plenty of other venues on the internet for people to go around making stuff up.

Except that it isn't absurdity to compare large swaths of America today to the third world. It's not. It's just not. Get that through your fucking skull.

Hello localroger. Compare away with your "large swathes", I make no argument against your undefined quantity. You're as entitled to your subjective take as the next poster. But I don't believe it's the case for the original assertion (bottom 90%), but maybe you have some data to back up that case? Apart from "It's just not", which isn't a valid argument even in the third world.
posted by amorphatist at 5:01 PM on February 12, 2012 [1 favorite]

Me (quoted by mediareport): I noticed that he includes a picture drawn by his son on his Kindle Fire. Now a kindle fire is only $200, but there is part of me that feels like if I didn't have insurance for my son, I wouldn't be buying like a kindle fire

Then:
No matter how many times this kind of stuff appears on the internet it remains so astonishingly rude and stupid in its assumptions I find myself boggling each time I see it.
posted by mediareport at 9:07 AM on February 12 [has favorites +] [!]

How is it boggling? I would use the money differently--probably in an emergency fund (even thought that wouldn't begin to cover any serious health care costs).

There are clearly multiple issues at play:
-the broken state of American health care
--which puts people in ridiculously stressful situations where they don't necessarily act in their best interest
-poor money management on the part of Americans (who aren't educated how to do it)
-a situation exacerbated by the opacity of health care pricing and the labyrinth of health insurance options

I'm about as socialistic as they come and believe the only real solution is a nationalized health care system. But we can't overlook our own failings in the current situation (and I include myself in that.)
posted by imposster at 5:15 PM on February 12, 2012

So of course you can't call an office and say, "how much is a well baby visit?"

Er, yes, you can. This is what a consultation fee is and it's how this is done all over the world. I'm astonished to hear that doctors in your part of the world find it necessary to put together some sheet of charges as if they were car mechanics. The way it works in Australia is that doctors are reimbursed according to the length of the consultation, possibly including a bonus for getting people vaccinated or whatever. I'm pretty sure it works this way in the USA too, at least when insurance companies have negotiated a standard rate with the doctor concerned. I suppose if lab tests have to be made then there will be a separate charge for those, but surely if there's any consultation that is standard it is a "well baby" checkup.
posted by Joe in Australia at 5:43 PM on February 12, 2012

Every action and procedure is coded and priced. You plug the ICD9 code and out comes the bill.
posted by c13 at 6:23 PM on February 12, 2012

You plug the ICD9 code and out comes the bill.

It's a good thing nobody needs any specialized knowledge to be able to do this accurately.
posted by one more dead town's last parade at 6:25 PM on February 12, 2012 [2 favorites]

Hello amorphatist. In my personal experience, medical care is so cheap in Mexico that even Mexicans find it readily affordable. I myself had what should have been a $40,000 oral reconstruction done for under $10,000 there back in 2003. Costa Rica has universal healthcare. True, their care for an aggressive cancer might not be up to our standards if you're rich enough to afford our care, but you won't go bankrupt there if your kid gets pneumonia. I understand there's a long list of other third world countries of which this is true. We are far closer toward the middle than the top of the list for infant mortality largely because of this low-end care gap.

I have about the best insurance available to a middle class person and it sucks. Our system can't be fixed fast enough and it won't be fixed until private health insurance is in the same dustbin as monopoly train service.
posted by localroger at 6:35 PM on February 12, 2012

It's a good thing nobody needs any specialized knowledge to be able to do this accurately.

It's a bad thing that a place that employs dozens of people that possess this specialized knowledge everyday to get money from the state and insurance companies for some reason cannot provide any concrete information to the patient. Especially when making said patient sign a from promising to pay whatever the hospital decides to charge.
Gee, I wonder if there is another business that can pull that sort of bullshit and remain viable...
posted by c13 at 6:37 PM on February 12, 2012

Ideally, Joe in Australia, that would be the case in America, but it's just not. There is no such thing as billing by time in most offices. For each insurance company, visits are billed by procedure or diagnosis code. That code does not vary from one insurer to another, it's uniform across the country. The cost however. Boy howdy is it different, not only in the out of pocket to the patient('s parents), but also in the total amount paid by the insurance company.

As c13 says, the ICD9 is important, and that can't be truly known until the patient is in front of the doctor (or MA or NP or PA), because a well baby, or other visit may turn into a bronchitis, or a stool culture, or or or or, well, any number of things.

