A single payer healthcare system shouldn't have to be a dream.
January 17, 2016 6:49 AM Subscribe
Even Insured Can Face Crushing Medical Debt, Study Finds. (slNYT)
"I Am Drowning": The Voices of People with Medical Debt. (also slNYT)
The Affordable Care Act, signed by President Obama in 2010, protected many Americans from very high health costs by requiring insurance plans to be more comprehensive, but at the same time it allowed or even encouraged increases in deductibles.
I hate the "you're either with us or against us" logical fallacy Democrats have trapped the Obamacare debate in. I dislike the Affordable Care Act. It was a shitty compromise with lots of problems and lots of vital coverage gaps (dental anyone?). It is better than nothing, but it's far from perfect and shouldn't ever have become the final word in healthcare reform.
And now, five years out, we've got the Hillary Clinton campaign accusing Bernie Sanders of wanting to dismantle Obamacare, which is kind of hilarious given that Bernie wants to replace it with single-payer.
posted by RonButNotStupid at 7:15 AM on January 17, 2016 [45 favorites]
I hate the "you're either with us or against us" logical fallacy Democrats have trapped the Obamacare debate in. I dislike the Affordable Care Act. It was a shitty compromise with lots of problems and lots of vital coverage gaps (dental anyone?). It is better than nothing, but it's far from perfect and shouldn't ever have become the final word in healthcare reform.
And now, five years out, we've got the Hillary Clinton campaign accusing Bernie Sanders of wanting to dismantle Obamacare, which is kind of hilarious given that Bernie wants to replace it with single-payer.
posted by RonButNotStupid at 7:15 AM on January 17, 2016 [45 favorites]
I've pretty much stopped going to the Doctor unless it's bleeding that I can't stop myself, or bones sticking out of my skin. I speculate that, with the crappy insurance we have (my wife's a teacher, we're on her plan, which has been cut and reduced to nothing by the Rick Snyder administration's funding reductions to schools), if I were to have a major illness, trying to treat it would ruin my life financially, so, what the hell, why bother....
posted by HuronBob at 7:33 AM on January 17, 2016 [3 favorites]
posted by HuronBob at 7:33 AM on January 17, 2016 [3 favorites]
>Even Insured Can Face Crushing Medical Debt, Study Finds
That's quite the crash blossom headline there. I briefly pictured someone crushing a can with their face.
posted by kcds at 7:34 AM on January 17, 2016 [6 favorites]
That's quite the crash blossom headline there. I briefly pictured someone crushing a can with their face.
posted by kcds at 7:34 AM on January 17, 2016 [6 favorites]
That's the plan, HuronBob. As Kentucky Gov. Matt Bevin is fond of saying, Gotta have skin in the game, or you'll actually use the doctors. We don't want you going to get preventative care all willy-nilly.
posted by filthy light thief at 7:40 AM on January 17, 2016 [10 favorites]
posted by filthy light thief at 7:40 AM on January 17, 2016 [10 favorites]
And now, five years out, we've got the Hillary Clinton campaign accusing Bernie Sanders of wanting to dismantle Obamacare, which is kind of hilarious given that Bernie wants to replace it with single-payer.I mean, I do too, but I'm not sure exactly what the path would be to getting it. Presidents can't do things by fiat. Do you think President Bernie is going to be able to get Congress to go along with his single payer plan?
It's actually really hard for me to see a path to improving this situation at all. Every single thing about our healthcare system is so totally broken. We need to change such fundamental things, and I don't know how you do that, barring some sort of catastrophe that totally destabilizes the entire society. Maybe after the zombie apocalypse, we can rebuild our healthcare system to make some damn sense.
posted by ArbitraryAndCapricious at 7:45 AM on January 17, 2016 [5 favorites]
skin in the game
I hate that phrase. As if the fact that I am in pain and scared because I might not be able to work is not enough skin in the game already. Oh, but physical and mental pain don't count, only financial pain.
posted by cynical pinnacle at 7:48 AM on January 17, 2016 [32 favorites]
I hate that phrase. As if the fact that I am in pain and scared because I might not be able to work is not enough skin in the game already. Oh, but physical and mental pain don't count, only financial pain.
posted by cynical pinnacle at 7:48 AM on January 17, 2016 [32 favorites]
It's my understanding that Rahm Emanuel decided to throw the single payer option on the phyre as a token to get the insurance industry on board and make Obamacare possible. This is enough to incur my disfavor forever.
I think Obama decided to play a long game here, setting things up to give people a taste of single payer (not worrying about pre-existing conditions, and extending medicare quite a bit), to make it more desireable when the insurance industry greed eventually implodes it all.
posted by MikeWarot at 7:57 AM on January 17, 2016 [4 favorites]
I think Obama decided to play a long game here, setting things up to give people a taste of single payer (not worrying about pre-existing conditions, and extending medicare quite a bit), to make it more desireable when the insurance industry greed eventually implodes it all.
posted by MikeWarot at 7:57 AM on January 17, 2016 [4 favorites]
...protected many Americans from very high health costs by requiring insurance plans to be more comprehensive, but at the same time it allowed or even encouraged increases in deductibles.
I had to purchase insurance on the private market for many years pre-Obamacare. I now, of course, use the Exchange. Honestly, the deductibles are pretty much the same. In my experience, a lot of the grousing about high-deductibles seems to come primarily from people who had to jump from employer-provided policies and policies on the exchanges, and don't qualify for any assistance.
posted by Thorzdad at 8:05 AM on January 17, 2016 [15 favorites]
I had to purchase insurance on the private market for many years pre-Obamacare. I now, of course, use the Exchange. Honestly, the deductibles are pretty much the same. In my experience, a lot of the grousing about high-deductibles seems to come primarily from people who had to jump from employer-provided policies and policies on the exchanges, and don't qualify for any assistance.
posted by Thorzdad at 8:05 AM on January 17, 2016 [15 favorites]
As long as someone is trying to profit in this setup, patients will be the losers. The federal government needs to put private insurers out of business. Hell, put state Mediciad programs out of business, too- why is every state reinventing the wheel on administering coverage when the federal government already knows how? Enough waste is enough. Medicare for all.
posted by ThePinkSuperhero at 8:17 AM on January 17, 2016 [46 favorites]
posted by ThePinkSuperhero at 8:17 AM on January 17, 2016 [46 favorites]
As I understand it, the ACA was not primarily about improving anyone's healthcare. It was about slowing the growth of prices in the healthcare sector which had been rising at multiples of the rate of inflation for decades. These increases had been eroding profits in the other sectors in two primary ways: increased costs insuring their workers and less discretionary cash in the pockets of consumers. Those were the planets that fell in line to make the ACA happen. Healthcare was essentially out-lobbied in Congress. The sop to the healthcare sector was requiring everyone be covered, trading quality for quantity to protect their margins. Everything else was pretty much incidental...
posted by jim in austin at 8:27 AM on January 17, 2016 [7 favorites]
posted by jim in austin at 8:27 AM on January 17, 2016 [7 favorites]
What Thorzdad said. Low-deductible insurance has always been limited to large group policies. Any insurance you choose to buy that doesn't exclude pre-existing conditions and a lengthy waiting period against claims not clearly driven by post binder accidents must have a high deductible or else adverse selection busts the insurer immediately. For what it's worth, the evidence is starting to show that the deductibles aren't high enough, because many ACA policies are losing money even with them.
posted by MattD at 8:33 AM on January 17, 2016 [1 favorite]
posted by MattD at 8:33 AM on January 17, 2016 [1 favorite]
skin in the game
I love this phrase, especially coming from conservatives. Because all we need to do is say: "Yes. We already have skin in the game. Along with bones, major organs, blood and our entire beings." What more can you ask for, really? I think it's great that conservatives want to talk about the skin in the game. Let's do it!
There is, in fact, no way for us to play in this game without our skin, but for-profit hospitals and insurers have been playing the same game with no skin of their own invested.
Yeah, let's talk about skin.
posted by Dashy at 8:34 AM on January 17, 2016 [15 favorites]
I love this phrase, especially coming from conservatives. Because all we need to do is say: "Yes. We already have skin in the game. Along with bones, major organs, blood and our entire beings." What more can you ask for, really? I think it's great that conservatives want to talk about the skin in the game. Let's do it!
