this is why that is important

February 19, 2013 7:11 AM

NSFWCORP presents This Is How You Healthcare: American Death in London by Sarah Bee:

The main things that keep me sane are the airy beauty and peacefulness of the hospital building, messages from friends and family far away on earth, the mundane magnificence of the staff: and the knowledge that all of this is free and taken care of and I do not have to fill in a single fuckforsaken form or bust one precious braincell worrying about how I might have to find money to pay for the futile care of my dying deadbeat dad.

I return to this miraculous fact many times a day, in exactly the same way that I return often to the little visitors’ bedroom, lock the door and curl up on the bed. The knowledge soothes me like clean sheets and heat.

Imagine, I think in the middle of the night. Imagine if I had to worry about that stuff. With what, exactly, would I worry about it?

posted by fight or flight (84 comments total)

Can't read the whole thing. Coming up on the 17th anniversary of my mom's death and sometimes that scar stops being a scar and just opens up all over again.

I'm damn lucky that she chose a family friend who was also a family law attorney as the executor (I was named as co-) and he handled all the insurance paperwork and bills and all. How could I have coped with that in aftermath of her death? I couldn't have. I could barely cope with it when she was alive and not yet sick enough to stop being able to help me with it.

The nurses and aides at the nursing home where she died were so kind. Her doctors were wonderful. If I never have to spend another minute on the phone with an insurance company it will be too soon.
posted by rtha at 7:24 AM on February 19 [4 favorites]

Yeah, I have to say, the state of healthcare in the U.S. is one of the primary things that often makes me want to just get out of here.
posted by adamdschneider at 7:30 AM on February 19 [12 favorites]

Yes, but teh socialism! So, this story is invalid.

I utterly dread the next few years, due to my mother's situation re:Alzheimer's. We're already bashing our heads against a granite wall of figuring how she can afford moving into memory care, while still paying the mortgage on her condo until it sells, while paying to get the condo ready for sale, while the memory care facility drains her meager funds. Add to that, piss few memory care facilities in my area even accept Medicaid. Most are private-pay. We even looked at one facility that accepted Medicaid for everything except their memory care unit. Christ!
posted by Thorzdad at 7:35 AM on February 19 [3 favorites]

, the state of healthcare in the U.S. is one of the primary things that often makes me want to just get out of here.

Be patient. By 2014, after the mid-term elections when he can't be punished for it, Obamacare kicks in full measure and in just a few years after that those British are gonna be asking if they can change the name of the NHS to the National Obamacare Service. You'll see.
posted by three blind mice at 7:39 AM on February 19 [4 favorites]

I watched the opening ceremonies of the Olympics with a bunch of other Americans, and there was open laughter when they spent part of the ceremony with a routine lauding the UK's National Health Service. As Americans, that's theater of the absurd, since we live with the most broken system in the developed world.

All healthcare systems have flaws, but I guarantee the U.S. is never doing a non-satirical song and dance number about the wonders of the 70-layer burrito that is our multipayer private healthcare monstrosity.
posted by mcstayinskool at 7:43 AM on February 19 [3 favorites]

This is too familiar a tug at the heartstrings of those not lost who understand and accept death as an inevitable end. Still there is the experience the actual death where you see much gnashing of teeth and theatrical tears from those who hardly knew the person they morn. Even accepting the natural order there is still a tweak of sadness, not for the deceased but for how your own life has been diminished.
posted by pdxpogo at 7:47 AM on February 19 [1 favorite]

Foreign nationals get free treatment when they’ve been here for a year or otherwise have legal residency.

This, and free emergency care for tourists (even if you're only visiting for the day), is the kind of idealism that still astounds me


here's a story about an American using the NHS as a tourist


(Will Obamacare reduce the amount of upfront wallet-checking and Kafkaesque paperwork for patients? My enduring memory of healthcare as a UK student in the US is being taken by ambulance for what turned out to be an emergency life-saving operation that needed to be done immediately (massve internal bleeding, the ER doctor, who curiously looked liked a very short George Clooney, told me) but first having to listen (while still being in shock from collapsing earlier) to a jaded discussion by the ambulance paramedics, talking over me as if I wasn't there, about why I wasn't actually an emergency case and shouldn't count on this ambulance ride being covered by insurance. It turns out the paramedics (!!!!) were evaluating me for the insurer. I was actually charged full-whack ($400 or $500 for a 10 minute ride) later for using the ambulance for a non-emergency reason. I tried complaining to the university through which I get my health insurance, but was told wearily that they didn't have the time to deal with the bureaucracy and I was on my own)
posted by Bwithh at 7:51 AM on February 19 [2 favorites]

Thorzdad: For the issue of nursing home care, a good portion of friends parents are putting homes in the names of the kids and moving assets around. When the time comes for the kind of care, the nursing home will hoover up every last dime and asset stretching back for the previous five years.
posted by dr_dank at 7:54 AM on February 19 [7 favorites]

It would be more efficient to save the money spent on a dying old man who refused to take care of his health.

Efficient but unkind.
posted by fullerine at 7:54 AM on February 19 [2 favorites]

The promise of health care after I retire is what keeps me at my civil service job. Sure, the pension will be nice, and I like not having to worry about getting fired, but health care is what's really inscribed on my golden handcuffs.
posted by elsietheeel at 7:56 AM on February 19 [1 favorite]

My husband broke his foot while jogging a couple of days in at our last American family visit/vacation. For something so minor, the song and dance at the urgent care clinic made him realize how bizarre and messed up our system is. (We always travel with insurance when out of Canada.) It was a round of phone calls, paperwork, more phone calls--in which I have to say having a South Carolinian receptionist attempt to communicate with a French-Canadian customer service rep was comedy gold--and finally, him getting x-rayed, given crutches and one of those boot thingys after nearly three hours.