I once had a nosebleed in a doctors office, and for jamming two cotton balls up my nose (forcibly, painfully, with doctor type tweezers), they billed my (at the time very good) health insurance $300. I hadn't bled on any furniture, my nosebleed had actually mostly wound down by the time the NP saw me. All of my bloody tissues went straight into a BioHazard bag. Just the act of bleeding in the office was costly. My copay (thankfully) remained the same, if I recall correctly. I didn't take up any extra time. And it was actually one of my chief complaints for being there so often, but they'd never seen one in action, so the NP was able to get an idea of volume and that was diagnostically very helpful.

You plug the ICD9 code and out comes the bill.

It's a good thing nobody needs any specialized knowledge to be able to do this accurately.

Oh. Ha. Ha ha ha ha. That was a good laugh. I used to work front desk and billing doctor's offices and managed dental offices. Ha. Ha ha ha. No. You have to have the insurance information in the computer already, coded correctly for...what you're allowed to bill and what they'll pay. Because if you screw up their "usual customary and reasonable" they deny the claim outright...unless your number is too low. Then they pay your lower fuckup number. You have to get the patient pre-approved for whatever is being done. You have to get the claim submitted "appropriately" (on the insurance company's preferred form, there are a variety to choose from) and mailed or emailed or faxed or sent by carrier pigeon, best of luck for you being certain which they actually want. If you have to resubmit a claim, you have to call about it and beg, often. Many doctor offices are finding staffing for this to be...expensive. So so no longer will bill insurance. They collect in full from the patient and then give the patient the information needed to file a claim and get reimbursed.

I agree. This is horrible. But until there is a single payer system, and the price is "the same" for everyone, there will be a hundred or a thousand different costs at the point of service. Things will be itemized. (A friend one had major major post-hit-and-run-accident hospitatlization. He's sometimes joking about wondering whether he'd see a line item for the extra jello he wanted with his lunch but didn't get.) That is to say, until we as a nation start acting like health care is a right and not a privilege, insurers will get away with this crap. (Many people say, well, doctors should just not put up with it. Great. Then they don't get patients who are insured. Some insurance companies will refuse to work with a doctor just because s/he tried to negotiate a better rate, so lots are afraid to try that route. They take what's offered them and they see more patients in a day than they should have to, because the margins are thin. The system needs to be overhauled from the outside at this point.)

It bears repeating: Insurance companies make their money by deciding not to pay, for reasons that are often spurious, cruel, and blatantly illegal. They don't expect patients to fight back. They don't care if the patient has the means to pay, or believed the insurance representative who told them a procedure would be covered. That does not change the fact that the doctor/hospital/staff/etc needs to get paid. Blaming the doctor for not knowing in advance what the insurance will actually send a check for is absurd and unfortunate. When you figure out how to see into the future and know the size of those incoming checks...let me know. I'll make a fortune finding a way to streamline medical billing based on that inside information. Until then, doctors make the best informed guess they can, and put somebody on the hook for it. It's not a good system, I'm just trying to clear up where the problem lies in it, based on my experience both behind the desk and as a patient.
posted by bilabial at 6:56 PM on February 12, 2012 [9 favorites]

Joe in Australia:
...I'm still astonished that USAns fear universal health care. It's like fearing universal education - and yes, I know that that was once controversial.

Well, we all know how universal education is working out in the US.

The Italian, Spanish, Japanese and Canadian co-operative models for insurance, hospitals and clinics might be possible as it can be formed independently by individuals. The Canadian govt has a nice summary of some models here.

Yes, but we've already determined that those models have flaws that we red-blooded Americans have detected and therefore refuse to consider.

...the US would be right up with the best, if it took care of its weakest. A lot of the extra costs of healthcare in America can be attributed to the fundamental unwillingness to accept the reality of cost-sharing.