There is, in fact, no way for us to play in this game without our skin, but for-profit hospitals and insurers have been playing the same game with no skin of their own invested.
Yeah, let's talk about skin.
posted by Dashy at 8:34 AM on January 17, 2016 [15 favorites]
Among the 32 percent of insured patients stuck with an out-of-network bill, more than than two-thirds of patients said they didn’t know the provider wasn’t covered.
Anthem Blue Cross sued again over narrow-network health plans: ... the company gave misleading or incorrect information, both last fall and this year, about the medical providers participating in these new plans. As a result, some consumers incurred unforeseen medical bills when they were treated by out-of-network doctors, according to the suit. EPO health plans usually have little or no coverage outside the network.
posted by RobotVoodooPower at 9:16 AM on January 17, 2016 [4 favorites]
Anthem Blue Cross sued again over narrow-network health plans: ... the company gave misleading or incorrect information, both last fall and this year, about the medical providers participating in these new plans. As a result, some consumers incurred unforeseen medical bills when they were treated by out-of-network doctors, according to the suit. EPO health plans usually have little or no coverage outside the network.
posted by RobotVoodooPower at 9:16 AM on January 17, 2016 [4 favorites]
Just how the old "welfare queens are buying caviar and filet mignon with food stamps!!1!" trope is used to discredit public assistance, "skin in the game" is meant to evoke images of ne'er-do-wells and hypochondriacs taxing the system with frivolous visits and tests without a care since they're not paying for it.
posted by dr_dank at 9:18 AM on January 17, 2016 [4 favorites]
posted by dr_dank at 9:18 AM on January 17, 2016 [4 favorites]
Among the 32 percent of insured patients stuck with an out-of-network bill, more than than two-thirds of patients said they didn’t know the provider wasn’t covered.
If you're going to the same medical provider more than once, ask each and every time if they are still in network. No one told me that my psychiatrist had dropped my network and I ran up hundreds of dollars without knowing it. I didn't learn my lesson and I got bitten AGAIN by this. I freaking hate office staff, I'm going to end this comment before I start swearing incoherently.
posted by desjardins at 9:23 AM on January 17, 2016 [18 favorites]
If you're going to the same medical provider more than once, ask each and every time if they are still in network. No one told me that my psychiatrist had dropped my network and I ran up hundreds of dollars without knowing it. I didn't learn my lesson and I got bitten AGAIN by this. I freaking hate office staff, I'm going to end this comment before I start swearing incoherently.
posted by desjardins at 9:23 AM on January 17, 2016 [18 favorites]
Does bankruptcy due to medical bills occur in any other first-world nation?
posted by yesster at 9:24 AM on January 17, 2016 [2 favorites]
posted by yesster at 9:24 AM on January 17, 2016 [2 favorites]
"One Canadian study suggested that between 7.1 percent and 14.3 percent of Canadian bankruptcies are attributable to health problems or other misfortunes (such as floods). And when journalist T.R. Reid questioned political leaders and health policy experts in several nations (all of which have some form of national health insurance) about the frequency of medical bankruptcy, he was told that they had none. Other nations have virtually eliminated medical bankruptcy by making coverage both universal (covering everyone) and comprehensive (covering virtually all medical costs)." [source] ( Emphasis mine.)
posted by blucevalo at 9:42 AM on January 17, 2016 [18 favorites]
posted by blucevalo at 9:42 AM on January 17, 2016 [18 favorites]
ArbitraryAndCapricious: And now, five years out, we've got the Hillary Clinton campaign accusing Bernie Sanders of wanting to dismantle Obamacare, which is kind of hilarious given that Bernie wants to replace it with single-payer.
Bernie: because fuck this shit (not official bumper stickers, but I saw one in real life yesterday and thought "yes, my thoughts exactly")
posted by filthy light thief at 9:46 AM on January 17, 2016 [4 favorites]
Bernie: because fuck this shit (not official bumper stickers, but I saw one in real life yesterday and thought "yes, my thoughts exactly")
posted by filthy light thief at 9:46 AM on January 17, 2016 [4 favorites]
If you scroll down on that CafePress page, your mellow will be ruined.
posted by Kirth Gerson at 9:57 AM on January 17, 2016 [5 favorites]
posted by Kirth Gerson at 9:57 AM on January 17, 2016 [5 favorites]
Wassa fecking problem, dearies? All ya gotta do is win Powerball. Ta-da, problem solved.
posted by telstar at 10:00 AM on January 17, 2016 [3 favorites]
posted by telstar at 10:00 AM on January 17, 2016 [3 favorites]
If you're going to the same medical provider more than once, ask each and every time if they are still in network. No one told me that my psychiatrist had dropped my network and I ran up hundreds of dollars without knowing it. I didn't learn my lesson and I got bitten AGAIN by this. I freaking hate office staff,
I know this is no consolation, but office staff have the same problem. We are not always informed about insurance changes. The names are so complex ,opaque , relentless and similar, it can be hard to keep them straight. Even if you ask, the answer you get may not be reliable. Better solution is to check online ( through the insurance company's website), who is on your panel ON the day of service / print / take a screenshot as proof of being in network.
posted by bchabcha at 10:26 AM on January 17, 2016 [3 favorites]
I know this is no consolation, but office staff have the same problem. We are not always informed about insurance changes. The names are so complex ,opaque , relentless and similar, it can be hard to keep them straight. Even if you ask, the answer you get may not be reliable. Better solution is to check online ( through the insurance company's website), who is on your panel ON the day of service / print / take a screenshot as proof of being in network.
posted by bchabcha at 10:26 AM on January 17, 2016 [3 favorites]
after my former GP died she was still listed on my insurer's website as being in-network for at least 6 months.
posted by poffin boffin at 10:36 AM on January 17, 2016 [9 favorites]
posted by poffin boffin at 10:36 AM on January 17, 2016 [9 favorites]
The ACA saved our asses when my husband was let go from his job. I haven't been working in a few years due to health issues, and needed regular medical care. That being said, it's a horrible system. Trying to predict your medical needs when doctors aren't even sure. I kind of wondered, perhaps wistfully, the same thing that MikeWarot wonders. If the frustration over dealing with the ACA plans and processes is to get more people fed up to encourage the people to demand single payer. Then I remember that most people are still going to be on employer provided care.
My husband is back working, and we're back on an employer plan. I just found out that the surgery that will provide some relief from the unrelenting pain is excluded from the policy. My medical debt keeps going up. My copay for specialists is $40/mo which doesn't seem that terrible, except the times when I have to see multiple doctors in a month. Then there is the unnecessary medical testing. And what I mean by that is I've been referred to so many doctors trying to find out what's wrong. They did, eventually, but I felt there was little options or recourse other than go to the doctor recommended, run expensive battery of tests, go to the next doctor. Once on that path, I was relying on the doctor's expertise, but there was no accountability, each doctor did their thing and washed their hands of me. At first I didn't know it would be like this or I might have put the breaks on. I thought it would be specialist finds something, done. Then specialist one says they really think you need to see specialist 2, etc. I have a procedure Monday that promises to be reoccurring and possibly life long and it only provides relief for a couple months. My doctor wants to send me for 2 more MRI's which I haven't schedules because that just adds more to the debt pile and I've been paralyzed with fear. If they find what they expect to find, that's going to be more money spent on ongoing care.
Coming back around to single payer; what scares me is if we manage to adopt it in the US, what's to stop it from being at risk for the same defunding that everything else in the US faces. I hardly imagine the republicans just letting that go unmolested. They'll be constantly trying to tear it down. As it stands, political forces in the UK are trying to tear down the NIH.
posted by [insert clever name here] at 10:40 AM on January 17, 2016 [6 favorites]
My husband is back working, and we're back on an employer plan. I just found out that the surgery that will provide some relief from the unrelenting pain is excluded from the policy. My medical debt keeps going up. My copay for specialists is $40/mo which doesn't seem that terrible, except the times when I have to see multiple doctors in a month. Then there is the unnecessary medical testing. And what I mean by that is I've been referred to so many doctors trying to find out what's wrong. They did, eventually, but I felt there was little options or recourse other than go to the doctor recommended, run expensive battery of tests, go to the next doctor. Once on that path, I was relying on the doctor's expertise, but there was no accountability, each doctor did their thing and washed their hands of me. At first I didn't know it would be like this or I might have put the breaks on. I thought it would be specialist finds something, done. Then specialist one says they really think you need to see specialist 2, etc. I have a procedure Monday that promises to be reoccurring and possibly life long and it only provides relief for a couple months. My doctor wants to send me for 2 more MRI's which I haven't schedules because that just adds more to the debt pile and I've been paralyzed with fear. If they find what they expect to find, that's going to be more money spent on ongoing care.