This was only for a broken foot. I cannot imagine what would have happened if it had been something slightly more serious.

Cut to almost five months later and we're getting phone calls from that urgent care clinic to remind us to pay up. We had insurance. The problem? They refused to mail the info our insurance company needs to take care of it to Canada. They refused to mail the bill.

I'm sure it will all be worked out in the end--because we are sure as shit not paying for something we had legally covered--but it serves to remind me that my home country's healthcare system is wonky and not a little bit shady.
posted by Kitteh at 8:01 AM on February 19 [4 favorites]

dr_dank...We're well inside the five-year lookback period. It's too late to make those moves. The five-year lookback is a Medicaid policy, not necessarily the facility's.
posted by Thorzdad at 8:02 AM on February 19 [2 favorites]

I cannot imagine what would have happened if it had been something slightly more serious.

The more serious the problem, the more quickly things will actually happen, but the more paperwork and general bullshit you'll have to do afterwards to prevent yourself from getting really screwed.

And 95% of that, at least in my experience, is various people/organizations/companies either refusing or being unable to communicate with each other and thus dumping everything on the patient in the most aggressive way possible.
posted by Kadin2048 at 8:27 AM on February 19 [5 favorites]

As an american working at mcgill university in montreal, I have university-supplied insurance through blue cross. Earlier this year I went to an emergency room, spent six hours doing tests, and ended up getting a prescription which I had to pay out-of-pocket for. I spent about five minutes in the ER talking to the receptionist giving her my health card and info.

Since that night, I haven't heard a single word from blue cross, the ER, or mcgill regarding my ER trip- which I didn't pay a dime for. The only thing I did pay upfront was the meidcation - but I went to the local bluecross office, showed them the receipt, and they reimbursed me 90% of my medication in about 3 minutes.

It shouldn't feel so amazing but it does.
posted by ianhattwick at 8:27 AM on February 19 [13 favorites]

Yes but it's COMMUNISM PLAIN AND SIMPLE or something.

One of our kids got chickenpox in Boston once while we were over from Europe visiting family. We had comprehensive travel insurance from a major provider but still had to pay on a credit card because we didn't have a US office address for the insurer that we could give them. They were still calling my brother and annoying him over some outstanding $10 about 6 months later.

America - your healthcare model is a fucking disaster.
posted by GallonOfAlan at 8:29 AM on February 19 [1 favorite]

My mother had a heart attack four years ago. Her sister was with her, she called the emergency line, and a helicopter landed down the street with medical personnel in less than 7 minutes. She was airlifted to the hospital, underwent heart surgery, but the lack of oxygen to her brain left her in a coma. Irreversible brain damage, no hope of her waking up. She was in one of the best ICUs in the country for ten days until she succumbed (was kindly and mercifully allowed to succumb) to a kidney infection.

Cost to the family? Zero dollars. And by dollars I mean euros, since this was in Italy.

Had this happened in the US? Ha. Ha. Ha.
posted by lydhre at 8:30 AM on February 19 [7 favorites]

Kitteh: you've reminded me of my own broken foot insurance weirdness: My doctor's visit was covered. My orthopedist was covered. But the boot itself?

Not covered.

Well, sort of. The nurse told me that the boot was actually not in my network of service providers. However, my insurance did have an option for out-of-network providers - but that had a $2000 deductible. The boot was going to be $500 if I used my insurance; but the nurse told me they also had different price for people who were not going to use their insurance, which was only $140, and if I chose I could do that instead. I am not able to rightly apprehend why there were these two different price points.

Even more ridiculous - when I was getting my physical therapy, I was a good girl and did my homework to research physical therapists covered by my network, and asked my doctor to recommend one of the ones I'd found. However - when I called them, I was informed that while yes, they were part of my own insurance network, there was a second network that my insurance also required physical therapists to be covered by, one I hadn't even known about, and that they were not part of this second network. So I had to keep looking.

--

A friend's girlfriend has about two or three chronic and rare-ish illnesses. After every doctor's visit, I've been told, she usually spends about two or three hours a day for a solid week afterward sorting out all the different bureaucratic snafus.
posted by EmpressCallipygos at 8:31 AM on February 19 [2 favorites]

Our US healthcare system is the envy of the world.


For values of world consisting of foreign insurance companies. To the rest of the world, our system is completely insane.
posted by Kirth Gerson at 8:48 AM on February 19 [3 favorites]

Friend of mine from the US was in one of the Socialist Yurropean countries and had to go to the hospital. She went back after to pay her bill or figure out arrangements and was baffled when the staff was like, "Billing department? You were sick and we made you better. That's our job." They thought she was joking.