Are you talkin' SOCIALISM there buddy?
posted by BlueHorse at 12:09 AM on February 13, 2012 [1 favorite]

I lived in Bosnia Hercegovina fir a year, and had two three month stays, I also sent a month in Croatia, both countries have better health care access than the U.S. So does the Republic of Ireland. Dental is separate in both Bosnia Hercegovina and Croatia, people pay separately for prescriptions, but even rather nice rehabilitation centers in lovely places like Vela Luka, are free for citizens. Both countries had horrific wars. For the entire population BiH and Croatia manage their healthcare better than we do in the U.S.
The only reason I have medical care is I am now disabled to the point
that I am on Medicaid for the rest
of my life. During my working years, I had ONE job with insurance 'coverage'. I made so little money at that job that I could not afford their insurance. I was working and supporting two kids. I still had to get partial assistance for my children to have Medicaid. I was not myself covered. Even once I was an insurance agent, I could not get coverage for myself.
I had two ER visits that I had to pay for in those years, I had one ER visit from a bus accident. The insurance of the driver of the car
that rear ended the bus paid that time. My ER bills that I had to
pay were $700, to make sure I wasn't broken. I wasn't. I had a bad IBS flare once where it was just non-stop, several days. I had a nonstop cough and a roaring fever. So I had to get antibiotics and the cough was so bad they actually prescribed codeine. That visit was $800. I was lucky! I was uninsured. Thank God by then I was paid well enough to just flat pay it both times.
I am older now and I really hate what insurance and health costs are doing to our country and our people. It has become a means of social control.
posted by Katjusa Roquette at 3:57 AM on February 13, 2012 [1 favorite]

You plug the ICD9 code and out comes the bill.

I guess it's not terribly surprising that some people think this is how it works. bilabial did a good job already explaining some of the details here.

As a self-insured person it's endlessly frustrating to deal with medical pricing. In fact, the whole reason I know about ICD9 codes at all was the result of an hour on the phone with our insurer trying to understand one of our EOBs.

Weirdly, because the procedures were performed on our 9-month-old daughter, the phone representative refused to explain the item descriptions. The most he would offer was the code itself, and I was advised to "look it up on the internet." Apparently there was a privacy concern with me inquiring about our baby's medical procedures. Yes, I get the privacy angle for older children, but come on... a baby?
posted by odinsdream at 5:46 AM on February 13, 2012 [1 favorite]

"I guess I'm going to be the asshole who mentions the numerous typos / grammar / usage errors that make me wonder who is paying this guy to write for a living, or who at Scientific American can't afford a proofreader's 10-minute run-through to fix the numerous errors. "

He is a blogger at Scientific American. SA doesn't proofread their bloggers' posts, just like MetaFilter contributions don't get proofread before they're posted (but MeFi Mag articles do).

"If you can't afford to pay for your kids coverage with your "consultation and writer's" salary, get another career or at least a second job."

I sense skepticism here, but science writing/consulting is not a well-paid job (see one of my recent AskMe replies to someone about science writing expectations). I don't know what Kevin earns, but it can't possibly be the kind of numbers you're imagining when you hear "consultant". It's not at all the same ballpark as, say, business consulting.

I only know Kevin from attending the same science writing/blogging meetings and having about a hundred or so mutual acquaintances, colleagues and friends, but knowing how close his career is to mine and all these others just makes his story scarier. I don't live in the US, and I don't have to worry about insurance, but now I'm wondering who ELSE I know without health insurance. I always thought it was something that only happened to people without a job at all. Others in the sci-comm community have reacted the same way, and someone has set up a donation page (which I can point people to if you're interested). That's a nice gesture, but the fact that it had to be done, just to keep friends and colleagues out of ridiculous, bacteria-induced debt, is absurd.
posted by easternblot at 8:08 AM on February 13, 2012 [2 favorites]

What percentage of the population is uninsured or underinsured? It may not be 80%, but I bet it's well in excess of thirty. Enough to make comparison to third-world conditions, for damn sure.
posted by five fresh fish at 8:35 AM on February 13, 2012

Zelnio is moving to Sweden

His tweet:

? for swedish/expat twitterati: When you move to a new country, does your credit history move or do you have to reestablish in new country?

Hahaha, credit rating. I think he's forgetting that he's moving to a country that doesn't treat it's citizens like cattle. From wikipedia:

_{Sweden also has a system for credit score. This system aims to find people with bad payment attitude. It has only two levels, good and bad. Anyone who does not pay a requested debt payment on time, and also not after a reminder, will have their case forwarded to the Swedish Enforcement Administration (Swedish: Kronofogdemyndigheten), a national authority which collects debts. The very appearance of a company as a debtor in this authority, will render a mark among private credit bureaus - however, this does not apply to a private person. This mark is called Betalningsanmärkning (non-payment record) and can according to the law be stored for three years for a private person and five years for a company.}

Anyway, it doesn't conclusively show he's moving to Sweden, but rather just thinking about doing so.