Coming back around to single payer; what scares me is if we manage to adopt it in the US, what's to stop it from being at risk for the same defunding that everything else in the US faces. I hardly imagine the republicans just letting that go unmolested. They'll be constantly trying to tear it down. As it stands, political forces in the UK are trying to tear down the NIH.
posted by [insert clever name here] at 10:40 AM on January 17, 2016 [6 favorites]
With an elderly parent, never mind my own issues, the amount of time I spend just dealing with insurance paperwork is a noticeable hit to my productivity. Multiply that by hundreds of millions of people and it has to be a noticeable drag on GDP. A national health care system like the one the torys are trying to kill in the UK would be a huge financial benefit to this country.
posted by LastOfHisKind at 10:44 AM on January 17, 2016 [13 favorites]
posted by LastOfHisKind at 10:44 AM on January 17, 2016 [13 favorites]
Looking at the in-network providers only works if you're insurers website works. I've literally not found been able to find any in-network doctors via the last two insurers' websites, but if I call, they verify they are. Billing has also proved out to verify they're in-network. You have virtually no options. I don't even know if you can trust the phone support, I've gotten answers that range from vague to outright wrong. It's week two on the customer service promising to email coverage documents, when they said it would take 24-48 hours (fortunately I got it elsewhere.)
posted by [insert clever name here] at 10:46 AM on January 17, 2016 [4 favorites]
posted by [insert clever name here] at 10:46 AM on January 17, 2016 [4 favorites]
Ugh. I'm currently wrestling with my insurer's website right now. I'm going to try a new migraine medication. There's a long list of ones that I could try, and none of them are any more likely to work than the other, so my doctor and I agreed that we'd start with whichever one is in my insurance plan's top coverage tier. But you have to log on to the website to see the tiers, and when I type in my user name and password, I get an error code. So frustrating.
posted by ArbitraryAndCapricious at 11:04 AM on January 17, 2016
posted by ArbitraryAndCapricious at 11:04 AM on January 17, 2016
Yup, I'm skittering through insurance changes and trying to save up for impending medical expenses. New job, yay! No FMLA, ever, boo. So a couple grand out of pocket and six weeks home bound recovery time ... Hmmm.
I picked up watching a new to me series on Hulu, too, and something like half of the commercials are from credit card companies, it seems. The ads are talking about how they'll help you rebuild you credit score after you're sick, out of work, and rack up those medical bills. Yay?
:::rolleyes:::
posted by tilde at 11:16 AM on January 17, 2016 [1 favorite]
I picked up watching a new to me series on Hulu, too, and something like half of the commercials are from credit card companies, it seems. The ads are talking about how they'll help you rebuild you credit score after you're sick, out of work, and rack up those medical bills. Yay?
:::rolleyes:::
posted by tilde at 11:16 AM on January 17, 2016 [1 favorite]
" I don't even know if you can trust the phone support, I've gotten answers that range from vague to outright wrong. It's week two on the customer service promising to email coverage documents, when they said it would take 24-48 hours (fortunately I got it elsewhere.)
You decidedly cannot. We insist on paperwork confirming eligibility / screenshots etc. Yesterday we had a phone call from a customer service rep, speaking on behalf of a patient helpfully exhorting us to hurry up and submit a prior auth request for a patient who was seen barely 6hrs prior and we didn't even know there was an issue. So this version of " help" was all about passing the buck to our office, adding to our office work burden and not really addressing the block- their restrictive formulary. We are not paid to and cannot obtain prior authorisations on an emergent basis ( within 6 hrs of patient office visit- really?) - other patients more pressing issues come first not insurance mandated roadblocks. But yes, Mr Customer service had ADVOCATED for the patient- check box ticked.
They are unempowered and seem only to want to get you off the phone.
posted by bchabcha at 11:21 AM on January 17, 2016 [7 favorites]
You decidedly cannot. We insist on paperwork confirming eligibility / screenshots etc. Yesterday we had a phone call from a customer service rep, speaking on behalf of a patient helpfully exhorting us to hurry up and submit a prior auth request for a patient who was seen barely 6hrs prior and we didn't even know there was an issue. So this version of " help" was all about passing the buck to our office, adding to our office work burden and not really addressing the block- their restrictive formulary. We are not paid to and cannot obtain prior authorisations on an emergent basis ( within 6 hrs of patient office visit- really?) - other patients more pressing issues come first not insurance mandated roadblocks. But yes, Mr Customer service had ADVOCATED for the patient- check box ticked.
They are unempowered and seem only to want to get you off the phone.
posted by bchabcha at 11:21 AM on January 17, 2016 [7 favorites]
Reminder that some medically necessary surgeries, like gender confirmation surgeries, are not covered at all in most US insurance plans, and even in some single payer countries (Australia). Or there is an extremely long wait and multiple gatekeepers. Almost everyone I know goes into debt for these, especially because the patients tend to be young. These can cost anywhere from $10k to $100k depending on surgery type. Trans people already experience high levels of poverty so I'm guessing a lot of these folks end up in bankruptcy.
posted by desjardins at 12:03 PM on January 17, 2016 [1 favorite]
posted by desjardins at 12:03 PM on January 17, 2016 [1 favorite]
Better solution is to check online ( through the insurance company's website), who is on your panel ON the day of service / print / take a screenshot as proof of being in network.
Every insurance I've ever had has a disclaimer on the web site that the listings are not authoritative, and that confirming with the doctor is recommended. In one case, my wife identified 5 or 6 endocrinologists who no longer practiced in the area, with one being dead, all listed as participating in our town. 1 year after she complained to the insurance company (I want to say Anthem but I don't remember for sure) nothing had changed.
Also, at my last job we had Carefirst (BC/BS) and even though the 200 page contract my company signed explicitly stated that ALL medically necessary expenses for diabetics are covered, I still needed to file a complaint with the DC Insurance Commission to get my wife's glucose test strips covered.
posted by COD at 12:09 PM on January 17, 2016
Every insurance I've ever had has a disclaimer on the web site that the listings are not authoritative, and that confirming with the doctor is recommended. In one case, my wife identified 5 or 6 endocrinologists who no longer practiced in the area, with one being dead, all listed as participating in our town. 1 year after she complained to the insurance company (I want to say Anthem but I don't remember for sure) nothing had changed.
Also, at my last job we had Carefirst (BC/BS) and even though the 200 page contract my company signed explicitly stated that ALL medically necessary expenses for diabetics are covered, I still needed to file a complaint with the DC Insurance Commission to get my wife's glucose test strips covered.
posted by COD at 12:09 PM on January 17, 2016
I came to the conclusion recently that Health Insurance Companies are essentially bookies taking bets that we won't file a claim, and charging a vig on every dollar.
posted by mikelieman at 12:12 PM on January 17, 2016 [14 favorites]
posted by mikelieman at 12:12 PM on January 17, 2016 [14 favorites]
Low-deductible insurance has always been limited to large group policies.
Not true. On the exchanges (as before the exchanges) you can buy a Gold plan that has low or no deductibles. Not surprisingly, the additional premium cost is very close to the alternative deductible.
The thing to keep in mind is that the typical employee plan costs the employer $6000 for an individual and $16,000 for a family. If you are buying a plan on the exchange that is much less than these amounts, its obviously going to have a higher deductible than an employer plan because it is a cheaper plan.
Any insurance you choose to buy that doesn't exclude pre-existing conditions and a lengthy waiting period against claims not clearly driven by post binder accidents must have a high deductible or else adverse selection busts the insurer immediately.
Also untrue, as the existence of low deductible Gold plans proves. The ACA reduces gaming and adverse selection by restricting plan changes to an annual enrollment period, similar that for to Medicare for decades.