I do miss the health care in Norway, we had some pretty great doctors and every illness didn't bring on a foreboding of "Oh god how will this potentially plunge us into financial ruin."
posted by Ghostride The Whip at 8:56 AM on February 19 [6 favorites]

Be patient. By 2014, after the mid-term elections when he can't be punished for it, Obamacare kicks in full measure and in just a few years after that those British are gonna be asking if they can change the name of the NHS to the National Obamacare Service. You'll see.
posted by three blind mice

Please do tell me more, because even thinking about our insurance system now and the stories in this thread make my heart ache. Is this really possible?
posted by fiercecupcake at 9:14 AM on February 19

My favorite part of hospital billing in the USA is how you get a different bill from every person whose hand you touch along the way, and there is no centralized office that can tell you exactly the sum total of what you owe. I mean I guess we wouldn't want to ruin the suspense.
posted by en forme de poire at 9:20 AM on February 19 [14 favorites]

fiercecupcake: This is a pretty good roundup of what happens and when with Obamacare.
posted by Freen at 9:22 AM on February 19

It would be more efficient to save the money spent on a dying old man who refused to take care of his health.

More efficient if your goal is saving money. Less efficient if your goal is saving people.

By now I am convinced that the NHS – and I hyperbolise, but only slightly – is the greatest achievement of humankind, the nearest we get to a benevolent deity, a goddamn superhero.

I don't like these pieces in general, as they tend to preach to the converted, lord it over less fortunate populations, and worst of all they set the NHS up as a foreign political target when it has enough on its plate domestically.

But, hyperbole or no, I do agree with this: what more noble enterprise could humans conceivably build for each other? Honestly, could anything be holier than the unconditional, prayerless faith that, when the time comes, someone will be there for you? There is not enough spit in the world for those people who work to break it down.
posted by forgetful snow at 9:25 AM on February 19 [15 favorites]

en forme de poire...This is because hospitals are just big boxes for the use of independent contractors. Aside from the nursing staff and, perhaps, a handful of resident doctors, everyone is an independent operator and generates their own billing through their practice/consultancy/medical group/etc.
posted by Thorzdad at 9:27 AM on February 19 [1 favorite]

The promise of health care after I retire is what keeps me at my civil service job. Sure, the pension will be nice, and I like not having to worry about getting fired, but health care is what's really inscribed on my golden handcuffs.

For me too....but my very liberal state has just filed a bill with the legislator that greatly reduces the health care benefit for some retirees in the future and eliminates the benefit for others entirely. You can't be sure that the pension you think you will get and the health care benefit you think you will get will still be on the table when you retire. These are uncertain times.
posted by Seymour Zamboni at 9:33 AM on February 19

forgetful snow: Honestly, could anything be holier than the unconditional, prayerless faith that, when the time comes, someone will be there for you?

Apparently, our government considers war and paranoia to be more holy and money-worthy goals. Universal health care is waaaaaay down the priority list.
posted by Greg_Ace at 9:34 AM on February 19 [3 favorites]

Foreign nationals get free treatment when they’ve been here for a year or otherwise have legal residency.

To really understand how bad American health care is all you need to know is that the workers in the NHS would rather just pretend an American is British and just treat them than try and get reimbursed by their health insurance. Basically they 'ain't nobody got time for that' it.
posted by srboisvert at 9:36 AM on February 19 [9 favorites]

Freen, I had seen that, and I know the broad outline of what Obamacare is supposed to do, but somehow I just can't believe that it will make things any better. I feel like states (I live in Texas) will take the teeth out of any of these measures -- I'm seeing that happen already in bills attempting to put firm controls on exchanges and such (and look at the Texas women's healthcare program).

I just can't believe anything will change and that we won't still be fucked, but we'll be fucked while our leaders pat themselves on the back about having done something.
posted by fiercecupcake at 9:38 AM on February 19 [4 favorites]

Two ER visits a week before my health insurance kicked in at work: $10,000. One was to have a pain in my abdomen checked out and the other was a recurring back problem. I was in for a total of 5 hours for both visits.

$10,000

I just dropped my family coverage (me, wife and daughter) because it was costing more than my mortgage ($845 per month). Last week I was cleaning out some old papers and found a pay stub from 1991. My weekly deduction for health insurance was $13.

$13

The even bigger kicker? I work for an insurance company. Fucking LOL. This shit could write itself. I do have LIFE insurance so we will be using that instead. Sure, I'll never be around to see my wife and daughter benefit from it but hey, it's something.

We've been fucked and are getting fucked harder and the fucking will not stop.
posted by KevinSkomsvold at 9:38 AM on February 19 [13 favorites]

Thorzdad: Yeah, I mean I understand that, but I also don't see why the independent contractors shouldn't have to at least carbon-copy some hospital administrator so at least one person knows all of what's going on with a particular patient. (Frankly I don't see why a lot of things about US health care but that's a separate story I guess.)
posted by en forme de poire at 9:40 AM on February 19 [1 favorite]

You can't be sure that the pension you think you will get and the health care benefit you think you will get will still be on the table when you retire. These are uncertain times.

Oh I'm aware of that. In general, they only change the pension and benefits for future employees. They'd have to negotiate to change what I already have and the union would vote and blah blah blah. It's definitely possible, but pretty unlikely.
posted by elsietheeel at 9:42 AM on February 19 [1 favorite]

We've been fucked and are getting fucked harder and the fucking will not stop.

But according to the timeline above:

Tax credits to help the middle class afford insurance will become available for those with income between 100% and 400% of the poverty line who are not eligible for other affordable coverage. (In 2010, 400% of the poverty line comes out to about $43,000 for an individual or $88,000 for a family of four.) The tax credit is advanceable, so it can lower your premium payments each month, rather than making you wait for tax time. It’s also refundable, so even moderate income families can receive the full benefit of the credit. These individuals may also qualify for reduced cost-sharing (copayments, co-insurance, and deductibles).