My intent wasn't so much to criticize his actions (the Kindle Fire is really a nonissue) but a certain kind of unrealistic attitude. I've seen it on Ask Metafilter. "I have a decent office job, but it's kind of boring and I think I'm going to quit and fulfill my dream of running a gallery. Where should I start looking for insurance? Oh, I have diabetes and Crohn's disease, my kid has asthma, and my wife is pregnant." And people have to give this person a reality check. No, you simply can't leave the office job. You are uninsurable, and one medical problem will bankrupt you.

Are you serious? The point is that no where else in the developed world is that an issue, and the fact it's not possible is reprehensible. And more to the point, this guy didn't chose to quit regular work and become a freelance writer, he had a good job with great insurance when he had kids, and he lost that job. So WTF is he supposed to do? Get a "reality check" about the fact that it's just unrealistic for him to live in the United States? Well, I guess he got the message since he's apparently thinking about leaving. But that's clearly not sustainable in the long run.

Anyway, you're actually wrong besides that. People with pre-existing conditions can get health insurance through state pools as a part of "Obamacare" for now, and in 2014, just two years from now they'll be able to buy insurance (in fact, they'll be required to buy it) through the exchanges, where pre-existing conditions won't be an issue. It remains to be seen how much the insurance people get will suck, though, like whether or not they'll still end up paying through the nose for procedures, since medical bankruptcy in this country often happens to people who have insurance.

amorphatist, since my post there have been several excellent examples, which you seem to have ignored. Mexico? Costa Rica? Little Caribbean Country? Turkey as a destiny for health care? Sonika's post above has a nice link.
Neither Poland nor Ukraine are places you'd like to compare with otherwise, but again excellent healthcare.

Do those count as "third world" or are they more "developing" world?

Compare the 85th percentile here with folks in Bangladesh, Sudan, Somalia, Ethiopia, Congo etc, and tell us with a straight face if they have the same access to health care as the 85th percentile American.

Well, let's see. There are 300 million Americans, and 40 million don't have health insurance. So while an '85 percentile' American has health insurance, an '87th percentile' American does not. But if you're looking at the 85th percentile of those under 65, you're almost certainly looking at someone who doesn't have health insurance. While they could go to an ER and get care if there was something wrong with them, it would cost them a fortune.

The bottom line is that it's ridiculous to claim that the US healthcare system is fine because the WHO ranks it around the same level as Costa Rica, Slovenia, Brunei and Cuba - instead of with other rich nations like Japan, France, Italy, Spain, and so on. But what would happen if you ranked countries only by the care for the bottom 50% or even the bottom 15%? I have no doubt that the U.S would rank much lower on the list.
posted by delmoi at 4:13 PM on February 13, 2012 [3 favorites]

Are you serious? The point is that no where else in the developed world is that an issue, and the fact it's not possible is reprehensible. And more to the point, this guy didn't chose to quit regular work and become a freelance writer, he had a good job with great insurance when he had kids, and he lost that job. So WTF is he supposed to do? Get a "reality check" about the fact that it's just unrealistic for him to live in the United States?

I know people in this thread have very good intentions, but questioning Zelnio's account is just not the same as scrutinizing, say, the lifestyle of someone on food stamps to see if they have "too many" consumer goods or the like. That's because people pretending to be poor to get food stamps is not a real contributor to poverty, but people opting out of shared risk pools because of a "can't happen to me" mentality is a real contributor to the healthcare mess. Did Zelnio make an entirely free choice to opt out? Probably not, but his writing on the subject veers between "couldn't afford it" and "didn't think it would really be a big problem." It definitely sounds like he made the choice to be a freelance writer (which is a choice that I think everyone should be free to make without going into medical bankruptcy.)
posted by Ralston McTodd at 4:44 PM on February 13, 2012

Kevin Zelnio tweeted yesterday: sigh, we are moving to Sweden this spring... guess the US wanted to make sure we'd go there poor
posted by lukemeister at 8:13 PM on February 13, 2012

I commented earlier about being in a similar situation with my toddler in Canada and not having to pay a dime in fees. He just had an asthma attack tonight, combined with an ear infection, that took us to the ER. Actually, it took us to the doctor's office first. The doctor sent us to a nearby hospital's ER, where we were given priority treatment. We were there for a couple of hours, during which we were seen by two nurses, a respiratory guy and a pediatrician. The pediatrician also called our pediatric specialist at home to consult -- and our specialist wants us to call her tomorrow for a follow-up visit.