There is nothing requiring high deductibles except that people prefer paying lower premiums, hoping they stay healthy and avoid the deductible. You get what you pay for (within the context of an over-priced medical system).
Why medical costs are so high in the U.S. compared to the rest of the world, requiring high premiums is a whole another story.
posted by JackFlash at 2:57 PM on January 17, 2016 [2 favorites]
Not true. On the exchanges (as before the exchanges) you can buy a Gold plan that has low or no deductibles. Not surprisingly, the additional premium cost is very close to the alternative deductible.
The thing to keep in mind is that the typical employee plan costs the employer $6000 for an individual and $16,000 for a family. If you are buying a plan on the exchange that is much less than these amounts, its obviously going to have a higher deductible than an employer plan because it is a cheaper plan.
Any insurance you choose to buy that doesn't exclude pre-existing conditions and a lengthy waiting period against claims not clearly driven by post binder accidents must have a high deductible or else adverse selection busts the insurer immediately.
Also untrue, as the existence of low deductible Gold plans proves. The ACA reduces gaming and adverse selection by restricting plan changes to an annual enrollment period, similar that for to Medicare for decades.
There is nothing requiring high deductibles except that people prefer paying lower premiums, hoping they stay healthy and avoid the deductible. You get what you pay for (within the context of an over-priced medical system).
Why medical costs are so high in the U.S. compared to the rest of the world, requiring high premiums is a whole another story.
posted by JackFlash at 2:57 PM on January 17, 2016 [2 favorites]
My parents just retired a little over a year ago and my dad is now undergoing treatment for non-Hodgkins lymphoma. My brother and I both had to carefully and nervously ask them how good my mother's retired-veteran health insurance was, and whether this was going to blow through all their retirement savings. Fortunately, through a complete stroke of luck (the state they decided to retire to and that state's arrangement with veteran health benefits), his care is completely covered. Thank god.
(1) They didn't know this until they had their How We'll Pay For It meeting with his oncologist's office. Because everyone who goes through a major health crisis like this has to have that meeting. There are people whose job it is to do this. That feeds back into overhead costs for treatment.
(2) The information they had about their insurance and what it did and didn't cover was opaque enough that they were unable to figure it out themselves. For an allegedly free-market system, the lack of information people have about what their care costs and what their insurance will and won't cover is significant and problematic.
(3) My Australian husband was stunned that we even had to have this conversation with my parents. It literally had not occurred to him that it was even something to consider.
I get that the haunting fear of every anti-single-payer person is that someone, somewhere, will get treatment they don't "deserve." But I utterly and completely fail to see how that is a bigger worry than having to discuss with your children whether you'll be spending your retirement dead or broke.
Any time the "defund the NHS" or "privatise the Australian system" conversation comes up with British and Aussie friends of mine, I beg them to understand what the US system actually means for people's healthcare decisions and financial well-being. Eliminating the occasional fraud or waste is not worth the lives the changes would ruin.
posted by olinerd at 3:04 PM on January 17, 2016 [22 favorites]
(1) They didn't know this until they had their How We'll Pay For It meeting with his oncologist's office. Because everyone who goes through a major health crisis like this has to have that meeting. There are people whose job it is to do this. That feeds back into overhead costs for treatment.
(2) The information they had about their insurance and what it did and didn't cover was opaque enough that they were unable to figure it out themselves. For an allegedly free-market system, the lack of information people have about what their care costs and what their insurance will and won't cover is significant and problematic.
(3) My Australian husband was stunned that we even had to have this conversation with my parents. It literally had not occurred to him that it was even something to consider.
I get that the haunting fear of every anti-single-payer person is that someone, somewhere, will get treatment they don't "deserve." But I utterly and completely fail to see how that is a bigger worry than having to discuss with your children whether you'll be spending your retirement dead or broke.
Any time the "defund the NHS" or "privatise the Australian system" conversation comes up with British and Aussie friends of mine, I beg them to understand what the US system actually means for people's healthcare decisions and financial well-being. Eliminating the occasional fraud or waste is not worth the lives the changes would ruin.
posted by olinerd at 3:04 PM on January 17, 2016 [22 favorites]
I came to the conclusion recently that Health Insurance Companies are essentially bookies taking bets that we won't file a claim, and charging a vig on every dollar.
That is the basis for all insurance, going back more than three centuries to Lloyds of London.
What single payer does is reduce the vig. For private insurance companies, the overhead cost is about 20% of your premiums. For Medicare it is only 3%.
What single payer could do is reduce the cost of healthcare by about 15% even if nothing else changed.
That's not enough, given that the rest of the world provides the same quality care for one-half to one-third, but it's a good start.
posted by JackFlash at 3:05 PM on January 17, 2016 [7 favorites]
That is the basis for all insurance, going back more than three centuries to Lloyds of London.
What single payer does is reduce the vig. For private insurance companies, the overhead cost is about 20% of your premiums. For Medicare it is only 3%.
What single payer could do is reduce the cost of healthcare by about 15% even if nothing else changed.
That's not enough, given that the rest of the world provides the same quality care for one-half to one-third, but it's a good start.
posted by JackFlash at 3:05 PM on January 17, 2016 [7 favorites]
Once when I was young and broke I needed some dental work. My insurance refused to tell me how much of the procedure they would cover (I presume because this would leak information to the dentist on how much he could charge). They would only disclose what my out of pocket expense would be after the dentist disclosed how much he would charge. This back and forth might have taken weeks or months, and I needed the work done, so I gambled and went ahead.
Imagine this situation, but instead of a filling or a crown instead it's surgery involving seven different billing parties, some in network and covered completely, some out of network and covered at 70%, and the patient having to coordinate coverage and make best guesses at the total cost to them, and you get a sense for how people with insurance can quickly be bankrupted by a major illness.
posted by zippy at 3:24 PM on January 17, 2016 [2 favorites]
Imagine this situation, but instead of a filling or a crown instead it's surgery involving seven different billing parties, some in network and covered completely, some out of network and covered at 70%, and the patient having to coordinate coverage and make best guesses at the total cost to them, and you get a sense for how people with insurance can quickly be bankrupted by a major illness.
posted by zippy at 3:24 PM on January 17, 2016 [2 favorites]
If it makes you feel any better, there is almost no country in the world that provides government dental coverage for adults. Not Canada, not the UK, not Germany, not Scandinavia. Everywhere it is add-on private insurance or self-payment.
posted by JackFlash at 3:32 PM on January 17, 2016
posted by JackFlash at 3:32 PM on January 17, 2016
Imagine this situation, but instead of a filling or a crown instead it's surgery involving seven different billing parties, some in network and covered completely, some out of network and covered at 70%, and the patient having to coordinate coverage and make best guesses at the total cost to them, and you get a sense for how people with insurance can quickly be bankrupted by a major illness.
Well first you have to make sure your hospital is in network. Then you have to know the surgeon is. Then you have to know the anesthesiologist is. Then there's the assistant surgeon that decides to scrub in who may not even show on the scene until you're already asleep. Then you need to make sure the radiologist is in network for any post-operative scans, the pathology lab for any post-operative bloodwork and possibly the doctor who is first on the scene if you have something life threatening and you code.
But this is so much better than single payer, right? USA! USA! USA! MURICA! AMIRITE FOLKS?
posted by Talez at 3:48 PM on January 17, 2016 [8 favorites]
Well first you have to make sure your hospital is in network. Then you have to know the surgeon is. Then you have to know the anesthesiologist is. Then there's the assistant surgeon that decides to scrub in who may not even show on the scene until you're already asleep. Then you need to make sure the radiologist is in network for any post-operative scans, the pathology lab for any post-operative bloodwork and possibly the doctor who is first on the scene if you have something life threatening and you code.
But this is so much better than single payer, right? USA! USA! USA! MURICA! AMIRITE FOLKS?
posted by Talez at 3:48 PM on January 17, 2016 [8 favorites]
I kind of wondered, perhaps wistfully, the same thing that MikeWarot wonders. If the frustration over dealing with the ACA plans and processes is to get more people fed up to encourage the people to demand single payer. Then I remember that most people are still going to be on employer provided care.