So there, Obamacare to the rescue (if you happen to be a tax attorney)!
posted by ennui.bz at 9:44 AM on February 19

In the US, if a person wasn't rendered homeless by mental issues resulting from war, or a foreclosure, they likely lost everything to medical bills. Once you are actually homeless for awhile you can get some health care. Once I was 'officially' homeless, which can be 'couch-surfing' with friends, it was in my situation, there is probably more help, than is available for mothers of small children. I know because I've experienced both.
There is NOTHING comprehensive and understandable in our country.
I can't stand how stupidly an illogically it's all arranged.
A drunk or a drug addict gets better care than a mother of small children, and may well see less judgemental attitudes along the way.
Good health care and social services are a 'must' for a really civilized society, and right from the begining.
posted by Katjusa Roquette at 9:45 AM on February 19 [3 favorites]

In general, they only change the pension and benefits for future employees.

In my state they are changing it for current employees--even me--and I am only 4 years away from being eligible for retirement (quite early, granted, but still). But yes, the bill has not passed yet. But it was the liberal Governor and the democratic dominated legislature that developed the parameters of the bill together. So I think it is a done deal. And FYI....I am talking about Massachusetts!

The thing about Obama Care is that it doesn't fundamentally change our screwed up system. But it does give access to those who never had access to the full glory of our screwed up system. So I guess that is progress.
posted by Seymour Zamboni at 9:48 AM on February 19

Health Insurance Exchanges in Illinois will be opening for registration in October and allegedly fully functioning by January of next year. We are waiting to see how this all pans out.
posted by KevinSkomsvold at 9:53 AM on February 19

I live in the UK. The NHS has its faults, but I would never, ever move to America - and one of the main reasons is its health care system sounds absolutely terrifying - utterly barbaric and evil.
posted by lucien_reeve at 9:58 AM on February 19 [7 favorites]

Like, when I hear people from Western Europe (I'm including the Uk here, whatever) or Canada talk about wanting to move to the US, I can't even believe it. Why would you do that?
posted by adamdschneider at 10:02 AM on February 19 [1 favorite]

I live in the UK. The NHS has its faults, but I would never, ever move to America - and one of the main reasons is its health care system sounds absolutely terrifying - utterly barbaric and evil.

Unless you were a millionaire. I mean, the US sounds like a great place to be rich. It sounds like a nightmare to be poor.
posted by Jehan at 10:03 AM on February 19 [6 favorites]

Despite its flaws and scandals, the NHS is cherished today as the most popular British institution in the UK, more so than the monarchy or the military:

The NHS beat both the monarchy and the Olympics to take gold in the patriotism stakes, as Ipsos-Mori's polling for British Future's new State of the Nation 2013 report, published today, shows. The army ranked second, when pollsters asked people which institutions made people proudest to be British, with Team GB taking bronze, nudging the royals off the podium altogether.

"The NHS was most popular with Britons from all backgrounds, being top for both white and non-white Britons, and across social classes, though the oldest segment of the population put the monarchy first, and the under-24s the army.

Seventy two per cent of people declared the NHS to be "a symbol of what is great about Britain and we must do everything we can to maintain it" while one in five (21 per cent) saw it as "a great project for its time, but we probably can not maintain its current form"."
posted by Bwithh at 10:04 AM on February 19 [2 favorites]

I live in the US, but my long term retirement plan is to get the hell out of here and go live in New Zealand, because there's no way any number of Obamacare-style tiny incremental improvements are going to get us a civilized health care system within my lifetime.
posted by Mars Saxman at 10:06 AM on February 19

And of course this is why the current English government want to destroy it and put into place something much more like the US system. (And yes, I do mean English, the NHS is in far safer hands in the non-English parts of the UK).
posted by Coobeastie at 10:10 AM on February 19 [2 favorites]

And of course this is why the current English government want to destroy it and put into place something much more like the US system. (And yes, I do mean English, the NHS is in far safer hands in the non-English parts of the UK).
posted by Coobeastie at 10:10 AM on February 19 [2 favorites +] [!]

There's definitely a scary Tory free market fundamentalist right-wing which is vocally anti-NHS, but most of the Conservative Party can't talk in that way because of the popularity of the NHS. They (and many - if not most - of them, I think, do believe this, it's not just pretence) for the most part think the NHS needs to be saved and it should be done through their market reforms and efficiency policies. Certainly, one can reasonably argue from the left that this is a case of destroying-the-village-in-order-to-save-it (though on the on the other hand, allowing private market-driven provision of healthcare has been part of the NHS system since its beginnings, and Labour did fail largely in reforming the NHS - granted, a huge complex group of organizations that is a management reform nightmare - ; Labour significantly expanded the NHS budget when they were in power under Blair & Brown but didn't follow through with effective restructuring) .
posted by Bwithh at 10:33 AM on February 19 [1 favorite]

Like, when I hear people from Western Europe (I'm including the Uk here, whatever) or Canada talk about wanting to move to the US, I can't even believe it. Why would you do that?

Aside from our fucked healthcare system, I suppose that we have a lot more rights and freedoms we take for granted that other countries envy?

(That's the only thing I can think of that might be it but I honestly have no idea. I fell in love with a Canadian, emigrated, and don't plan on moving home any time soon.)
posted by Kitteh at 10:38 AM on February 19

Coobeastie, I work for an English NHS trust, and deal a fair amount with Welsh patients who need to be treated in Wales.