The hospital had him on a mask with Ventolin, plus they gave us some liquid steroids and amoxicillin for the infection.

The cost to us: $9 for the parking. And that's only because I paid for all night, thinking it was going to be another overnighter, if not more, at the hospital.

I make a pretty good living now, but in the past I was pretty poor because I followed my dreams of being a freelance writer. My health care experience then was just as good as it is now.

Yeah, some of us pay more in taxes in Canada than we would in the U.S. I'm pretty sure it's worth it.
posted by showmethecalvino at 10:28 PM on February 13, 2012 [3 favorites]

TL,DNR version:
Bad parent makes very poor decisions; blames corrupt, broken system. Everybody loses.
posted by Threeway Handshake at 8:57 AM on February 14, 2012

TL,DNR

That was the only part of your snarky comment that is accurate.
posted by localroger at 9:21 AM on February 14, 2012 [1 favorite]

This is not a riposte to amorphatist, since I feel we settled this argument upthread, but when I saw it, I felt this week's Andrew Sullivan Blog view from my window contest was a really good example of an other image of the "third world" than the one we usually get. People are guessing Legoland and Germany. They are wrong.
posted by mumimor at 2:16 PM on February 14, 2012

mumimor, Madagascar is probably not the best example of how the Third World exceeds our first-worldish expectations. My wife travels extensively for birding and spent three weeks there just before the recent military coup. The way she puts it:

Rural Mexico and Central America is definitely the third world; there are no building codes, the wealthy build walls topped by broken glass around their houses, everything is jerry rigged, and because of all this you can live a comfortable life with a phone, cable TV, and small car on a typical income of USD$3,000 a year. But there are mostly good roads, most everywhere is wired with dependable electricity, cell phone service is almost universal (it's quite striking to be deep in a rain forest and have your guide's cell phone ring), and the food tends to be local but also very good because they don't have our economies of scale in that area.

Kenya, which she's visited twice, makes Central America look like the first world. Take a typical rural Kenyan, drop them in Cardel, Mexico, and they'd readily believe they were in America. In Kenya, much of the rural areas aren't electrified, cell service is iffy and people don't have cell phones with the universality that they do in the New World, and even government built toll roads turn to muddy pits when it rains. But at least in the cities they do have first-world amenities, reliable power, and a growing network of internet-connected businesses.

Madagascar, she says, makes Kenya look like the first world. Outside of cities there are hardly any decent roads, and many of those are private; large populations live in mud huts, there is hardly any electricity outside of the cities and even in the cities it's not on 24/7, including their capital. Even wealthy ranchers schedule "generator run time" for a few hours a day so their guests can do the things that can't be done on battery power. Even if you are a rich westerner you cannot hope to indulge in a steak or fine cheese; the country's staple food is rice and there is little else apart from scrawny chickens that have to catch their own food and have little meat on them when you splurge at the restaurant.

As I write this they are getting hit hard by a cat 3 tropical cyclone which will cause massive flooding because of deforestation. It's been reported that the town criers, their principle means of news dissemination since few people in the countryside have even radios, did not warn anyone about the coming storm. Unless you take one more step to some place like Rwanda or Somalia, Madagascar is pretty much a poster child for all the reasons you might want to move to a more modern country.
posted by localroger at 3:51 PM on February 14, 2012 [3 favorites]

Kevin's story is being covered on Wired. Also, here's a National Geographic blog post comparing national health care expenditure to life expectancy. You need to expand the graph to see the USA's expenditure; it's that far off the scale. Short version: the USA pays vastly more for health care and gets worse results.
posted by Joe in Australia at 6:59 PM on February 14, 2012

An Eye-Opening Adventure in Socialized Medicine

I woke up in a rented room in London in the middle of the night, feeling like my eyes had been packed with hot sand and the lids were somehow glued together. When I pried them apart, the whites of my eyes were an angry crimson.

posted by Joe in Australia at 7:14 PM on February 14, 2012 [1 favorite]

I know people in this thread have very good intentions, but questioning Zelnio's account is just not the same as scrutinizing, say, the lifestyle of someone on food stamps to see if they have "too many" consumer goods or the like. That's because people pretending to be poor to get food stamps is not a real contributor to poverty, but people opting out of shared risk pools because of a "can't happen to me" mentality is a real contributor to the healthcare mess. Did Zelnio make an entirely free choice to opt out? Probably not, but his writing on the subject veers between "couldn't afford it" and "didn't think it would really be a big problem." It definitely sounds like he made the choice to be a freelance writer (which is a choice that I think everyone should be free to make without going into medical bankruptcy.)