We have fairly good insurance through my partner's employer, and we deal with almost everything that is being described here (and ditto with the insurance from both of our previous jobs), with the exception of having to choose/buy new plans each year. All the in and out of network stuff, opaque charges, and so on apply. The whole thing in the US is a hot wet mess, and the only question is how badly you get screwed and how much of a time suck it will be this year.
Like most people, we are always juggling cost/benefit questions, having to choose whether or not to fight things where we are clearly in the right but where the time it will take can outweigh the savings. The latest is about $300 in charges that need to be resubmitted by the clinic as well as argued about with the insurance company, so that's double the time on the phone, with no guarantee that it won't get kicked back for a second time. There needs to be a financial penalty for every time an insurance company incorrectly denies a claim, because this stuff has a human cost and they are way too casual about it.
I would kill for a decentish single payer system so that at least we'd only need to learn one system's quirks and wouldn't need to build in stress over health care into questions about career options, where to live, and so on. There is a lot that is good about the ACA, but it was like putting some duct tape on a broken leg and calling it good.
posted by Dip Flash at 5:14 PM on January 17, 2016 [4 favorites]
We have fairly good insurance through my partner's employer, and we deal with almost everything that is being described here (and ditto with the insurance from both of our previous jobs), with the exception of having to choose/buy new plans each year. All the in and out of network stuff, opaque charges, and so on apply. The whole thing in the US is a hot wet mess, and the only question is how badly you get screwed and how much of a time suck it will be this year.
Like most people, we are always juggling cost/benefit questions, having to choose whether or not to fight things where we are clearly in the right but where the time it will take can outweigh the savings. The latest is about $300 in charges that need to be resubmitted by the clinic as well as argued about with the insurance company, so that's double the time on the phone, with no guarantee that it won't get kicked back for a second time. There needs to be a financial penalty for every time an insurance company incorrectly denies a claim, because this stuff has a human cost and they are way too casual about it.
I would kill for a decentish single payer system so that at least we'd only need to learn one system's quirks and wouldn't need to build in stress over health care into questions about career options, where to live, and so on. There is a lot that is good about the ACA, but it was like putting some duct tape on a broken leg and calling it good.
posted by Dip Flash at 5:14 PM on January 17, 2016 [4 favorites]
I get that the haunting fear of every anti-single-payer person is that someone, somewhere, will get treatment they don't "deserve."
I'm not anti-single-payer but I'm a little skeptical about it and this isn't my fear. My fear is rationing and increased waiting times for specialists and non-emergency procedures. I already have to wait 5 months to see a psychiatrist and I have insurance. I don't see how that's going to be even better on single payer. I suppose one of the furriners can jump in here - without paying privately, how long does it take you to see a specialist? I know Canadians have to go through their GP first. I can see my GP on Tuesday if I call on Monday - can you?
posted by desjardins at 7:50 PM on January 17, 2016 [1 favorite]
I'm not anti-single-payer but I'm a little skeptical about it and this isn't my fear. My fear is rationing and increased waiting times for specialists and non-emergency procedures. I already have to wait 5 months to see a psychiatrist and I have insurance. I don't see how that's going to be even better on single payer. I suppose one of the furriners can jump in here - without paying privately, how long does it take you to see a specialist? I know Canadians have to go through their GP first. I can see my GP on Tuesday if I call on Monday - can you?
posted by desjardins at 7:50 PM on January 17, 2016 [1 favorite]
I know Canadians have to go through their GP first. I can see my GP on Tuesday if I call on Monday - can you?
I suspect this varies by country and city, just as it does in the US. When I lived in England, I was able to get a next-day appointment for my GP. In the last state I lived in, I could also get in the next day; my current doctor took two weeks to get an opening. A specialist appointment takes at least a month, and I have very good insurance in a system with a lot of options. I would go back to the NHS in a heartbeat.
posted by jetlagaddict at 8:14 PM on January 17, 2016 [2 favorites]
I suspect this varies by country and city, just as it does in the US. When I lived in England, I was able to get a next-day appointment for my GP. In the last state I lived in, I could also get in the next day; my current doctor took two weeks to get an opening. A specialist appointment takes at least a month, and I have very good insurance in a system with a lot of options. I would go back to the NHS in a heartbeat.
posted by jetlagaddict at 8:14 PM on January 17, 2016 [2 favorites]
My fear is rationing ...
Yet what we have now is rationing to keep out others so that you have easier access? I'm pretty sure that's not what you want if you think about it.
posted by JackFlash at 8:17 PM on January 17, 2016 [7 favorites]
Yet what we have now is rationing to keep out others so that you have easier access? I'm pretty sure that's not what you want if you think about it.
posted by JackFlash at 8:17 PM on January 17, 2016 [7 favorites]
I'm not anti-single-payer but I'm a little skeptical about it and this isn't my fear. My fear is rationing and increased waiting times for specialists and non-emergency procedures. I already have to wait 5 months to see a psychiatrist and I have insurance. I don't see how that's going to be even better on single payer. I suppose one of the furriners can jump in here - without paying privately, how long does it take you to see a specialist? I know Canadians have to go through their GP first. I can see my GP on Tuesday if I call on Monday - can you?
I'm Canadian. If I call my GP on Monday I won't have to wait until Tuesday to see her, I can go in on Monday. Or, if I prefer, she can give me a call back and we can talk on the phone. She usually calls within half an hour.
My doc leaves slots open every day for same-day calls. Does every doctor do that? I don't know. They're mostly in private practice, so each practice can set up it's own policies. But you know if that's something you prioritize, you can prioritize it because there's no in-network or out-of-network or anything like that, so you can find a doctor who does that and go to that doctor. Hell, since there's no need to designate someone as "your doctor" if you want, you can have 12 GPs you go to and call them all on Monday to find out which one will see you first. And whichever on that it is, provincial insurance will pay for it.
I think there's something fundamentally mean-spirited about wanting to deny some people something so that you can have it faster. And make no mistake, that's exactly what this fear is, because if giving everyone access means you get it slower, then you're getting it faster BECAUSE some people are going without. You're getting it on someone else's back. That always nagged at my conscience when I lived in the US; knowing that I was getting treatment X BECAUSE there are homeless people outside getting their healthcare from a trailer. I thought about it every time I walked past that trailer and into an appointment. It ate at me. I don't know how people can be ok with that.
If there are 1000 psychiatrists in your city and each sees patients for 30 hours a week, there are 30000 psychiatrist hours available. Obviously with single-payer that number will go up, since they won't be spending all that time on insurance bullshit, so say with single-payer there are 1000 psychiatrists but maybe 33,000 psychiatrist hours. So more hours, but longer wait times. Why would that be? Oh because there are more people getting care. So basically you want those people to be denied care so you can be seen faster. You may not think of it that way, but that's the only way this argument makes sense.
As for rationing, I've never seen rationing here. When my doctor wants to run a test, she runs a test. When she wants to do a treatment, she does the treatment. When she wants me to see a neurologist, ophthalmologist, surgeon of various sorts, endocrinologist, etc. etc. I see said doctor. There exists no one to whom she has to ask permission. She is in private practice and does what she thinks is medically in the best interest of her patients and then sends the bill to our provincial health insurance plan. Oh, and since everyone has the same plan and it covers 100% with no co-pays and no deductibles, the billing is super simple, so the administrative overhead is low. And since the government doesn't do what US health insurance companies do and try to find every which way of getting out of paying and pay people to try to find ways to avoid paying claims, that overhead is reduced, too.
Do you know that if I wanted to call my provincial health insurance plan I would have no idea how to do that? I don't know what the phone number is. I don't know where I would find the phone number. I guess I could call the Ontario Government general service line and find out. They don't run commercials on TV about how helpful and friendly their CSRs are. I always found those commericals strange when I lived in the US. You have nurses who answer the phone? You have super friendly CSRs? Man that's the dumbest thing in the world to want in a health insurnace company because if I'm calling you, you've already done something wrong. You want to convince me that you're awesome, tell me how I'll never get a phone call or letter from you or have any reason to contact you because you're just going to pay for all my healthcare without my ever having to deal with anything at all related to the payment for my healthcare. I don't care what you were billed for. I don't care what you paid. I don't want to knwo who your "network" is because I think I should get to go to any doctor I damn well want to go to. If my heath insurance is doing it's job, there's no reason in the world I should ever need to talk to their CSR or look up something on their web site or interact with them in any way.