After several months of delay when someone's been under our care and I've desperately been trying to get them care closer to home, nagging them for a bed, telling them it's not safe to discharge this patient from our team's caseload, I send the bill to the Welsh local health board. There's a bit of back and forth with their accounts team, and I make it absolutely clear we were doing this work because the clinical risk was too high, and all the regulations are crystal clear that they should pay (remember this is someone whose referral they'd been sitting on four months). It got escalated on their side & their director of finance (annual budget £1bn) replied:

"Were not paying. end of"

So Wales is in pretty poor hands, too.
posted by ambrosen at 10:44 AM on February 19

And to give a bit more insight, my wife just had to have surgery. She and the surgeon spent a good year working with Blue Cross to make sure she would have to pay a certain amount, which was, let's say X. They assured us up and down that everything would be okay, we'd only have to pay X, and everything else would be covered and life would be wonderful and sweet. I didn't believe that, of course, and put some money aside.

Because once we had the surgery done, Blue Cross suddenly forgot they said we only had to pay X. Instead, we have to pay much larger amounts and, of course, for all the things they decided (after pre-authorizing them) they weren't going to cover like the anesthesiologist, the hospital, and so on. So now we're wrangling with Blue Cross and all those entities over tens of thousands of dollars and, fortunately, we have documentation. It may take years to sort out.

The biggest bill is the surgeon and he could, if he was an asshole, basically force us into bankruptcy because we owe him a LOT of money. Fortunately for us, his office has really gone to bat for us and is knocking heads together at Blue Cross to help us out. But god, I hate relying on the generosity of the doctor because he'd be fully within his rights to go "Tough shit, pay up" and there'd be nothing we could do.
posted by Ghostride The Whip at 10:49 AM on February 19 [1 favorite]

Oh I'm aware of that. In general, they only change the pension and benefits for future employees. They'd have to negotiate to change what I already have and the union would vote and blah blah blah. It's definitely possible, but pretty unlikely.

Hi elsietheeel, I'm from Wisconsin. The state has been refusing to communicate with my union for two years now--even about the few topics that are still legal for the union to bring up to the state since my governor's hostile takeover of government employment. Negotiations? What are those? The union would vote...sure...and why again would the state have to listen to the union? About anything?

All I'm saying is, don't assume anything makes you safe and ensures you quality health care after retirement, even all the time you are putting in wearing those golden handcuffs.
posted by gillyflower at 10:49 AM on February 19 [2 favorites]

But god, I hate relying on the generosity of the doctor because he'd be fully within his rights to go "Tough shit, pay up" and there'd be nothing we could do.

Well, presumably the doctor realizes that Blue Cross has much deeper pockets than you do. He could drive you into bankruptcy, but it's very likely that the average patient will go bankrupt long before the majority of their medical expenses (esp. for something like major surgery) will be recovered. So it makes sense to pursue the insurance companies.

Most doctors realize that going after patients directly is like squeezing blood from a stone. Unless you are working with very wealthy patients (or doing something that's rarely covered by insurance like certain types of cosmetic surgery) the insurance company is generally the only one with the money to actually pay up.

Not that your doc wasn't a good guy, but their behavior is rational, not necessarily simply generous.
posted by Kadin2048 at 11:03 AM on February 19

I am not looking forward to moving back to America, even though I will be covered on my husband's insurance. In Seoul, where I'm living now, If I feel like I'm beginning to get sick and don't want it to develop into anything worse, I can pop by a local clinic on my lunch break, see a doctor, be treated, and have a prescription for a total cost of less than 30$ and under an hour of my life.

It took me a while to get used to, back home I was only intermittently covered, and definitely wouldn't see a doctor unless I'd been through a solid week of misery.

For my compressed disc related back issues, it's the same, but takes about an hour and a half. I got 12 x-rays done on my first visit to a spine specialist, so that was expensive - about 45$. Acupuncture and a month of physical therapy both were covered by my insurance and only cost me 6$ a visit out of pocket.
posted by nile_red at 11:21 AM on February 19

I'm from Wisconsin.

I'm sorry.
posted by elsietheeel at 11:30 AM on February 19 [1 favorite]

I suppose that we have a lot more rights and freedoms we take for granted that other countries envy?

Like what? I can't think of any, unless you're a gun nut.
posted by adamdschneider at 11:31 AM on February 19 [3 favorites]

Apart from the politics, it's a beautiful text. I've spent a great deal of the last decade in different hospitals while family members died, and the way she describes this is both accurate and poetic. Thanks for the link.
posted by mumimor at 11:32 AM on February 19 [1 favorite]

Like what? I can't think of any, unless you're a gun nut.

Again, it was only a thought not a declaration, ffs.
posted by Kitteh at 11:35 AM on February 19

My favorite American health care story is this one:

A few years back, I was working for a smallish (under a hundred people) locally owned business. They purchased an insurance plan after investigating to make sure that the hospital that was local to almost all the employees was covered.

Some months after the plan was purchased, and after quite a few of us had visited the hospital for one reason or another, we started getting bills that insurance wasn't paying. It turns out that while the hospital was covered by our insurance, the doctors and nurses who were contracted to work there were not. Good times and wacky hijinks all around! And thousands of dollars of bills, but who's counting?
posted by MeghanC at 11:37 AM on February 19

I just want to say as well that the article itself is a beautiful piece. Thanks for posting
posted by Bwithh at 11:43 AM on February 19

If my family and I had had to deal with the vagaries of insurance, forms, debt, extra disaster or extra anything, I suspect we would have proceeded directly to becoming burdens on the system ourselves.