Why shouldn't people "Opt Out" of a system that's going to try to screw them up the ass at every opportunity? Remember, this guy had insurance, and still ended up paying thousands of dollars for routine, and mandatory, vaccinations. Why on earth would he even want to pay hundreds of dollars a month for something that wouldn't even actually cover the risk.

If you have a good job, you get good health insurance. If you try to buy insurance on your own, you get completely screwed. So demanding he get "good insurance" is basically demanding that he get a good job, which I'm sure he would like to have. even if he was paying hundreds in shitty insurance, he still make the same decisions because the costs could still be huge, up to $10k annual deductibles and stuff like that.

I actually heard about a story about someone in kimdog's situation, where they got a new job and had a horrible medical problem, that their old insurance wouldn't cover but that their new insurance would. Except, the hospital didn't update her information and thought she still had the old insurance. No one realized the mistake, she didn't get the care she needed and died.

But in some people's mind that's a "poor decision" because she didn't know her way around a completely byzantine, arbitrary system.

Bad parent makes very poor decisions; blames corrupt, broken system. Everybody loses.

If only there was a way to antifavorite.
posted by delmoi at 1:25 AM on February 15, 2012 [2 favorites]

localroger, I completely agree with everything you wrote. I think I was too vague in my comment. As stated above, I've never been to sub-saharan Africa, but have several African friends, and an office I worked in when I was young built a skyscraper in Mombasa, so colleagues went there a lot. Right now, one of my students is doing fieldwork in an African country. What I was trying to say was that even in the real third world, things are more complex than "refugee camps and children with flies in their eyes". The upper middle class in most African countries lives very comfortably indeed, thank you, and the very rich are very, very rich. The ratio of very rich to very poor is much, much more skewed than in the US, and the middle class is small, but they exist.
When only about 50% of Americans get insurance through their employers, a lot of people are just a bout of pneumonia or a broken back from moving from middle-class to poor, even if they are insured because of co-payments. Which is why it is relevant to compare the US with developing countries, even though it is still one of the richest countries in the world.

(OT: I never eat western food in third world countries after my first years of experiencing it was consistently what got me sick. No, I lied, I did it last year in Morocco out of politeness and got very, very sick).
posted by mumimor at 4:51 AM on February 15, 2012

Yesterday I had a brief insight into an interesting analogy between US-style health care and that of other civilized countries, that of food.

At home, when you are hungry, you go into the kitchen and you check the cabinets or the fridge, prepare something that will satisfy you, and you take it away and eat it. Occasionally you will go to a grocery and buy food to fill up the larder. When you are out, and you are hungry, you must find a nearby restaurant with a compatible menu that is open and not too busy, check the prices and negotiate for service and exchange money for what is provided immediately.

In the US, healthcare is like always being away from home when you are hungry. Oh, you might have a gift card (PPO) or cafeteria card (HMO), but by and large you must negotiate a purchase every time you need care with all the attendant purchase issues and caveats. And if you haven't money on you, you don't get service like you don't get to eat in a restaurant when you're broke.

In Canada and elsewhere, healthcare is like always being at home when you are hungry. You have a medical need, you seek service, and you leave. Payment is handled indirectly through taxation; you don't have to worry about it. The larder is there for you to loot.

For someone like me who grew up in the US under the "restaurant" healthcare model where there's always a business transaction looming overhead and the fact that if I couldn't pay I wouldn't be served, living as I do now in the "kitchen" model is still startling and shocking at times. "You mean I can just go to the doctor?" "Yes." "No one will ask me for money?" "No." "What about forms?" "There aren't any. Give them your health card. That's it." "What about the hospital? What if I get in an accident?" "Someone will, at some point, ask for your health card so they know who you are." "No one will turn me away if I haven't got any money?" "No."

What if, whenever you were hungry, you could just go into the kitchen and get something to eat? What if, when you were sick, you could just go to the doctor and be cared for?

Why does this seem so "evil" to so many people?
posted by seanmpuckett at 5:58 AM on February 15, 2012 [3 favorites]

I'll just append that even if you're too broke to have something in the kitchen at home, you can still get healthcare here, so the analogy does break down. Homeless guys receive the same standard of care as everyone else.
posted by seanmpuckett at 6:00 AM on February 15, 2012 [1 favorite]