On the other hand, when I lived in the US and needed an MRI, the insurance company had to approve it. Before I started X treatment, the insurance company had to approve it, etc. etc. I've never understood why Americans aren't outraged by that, both because who the hell are the insurance companies to decide what healthcare you get AND because of the enormous violation of privacy and doctor-patient confidentiality -- to justify whatever test/procedure they're going, they have to tell the insurance company your private medical info. What the flying fuck. How the hell is that allowed?
So yeah, not only does single payer mean that I can sleep at night without it weighing on my conscience that I got something because someone else is being denied the healthcare they need, but it also means I can get the healthcare I need without the hassle of all the administrative barriers and restrictions and conditions to care that non-single-payer insurance puts up.
posted by If only I had a penguin... at 8:30 PM on January 17, 2016 [36 favorites]
I'm Canadian. If I call my GP on Monday I won't have to wait until Tuesday to see her, I can go in on Monday. Or, if I prefer, she can give me a call back and we can talk on the phone. She usually calls within half an hour.
My doc leaves slots open every day for same-day calls. Does every doctor do that? I don't know. They're mostly in private practice, so each practice can set up it's own policies. But you know if that's something you prioritize, you can prioritize it because there's no in-network or out-of-network or anything like that, so you can find a doctor who does that and go to that doctor. Hell, since there's no need to designate someone as "your doctor" if you want, you can have 12 GPs you go to and call them all on Monday to find out which one will see you first. And whichever on that it is, provincial insurance will pay for it.
I think there's something fundamentally mean-spirited about wanting to deny some people something so that you can have it faster. And make no mistake, that's exactly what this fear is, because if giving everyone access means you get it slower, then you're getting it faster BECAUSE some people are going without. You're getting it on someone else's back. That always nagged at my conscience when I lived in the US; knowing that I was getting treatment X BECAUSE there are homeless people outside getting their healthcare from a trailer. I thought about it every time I walked past that trailer and into an appointment. It ate at me. I don't know how people can be ok with that.
If there are 1000 psychiatrists in your city and each sees patients for 30 hours a week, there are 30000 psychiatrist hours available. Obviously with single-payer that number will go up, since they won't be spending all that time on insurance bullshit, so say with single-payer there are 1000 psychiatrists but maybe 33,000 psychiatrist hours. So more hours, but longer wait times. Why would that be? Oh because there are more people getting care. So basically you want those people to be denied care so you can be seen faster. You may not think of it that way, but that's the only way this argument makes sense.
As for rationing, I've never seen rationing here. When my doctor wants to run a test, she runs a test. When she wants to do a treatment, she does the treatment. When she wants me to see a neurologist, ophthalmologist, surgeon of various sorts, endocrinologist, etc. etc. I see said doctor. There exists no one to whom she has to ask permission. She is in private practice and does what she thinks is medically in the best interest of her patients and then sends the bill to our provincial health insurance plan. Oh, and since everyone has the same plan and it covers 100% with no co-pays and no deductibles, the billing is super simple, so the administrative overhead is low. And since the government doesn't do what US health insurance companies do and try to find every which way of getting out of paying and pay people to try to find ways to avoid paying claims, that overhead is reduced, too.
Do you know that if I wanted to call my provincial health insurance plan I would have no idea how to do that? I don't know what the phone number is. I don't know where I would find the phone number. I guess I could call the Ontario Government general service line and find out. They don't run commercials on TV about how helpful and friendly their CSRs are. I always found those commericals strange when I lived in the US. You have nurses who answer the phone? You have super friendly CSRs? Man that's the dumbest thing in the world to want in a health insurnace company because if I'm calling you, you've already done something wrong. You want to convince me that you're awesome, tell me how I'll never get a phone call or letter from you or have any reason to contact you because you're just going to pay for all my healthcare without my ever having to deal with anything at all related to the payment for my healthcare. I don't care what you were billed for. I don't care what you paid. I don't want to knwo who your "network" is because I think I should get to go to any doctor I damn well want to go to. If my heath insurance is doing it's job, there's no reason in the world I should ever need to talk to their CSR or look up something on their web site or interact with them in any way.
On the other hand, when I lived in the US and needed an MRI, the insurance company had to approve it. Before I started X treatment, the insurance company had to approve it, etc. etc. I've never understood why Americans aren't outraged by that, both because who the hell are the insurance companies to decide what healthcare you get AND because of the enormous violation of privacy and doctor-patient confidentiality -- to justify whatever test/procedure they're going, they have to tell the insurance company your private medical info. What the flying fuck. How the hell is that allowed?
So yeah, not only does single payer mean that I can sleep at night without it weighing on my conscience that I got something because someone else is being denied the healthcare they need, but it also means I can get the healthcare I need without the hassle of all the administrative barriers and restrictions and conditions to care that non-single-payer insurance puts up.
posted by If only I had a penguin... at 8:30 PM on January 17, 2016 [36 favorites]
I can see my GP on Tuesday if I call on Monday - can you?
Yup. Waitlist for specialists tends to be based on need vs supply. (also geography). Yes there are some private clinics, but the vast majority of people simply access healthcare through the provincial system. Wait times for mental healthcare can be very long (a year) mainly because it's an underserved discpline. I have been told that the Ontario government is moving to add psychologists with a Masters to bill OHIP (Ontario Health Insurance Plan) for treatments--a lot of people are quite excited about this, and should ameliorate the current wait times significantly within a couple of years.
And it's worth pointing out that we have better health outcomes for like half the total cost of yours, and worth pointing out that health care is a human right, which means equal access for all, or as close to that--and striving to get closer--as possible.
posted by feckless fecal fear mongering at 8:33 PM on January 17, 2016 [4 favorites]
Yup. Waitlist for specialists tends to be based on need vs supply. (also geography). Yes there are some private clinics, but the vast majority of people simply access healthcare through the provincial system. Wait times for mental healthcare can be very long (a year) mainly because it's an underserved discpline. I have been told that the Ontario government is moving to add psychologists with a Masters to bill OHIP (Ontario Health Insurance Plan) for treatments--a lot of people are quite excited about this, and should ameliorate the current wait times significantly within a couple of years.
And it's worth pointing out that we have better health outcomes for like half the total cost of yours, and worth pointing out that health care is a human right, which means equal access for all, or as close to that--and striving to get closer--as possible.
posted by feckless fecal fear mongering at 8:33 PM on January 17, 2016 [4 favorites]
I'm in the US. Right now I can get next day and sometimes same day appointments, but with my last doctor everything was scheduled at least a month ahead. For anything urgent you had to call the minute they opened each day until there was an opening. I've lived in places with single payer and it was way easier, no drama, and it felt fairer in the way described just above.
posted by Dip Flash at 8:48 PM on January 17, 2016 [1 favorite]
posted by Dip Flash at 8:48 PM on January 17, 2016 [1 favorite]
I think one thing a lot of Americans don't understand is that though we use the word "waitlists" in casual conversation, there exist no lists. I think Americans imagine lists kind of akin to organ transplant lists, where some people are ranked higher than others and then organs are distributed in some sort of centralized fashion to that list.
This is not at all how it works. Instead, when you need to see a specialist, your GP will probably suggest one. I mean they all have a few specialists in each area that are their go-to person in that specialty, but the doc also asks about preference you might have (male or female, what part of the city, what hospital they have priviliges at, if any, or anything else (my mom is all about free parking)). So either from your doctors list of usual people filtered by your preferences or based on some specialty need (e.g. you need not just an ophthalmologist but someone who knows a lot about eyelashes on the left eye or something, in which case my doc would take a couple of days t0 look into this and get back to me) you pick a specialist to go to and either you or your doctor's receptionist calls to ask for an appointment.
Now how soon the appointment is is entirely up to the specialist. It's their appointment book, it's their private practice usually, and even in a hospital clinic, they set their own policies. They can give out appointments however they want. In practice, they tend to give priority to people in more urgent need (leave appointment slots open for the inevitable urgent cases and fill those when urgent cases call). And of course, it means that the more popular a doctor is (for whatever reason, including say that they are the only doctor in that specialty in a large rural area), the fewer slots they will have. So two identical people with identical conditions living in the same place could call two different doctors and get appointment times that are wildly different, because there is no organized wait list. Each doctor has his own practice, and there's no insurance company giving orders, so there would just be no way to coordinate such a list and if there were, it wouldn't be fair because it would take away people's ability to choose their doctors.