This is why I'll never understand the counterarguments. You always have to pay to take care of people one way or the other. The last resort is always law enforcement. And for some reason in the U.S. its the first resource we want to use.
It's like the problem just goes away. Flush it down the toilet - where is it? Gone. Just "away."
Like we don't have to think about it anymore.

I'm curious what an insurance company would do if you just showed up to pay your bill with a dufflebag full of cash.
posted by Smedleyman at 11:56 AM on February 19 [1 favorite]

Last time I went to the emergency room it was to get an x-ray for a leg that turned out to just be bruised. Total was about $2,000 and about 40 hours of dealing with the hospitals and insurance companies as they sent a dozen conflicting bills over six months. All this for ten minutes of a doctor's time and about an hour with technicians.

It would have been cheaper to fly to Cozumel, spend a few days at a nice resort, and get the leg seen to by Mexican doctors cash-only. Even with the missed days at work we'd still have come out ahead especially if you count the paperwork and stress as an opportunity cost.
posted by RobotVoodooPower at 12:19 PM on February 19 [6 favorites]

Medical science has given us extended life expectancy - quantity without quality in many cases. Oregon has a right to die law. The people who choose suicide usually say they did not want to suffer through a long painful death, and did not want to bankrupt the family for care that could not cure them. Indeed, the US model is wretched.
posted by Cranberry at 1:00 PM on February 19 [1 favorite]

It turns out that while the hospital was covered by our insurance, the doctors and nurses who were contracted to work there were not.

You can run into this even within multi-doctor practices, where some of the doctors are covered under your plan, while the other doctors aren't. How anyone can defend the US medical system as somehow being superior is beyond me. Maybe they're basing their rating on how many BMWs are parked in the reserved spots of the parking lot?
posted by Thorzdad at 1:03 PM on February 19 [1 favorite]

One of the worst things about our system is that it fosters (and/or plays into the existing attitude - probably some of both) an attitude that if you are unable to negotiate the insurance rules and regulations, or can't afford the fees in the first place, then you are a worthless loser who deserves no better than to die in the streets. I can guarantee you that there are many people who will happily point and laugh at you for not knowing that just because the insurance company confirmed that the local hospital was within their plan, that didn't mean that any of the actual doctors and nurses were. And if you haven't done your due diligence by ascertaining ahead of time which hospital offers cheaper care for broken legs/heart attacks/kidney stones/limb reattachments in the case of accidental dismemberment, well, you deserve to have to declare medical bankruptcy because you should have known to direct the ambulance to the correct facility.
posted by rtha at 1:12 PM on February 19 [5 favorites]

Yeah, I wouldn't mind shipping all those people off to Nasty Bullshitopia where everyone is assumed to have an infinite amount of time and attention to focus on such things. Oh, wait, that's here.
posted by adamdschneider at 1:25 PM on February 19

Maybe they're basing their rating on how many BMWs are parked in the reserved spots of the parking lot?

Yes.
posted by TheWhiteSkull at 1:27 PM on February 19

Medical science has given us extended life expectancy - quantity without quality in many cases. Oregon has a right to die law. The people who choose suicide usually say they did not want to suffer through a long painful death, and did not want to bankrupt the family for care that could not cure them. Indeed, the US model is wretched.
This is what I fear most about privatised health care: that people who could have a caring, honorable end of life are feared out of it because of economy. Actually, this is the direct opposite argument of the Palin death panels argument, and it is sad that no one in the US was ready to make it.
At some point, we will all die, and from a decade of sad experience, I am 100% certain that the best way to go is with knowledge and care. And thus a lot of hospital care.
Since I am not in the US, it is not an immediate threat to me, but as stated above, conservatives in Europe have a strange obsession with privatized health care. Even as we all know it is more expensive and less effective.
I think a lot of conservative voters and politicians imagine themselves becoming immensely rich. even when there is no such future in sight. So they don't all care about those "others".
posted by mumimor at 1:31 PM on February 19

The Oregon law isn't just about finances, though I'm sure that could play into it in some cases. My mom is a pretty outspoken right-to-die proponent and while emotionally that is obviously difficult for me to think about, especially since she's getting older and has had some attendant health problems lately, the thought of her in constant and unremitting pain with zero agency is even harder to bear. So I would fully support her decision to make an early exit if that's what she really wants, and I think she should have that right.
posted by en forme de poire at 2:19 PM on February 19

The article presents a sort of false dichotomy. I (in the US) just two weeks ago watched my wife die of cancer, at home under the care of hospice, who came to visit every day, and made me fill out all of *one* form, which hospice's social worker helped me to do. She could have stayed in the hospital if she had liked, instead, but she wanted to go home, where she spent her final 10 days.

It was not a barrage of forms, or uncaring medical workers. While my wife was still in the hospital and able to sit up and speak coherently, at least one nurse bought her coffee with his own money, because it was better than the stuff the cafeteria brought. The obstetrician that delivered our daughter a year and a half ago saw her name in a list of current patients, and stopped by to visit for an hour. Hospice was kind and helpful to my wife and to me and my daughter and to all the relatives that came to help and visit.

Yes, in the end, I had to pay the deductible and co-insurance for her care. It cost about 1/3 of what her burial cost. Our system is deeply flawed, but to watch an English example and declare the American experience to be an abomination in contrast *without ever experiencing it* is disingenuous. The part of American healthcare that is broken is the billing and payment and selective coverage part, not the care part.
posted by tylerkaraszewski at 2:22 PM on February 19 [1 favorite]

So I would fully support her decision to make an early exit if that's what she really wants, and I think she should have that right.

You can't really understand this issue until you've been there. I never had strong feelings on this issue until I watched my wife die. I would have euthanized my wife the day before she died on her own, if I could have. She had no agency left to make the decision herself. For my wife, it would have saved her one day of suffering. For others, it might be weeks or months.
posted by tylerkaraszewski at 2:25 PM on February 19

. for your wife, tylerkaraszewski
posted by sobell at 2:31 PM on February 19 [1 favorite]

My mom died in a nursing home instead of at home with hospice care because I couldn't get the insurance company to authorize hospice care. I probably did something wrong - asked the wrong person, used the wrong terms, something - but I (like you, tyler, I imagine) was exhausted and stressed and alternately numbed out and freaked out, and just couldn't figure out how to do it right. I'm very glad that your experience was different.
posted by rtha at 2:34 PM on February 19

My 87-year-old father-in-law fell and broke his leg Sunday. My wife had to kill her Sunday hauling him to an emergency room, then accompanying him when they transferred him to an ortho center many miles away. She ended-up sleeping there that night, because the doctor was coming in at 6am to talk about treatment, and her father was in no condition to understand or make decisions.

She lost her entire Monday at the ortho center, meeting with doctors and hospital people, to determine his further care and explaining things to her heavily-drugged father.

Today, she's had to lose another half day of work driving across the north side of Indianapolis, looking at rehab facilities in anticipation of his being released Thursday, trying to find one that has room, takes Medicaid, and isn't a complete shit hole. She'll probably have to do more legwork tomorrow, missing more work.

Due diligence!!!
posted by Thorzdad at 2:55 PM on February 19 [1 favorite]

tylerk, I don't doubt that. I'm really sorry for your loss.
posted by en forme de poire at 3:10 PM on February 19

(sorry, that was in ref to "You can't really understand this issue until you've been there.")
posted by en forme de poire at 3:11 PM on February 19

I'm so sorry for your loss, tylerk.

The part of American healthcare that is broken is the billing and payment and selective coverage part, not the care part.

I think that's precisely what everyone here is saying, and precisely what the original article is trying to get at; that the care is often wonderful, but the billing and paperwork is nightmarish, and - especially for a family going through something as difficult as pallative care - no matter how good the care is, you're still dealing with people who are incredibly vulnerable, and who more likely than not are not as capable of dealing with the frustrating complexity of the billing and payment paperwork.

But the care is indeed often stellar. I've always had very good luck with the doctors and the nurses in every health care place I've been to.
posted by EmpressCallipygos at 4:11 PM on February 19

My condolences tylerkaraszewski. But hospice can be very nice, yes. Thankfully we have that some places.

I went through something pretty tough with my child a bit ago and it struck me how good the care was and how insane the insurance was.

And I can't help but see how that seems to be a pattern in so many things in the U.S.
You have this sort of layer where you have genuine caring people on the front line, who are dedicated to what they do. And in the back you have people just sucking money out of that situation any way they can. Setting up huge legal/financial apparatus and infrastructure to do all that.
I argued a bit back from a military perspective on health care.
One of the things that's in the news now is college athletes. It wasn't too long ago, college athletes didn't get health insurance from their school. If you're injured, screw you. And colleges made and make boatloads of money on this.

People forget how doctors and medical staff are exploited and suborned by the system in the U.S. as well. Drug pushers from pharmaceutical companies are all over them all the time. Insurance gives them all kinds of hell.

I, of course, plan to die gloriously fighting some vicious bastards. Hasn't happened yet for some reason.

But our society is weird that way. Many families don't want to live together in the same house. Death is so much a thing apart. Managed by strangers. Followed by mail that has bills in it. Which can ruin what's left of our lives.
Scary stuff. I don't know why we put up with it. What drives someone to stand out with a sign that says "Keep the government out of my medicaid" in protest of universal health care? I have no idea why we should treat getting sick as an economic crime.
Although we in the U.S. call our trips and relaxation time "vacations" because we leave a vacancy in our jobs. I've always liked "Holiday" from the U.K. to describe that.
posted by Smedleyman at 8:22 PM on February 19

I'm so sorry about your wife, Tyler, but glad that you had an effective Hospice who managed her care so well and also managed the associated paper jungle. It's doubly sad that she suffered so much even with good care. I hope you and your daughter can rest now and that your grief will be replaced by warm memories very soon.

Thorzdad: I've had to ask my daughter to take me to the ER on several occasions and she's "lost" days and nights of her own life taking care of me on those occasions, but "hauling" me is not the way she sees it and she doesn't begrudge the time lost from her own activities/work, either; she reminds me that I've lost more than a few days in caring for her, also. I'm reminded by your post how grateful I am for her kindness.

I'm certainly in agreement that our healthcare business in this country is atrocious and out of control on all levels, but I don't see where anyone other than your own family had the responsibility to get your father-in-law moved to an appropriate facility for recuperation. Did you expect the hospital - or the doctor - who set his broken leg to find a rehab facility and have him moved there so your family didn't have to do it? I don't quite get this. I do understand your frustration with the impact of Alzheimer's on the entire family. I wonder what they do with Alzheimer's patients in Europe; surely their medical care is covered and their families aren't bankrupted by the cost of placing the person in a safe facility. With the baby boomers reaching old age, we'd really better figure something out soon in this country.
posted by aryma at 11:36 PM on February 19

And what a beautiful story this was, a good death, a proper death.