So yeah, sometimes you wait, but that's because there's no one dying on the sidewalk who doesn't have access to the very same doctor you do, and it's not because there's a list, it's because doctors have this or that system of organizing their appointment books.
posted by If only I had a penguin... at 8:53 PM on January 17, 2016 [4 favorites]
This is not at all how it works. Instead, when you need to see a specialist, your GP will probably suggest one. I mean they all have a few specialists in each area that are their go-to person in that specialty, but the doc also asks about preference you might have (male or female, what part of the city, what hospital they have priviliges at, if any, or anything else (my mom is all about free parking)). So either from your doctors list of usual people filtered by your preferences or based on some specialty need (e.g. you need not just an ophthalmologist but someone who knows a lot about eyelashes on the left eye or something, in which case my doc would take a couple of days t0 look into this and get back to me) you pick a specialist to go to and either you or your doctor's receptionist calls to ask for an appointment.
Now how soon the appointment is is entirely up to the specialist. It's their appointment book, it's their private practice usually, and even in a hospital clinic, they set their own policies. They can give out appointments however they want. In practice, they tend to give priority to people in more urgent need (leave appointment slots open for the inevitable urgent cases and fill those when urgent cases call). And of course, it means that the more popular a doctor is (for whatever reason, including say that they are the only doctor in that specialty in a large rural area), the fewer slots they will have. So two identical people with identical conditions living in the same place could call two different doctors and get appointment times that are wildly different, because there is no organized wait list. Each doctor has his own practice, and there's no insurance company giving orders, so there would just be no way to coordinate such a list and if there were, it wouldn't be fair because it would take away people's ability to choose their doctors.
So yeah, sometimes you wait, but that's because there's no one dying on the sidewalk who doesn't have access to the very same doctor you do, and it's not because there's a list, it's because doctors have this or that system of organizing their appointment books.
posted by If only I had a penguin... at 8:53 PM on January 17, 2016 [4 favorites]
Came in to comment on the rationing problem, but I see that's been answered. The psychiatry issue one o supply, as I recall. Not much you can do about that. Single payer would make more people eligible, and push appointments out further, but I'm not sure if the status quo is the right answer. If anything, the small amount of money mental health services get through insurance is screwing things up. Let's see, doctors and therapists have generally a longer appointment -usually an hour, as opposed to 10-15 minutes to see a GP and maybe 20-30 minutes with a specialist. It's not a glamorous, well paid life. Single payer would probably drive reimbursements down more.
(I say this as someone 3 of the 5 months into the wait to see a psychiatrist.)
posted by [insert clever name here] at 9:15 PM on January 17, 2016
(I say this as someone 3 of the 5 months into the wait to see a psychiatrist.)
posted by [insert clever name here] at 9:15 PM on January 17, 2016
I guess it's okay as is. Nobody really *needs* eye examinations to see unless they can afford them. It's not like losing your vision or corrected astigmatism or myopia is important to your health or employability. As for dental care, it's nice, but imagine the flood of people who would rush in to take advantage of purely cosmetic improvements like a few unsightly cavities, scaling, missing teeth or abcesses. Lots of people in the world manage alright. Most people who have clearly abused dietary guidelines and avoided effective decay-preventive dentifrices have no one to blame but themselves. Try eating food without sugar!
Yep, it would be a nice gesture, but maybe in a few decades. We have infrastructure to rebuild and defensive actions topromulgate consider. Besides, what else would all those insurance employees do? Build bridges? ... ha ha ha!!
posted by Twang at 9:27 PM on January 17, 2016 [4 favorites]
Yep, it would be a nice gesture, but maybe in a few decades. We have infrastructure to rebuild and defensive actions to
posted by Twang at 9:27 PM on January 17, 2016 [4 favorites]
Canadian here. Ditto on people replying above about wait times and specialist. I live in a small town and my GP along with two others recently left. There's some new ones coming in soon and they've had some locums come in. Right now I've been assigned a doctor at the clinic and for non urgent stuff there is a bit of wait. However for urgent things I can get to see someone right away, usually same day. They also have nurse practitioners which I've got in to see same or next day. If you need a doctor they find a doctor ASAP. It helps that the majority of the doctors are all in the same place right next to the hospital and they really work together as a team to make sure people get what they need.
posted by Jalliah at 9:31 PM on January 17, 2016
posted by Jalliah at 9:31 PM on January 17, 2016
Story time. My Grandparents lived in Florida and growing up we didn't see them much at all because it was too expensive for our whole family to travel there. My Grandfather was super paranoid about his health and getting sick and wouldn't travel unless absolutely necessary. For a long time I thought it was just him scared of being sick but I found out that while it was that, the primary reason was fear of the COST of getting sick. When I was young he had a cancerous thyroid removed which ended up costing him over 100,000 dollars and it made him super skittish. So many times growing up they planned to come and then at the last minute he'd get stressed and back out. It wasn't until I was an adult that I was able to understand the factors at play and let go of feeling like they didn't come because Grandpa didn't like us.
So indirectly or directly depending on how one looks at it the fucked up healthcare system in the US led to me not seeing and getting to know my grandparents that well. Sad.
posted by Jalliah at 9:49 PM on January 17, 2016 [3 favorites]
So indirectly or directly depending on how one looks at it the fucked up healthcare system in the US led to me not seeing and getting to know my grandparents that well. Sad.
posted by Jalliah at 9:49 PM on January 17, 2016 [3 favorites]
Personnel director in some crappy sweatshop factory demotes a guy because his guy's wife gets sick and has to use company health insurance. Eighteen months later the personnel director is dead from a sudden onset of brain cancer. Sad; but a rewarding justice in an odd way. I was no longer employed there when she was diagnosed and then died; but I often wonder if she demoted herself before she did die.
posted by buzzman at 10:56 PM on January 17, 2016 [1 favorite]
posted by buzzman at 10:56 PM on January 17, 2016 [1 favorite]
I'm not anti-single-payer but I'm a little skeptical about it and this isn't my fear. My fear is rationing and increased waiting times for specialists and non-emergency procedures. I already have to wait 5 months to see a psychiatrist and I have insurance. I don't see how that's going to be even better on single payer. I suppose one of the furriners can jump in here - without paying privately, how long does it take you to see a specialist? I know Canadians have to go through their GP first. I can see my GP on Tuesday if I call on Monday - can you?
I've lived under both the NHS and the Australian system. In both cases I have been able to get same-day or next-day appointments with my GP. Failing that, or if I need something after hours, here in Australia I can go to a 24 hour clinic where I will wait for a couple of hours but I will be seen and receive free care, or (locally) I can call a service who will come to my house later in the day for free. Over New Year's I had an MRSA infection that required daily doctor appointments for over a week, and because all the usual GP offices were closed, I was relying on the dial-a-doctor who sent me off to the ER because they weren't equipped to handle my disgusting abcess. So I went to the ER of a relatively small regional public hospital which serves a huge region over a holiday weekend and I waited... about 1.5 hours. When I had to go back again the next morning, I waited about 45 minutes before being seen.
Throughout my pregnancy, which spanned time in both the UK and Australia, I saw the same two midwives for all my appointments. My labor and delivery, at a public hospital as a public patient, were all meant to be midwives* only but when things went a bit south toward the end I had about five obstetricians in the room within minutes. I walked out of the hospital with my daughter without any financial transaction whatsoever (and no bill appearing in the mail weeks later!), then had a midwife come visit me at home each day for the next four days, followed by a free lactation consult when I had breastfeeding issues. All through the public system. Had I wished to pony up $60/day, I could have had a private room for recovery at the hospital.
* by midwives I mean those who are effectively nurse practitioners, with a specialty in pregnancy and childbirth. Not a privately hired midwife for a hippie birth, as I think Americans tend to assume.
I have not yet had to deal with specialist care or hospital admission beyond pregnancy-related stuff. I do have private insurance here, because based on our family income I'm required to, but I pay about AU$140/month with a $500 deductible for myself and my daughter. I have not used it yet.