Especially this: "They respect life and death equally, and they allow death to take over the second they see that inducing life to continue would be abominable."

Exactly.
posted by aryma at 11:57 PM on February 19

but the nurse told me they also had different price for people who were not going to use their insurance, which was only $140, and if I chose I could do that instead. I am not able to rightly apprehend why there were these two different price points.

Because (a) negotiating with insurance is a nightmare. The insurance company would haggle the hospital down to about $250, $100 of that being would be spent on administration fees. And (b) so the insurance company can claim they are saving money by doing this haggling. or to put it another way:

To really understand how bad American health care is all you need to know is that the workers in the NHS would rather just pretend an American is British and just treat them than try and get reimbursed by their health insurance. Basically they 'ain't nobody got time for that' it.

There are exceptions. If you're taken ill in London and treated by one of the big London hospitals there'll be a couple of people who might have time for that and even then they'll swear sulphurously and unless it's majory surgery they'll probably decide fairly rationally it's not worth it. And you won't get e.g. much in the way of dialysis. But healthcare free at point of delivery is one of the founding principles of the NHS and the doctors and nurses are purposely insulated from any such billing issues. (Also we don't charge per aspirin - it's per hospital stay)
posted by Francis at 6:47 AM on February 20 [1 favorite]

Because (a) negotiating with insurance is a nightmare. The insurance company would haggle the hospital down to about $250, $100 of that being would be spent on administration fees. And (b) so the insurance company can claim they are saving money by doing this haggling.

This wasn't even with the hospital, though, it was with the manufacturer of the boot itself.
posted by EmpressCallipygos at 6:55 AM on February 20

It's strange to me hearing stories of people having to do all the legwork for finding rehab facilities by themselves. In the hospital where I work, there's a social worker who will talk to the family to find out what locations are convenient, then call around to facilities to find one with an open bed that will be covered by the patient's insurance. Many families choose to visit the short-list facilities suggested by the social worker, to make sure they're not awful, so it's a lot of driving and time to spend. But at least we have an expert grappling with all the paperwork stuff. If a patient isn't safe to go back home, they don't leave our hospital until we've found a facility for them to go to. We can't just discharge them without a plan and hope they figure it out on their own.
posted by vytae at 1:41 PM on February 20

July 2011 Palm Springs. Hospital asked $200 to remove one stich. (The other two I had removed myself). Found another clinic which did it for $60 and five pages of form filling.
Cost to diagnose, biopsy and then cut precancerous lump out of leg and insert three stitches (in Spain) Euro 0.
posted by adamvasco at 9:52 AM on February 21

ok here's the NHS (England) official breakdown of if tourists have to pay. most emergency treatment is free for everyone apart from major operations etc. it's up to the hospital to check if you should pay or not

If your country has a healthcare agreement with the UK ( e.g. Other EU countries), everything is covered

(A&E is the equivalent of an American ER)
posted by Bwithh at 10:29 AM on February 21

I just found this article. Wow.
posted by KevinSkomsvold at 1:22 PM on February 21

The $21,000 Heartburn Bill
One night last summer at her home near Stamford, Conn., a 64-year-old former sales clerk whom I’ll call Janice S. felt chest pains. She was taken four miles by ambulance to the emergency room at Stamford Hospital, officially a nonprofit institution. After about three hours of tests and some brief encounters with a doctor, she was told she had indigestion and sent home. That was the good news.

The bad news was the bill: $995 for the ambulance ride, $3,000 for the doctors and $17,000 for the hospital — in sum, $21,000 for a false alarm


Boy, I got off pretty cheap then.
posted by KevinSkomsvold at 1:23 PM on February 21

And how sick is it, KevinSkomsvold, that my first horrible blaming-the-victim thought was "Why the hell did she go in an ambulance? Was there no one to drive her?"

Ugh. That's fucked up.
posted by fiercecupcake at 10:07 AM on February 22

KevinSkomsvold, that is a terrible article. I almost couldn't read it to the end. Actually, I had the exact condition you reference - the heartburn seemingly like something dangerous. I called the local doctor, the nurse asked me to come without delay, offering an ambulance if necessary. At the clinic, I lay for a couple of hours having a cardiogram, and then the doctor came in to explain I was fine, and what the symptoms were about. He suggested I try some over the counter tablets and get back if they didn't work after a week. They did.
Cost for me: nothing. Cost for society, maybe 200 dollars. (it would have been a bit more if they had called an ambulance from 10 miles away).
I've often been tempted to move to the US, because my earnings would improve significantly. But if all the money go to basic healthcare, for huge insurance payments or even larger out of pocket bills, that makes no sense. So I'll stay on in old Europe
posted by mumimor at 11:15 AM on February 22

Btw, last time I was at the ER with my accident-prone daughter, a Latin-American family was there with a child who had broken something. After the child had been treated, they wanted to pay but the staff just said, "we are here to heal not to make money". Officially, the family should have paid, but staff chose to just write it off. I think in countries with free healthcare, and free education, the people who choose to enter healthcare professions are generally less motivated by money and more by other values. Though I did hear a woman on the radio who'd worked in the US for a year and was very inspired by the novel concept of rich doctors.
posted by mumimor at 11:33 AM on February 22