We all hear about individual cases under the NHS, Australian, or Canadian systems of someone having to wait a long time for surgery or treatment, but if you read those stories *in the country they took place in* the complaint is about staffing, funding, and hospital capacity, not "too many people want healthcare! That shouldn't be the case!" Wait time metrics are carefully measured and scrutinized in these systems and are used as a basis for increasing funding or otherwise trying to improve them. Frankly, I think "it took a long time to get treatment" is better than "I cannot afford treatment so I lost the leg/went bankrupt/lost my house/died".
My experience with "rationing" in Australia is:
- My doctor had to fill out a bunch of paperwork to get me on a broad spectrum antibiotic for my (then only suspected) MRSA infection, because Australia is extremely careful not to overuse those so as not to encourage the spread of, you know, MRSA.
- Full coverage of the cost of my daughter's vaccines is limited to those agreed upon by the government; if I want anything new or otherwise not covered under that, I pay out of pocket. (I just did this for a new meningococcal vaccine)
- My flu vaccine was free in pregnancy but I had to pay for it when I wasn't pregnant.
- Ultrasounds during my pregnancy were limited to medically necessary ones on a standard schedule, not vanity ultrasounds or "just to see"
- Because my pregnancy was going perfectly normally, I never saw an obstetrician, or anyone other than my GP and midwife, until the last hour of my labor.
And I know you said not to rely on this argument, but the fact remains that in every country with a socialized system, it is always possible for those with the means to get exactly the treatment they want, from the provider they want, when they want, if they are willing to pay for it. It's crappy and still allows some inequality but wealthy people who are worried about the unwashed masses pushing them down "wait lists" are simply afraid of something that won't happen.
There is no perfect system, but I guarantee you that you'd have a hard time finding someone living under one of the more socialized systems who would gladly trade it for the American system and all its paperwork, bureaucracy, expense, anxieties, and tragedies.
To be honest, we're looking at moving back to the States, and the more I consider the anxiety and expense around healthcare, pregnancy and parental leave, daycare, and everything else that Australia considers a natural part of the social safety net but which the US prefers you bootstrap because FREEDOM and CAPITALISM, the more I question the idea of moving. The slightly lower taxes don't in any way make up for what's lost.
posted by olinerd at 11:00 PM on January 17, 2016 [13 favorites]
I've lived under both the NHS and the Australian system. In both cases I have been able to get same-day or next-day appointments with my GP. Failing that, or if I need something after hours, here in Australia I can go to a 24 hour clinic where I will wait for a couple of hours but I will be seen and receive free care, or (locally) I can call a service who will come to my house later in the day for free. Over New Year's I had an MRSA infection that required daily doctor appointments for over a week, and because all the usual GP offices were closed, I was relying on the dial-a-doctor who sent me off to the ER because they weren't equipped to handle my disgusting abcess. So I went to the ER of a relatively small regional public hospital which serves a huge region over a holiday weekend and I waited... about 1.5 hours. When I had to go back again the next morning, I waited about 45 minutes before being seen.
Throughout my pregnancy, which spanned time in both the UK and Australia, I saw the same two midwives for all my appointments. My labor and delivery, at a public hospital as a public patient, were all meant to be midwives* only but when things went a bit south toward the end I had about five obstetricians in the room within minutes. I walked out of the hospital with my daughter without any financial transaction whatsoever (and no bill appearing in the mail weeks later!), then had a midwife come visit me at home each day for the next four days, followed by a free lactation consult when I had breastfeeding issues. All through the public system. Had I wished to pony up $60/day, I could have had a private room for recovery at the hospital.
* by midwives I mean those who are effectively nurse practitioners, with a specialty in pregnancy and childbirth. Not a privately hired midwife for a hippie birth, as I think Americans tend to assume.
I have not yet had to deal with specialist care or hospital admission beyond pregnancy-related stuff. I do have private insurance here, because based on our family income I'm required to, but I pay about AU$140/month with a $500 deductible for myself and my daughter. I have not used it yet.
We all hear about individual cases under the NHS, Australian, or Canadian systems of someone having to wait a long time for surgery or treatment, but if you read those stories *in the country they took place in* the complaint is about staffing, funding, and hospital capacity, not "too many people want healthcare! That shouldn't be the case!" Wait time metrics are carefully measured and scrutinized in these systems and are used as a basis for increasing funding or otherwise trying to improve them. Frankly, I think "it took a long time to get treatment" is better than "I cannot afford treatment so I lost the leg/went bankrupt/lost my house/died".
My experience with "rationing" in Australia is:
- My doctor had to fill out a bunch of paperwork to get me on a broad spectrum antibiotic for my (then only suspected) MRSA infection, because Australia is extremely careful not to overuse those so as not to encourage the spread of, you know, MRSA.
- Full coverage of the cost of my daughter's vaccines is limited to those agreed upon by the government; if I want anything new or otherwise not covered under that, I pay out of pocket. (I just did this for a new meningococcal vaccine)
- My flu vaccine was free in pregnancy but I had to pay for it when I wasn't pregnant.
- Ultrasounds during my pregnancy were limited to medically necessary ones on a standard schedule, not vanity ultrasounds or "just to see"
- Because my pregnancy was going perfectly normally, I never saw an obstetrician, or anyone other than my GP and midwife, until the last hour of my labor.
And I know you said not to rely on this argument, but the fact remains that in every country with a socialized system, it is always possible for those with the means to get exactly the treatment they want, from the provider they want, when they want, if they are willing to pay for it. It's crappy and still allows some inequality but wealthy people who are worried about the unwashed masses pushing them down "wait lists" are simply afraid of something that won't happen.
There is no perfect system, but I guarantee you that you'd have a hard time finding someone living under one of the more socialized systems who would gladly trade it for the American system and all its paperwork, bureaucracy, expense, anxieties, and tragedies.
To be honest, we're looking at moving back to the States, and the more I consider the anxiety and expense around healthcare, pregnancy and parental leave, daycare, and everything else that Australia considers a natural part of the social safety net but which the US prefers you bootstrap because FREEDOM and CAPITALISM, the more I question the idea of moving. The slightly lower taxes don't in any way make up for what's lost.
posted by olinerd at 11:00 PM on January 17, 2016 [13 favorites]
I'm having cancer treatment in Australia right now. The longest delay was 3 days to see a professor of haematology. I suppose a registrar would have done (enormously competent people!), but if the prof wants to drive the car in the first instance, that's totally fine with me. Out of pocket expenses have been $0 for a list of procedures, drugs, etc., as long as your arm. This affords me the luxury of worrying about the disease rather than the bill, which I can't help thinking is therapeutically superior.
posted by Wolof at 11:55 PM on January 17, 2016 [5 favorites]
posted by Wolof at 11:55 PM on January 17, 2016 [5 favorites]
I'm not anti-single-payer but I'm a little skeptical about it and this isn't my fear. My fear is rationing and increased waiting times for specialists and non-emergency procedures. I already have to wait 5 months to see a psychiatrist and I have insurance. I don't see how that's going to be even better on single payer. I suppose one of the furriners can jump in here - without paying privately, how long does it take you to see a specialist? I know Canadians have to go through their GP first. I can see my GP on Tuesday if I call on Monday - can you?
I'm in Scotland, so, NHS, but not exactly the same as the systems in England/Wales/Northern Ireland. Also I work for the government (just as a disclaimer - I am far from an expert on health system finances!) so have a particular perspective on how this sort of stuff works.
Yes, the system here is that you go through your GP for referrals to specialists - your GP would typically be your first point of contact with the medical service for non-emergency situations. How long it takes to get an appointment varies between GP practices. Mine has a system where you can phone up at 8am and get an appointment for that day, or you can phone up later and get an appointment scheduled for further ahead (a few days to a week). They also do same-day appointments where possible for more urgent things. If it's more routine, though, and it's a busy time of year (i.e. winter), you can be waiting a while. Compared to other systems, GPs are a massive, massive part of care here, and they deal directly with issues that in other systems would require a specialist. So, I don't see a paediatrician for my kid, or a gynaecologist for cervical screening and contraception - I just see my GP.
Waiting times for secondary care will vary hugely depending on what procedure/specialist you need, where you live, and how urgent your situation is considered.
We do measure this, though, and set down expectations and guidelines around waiting times. This is done centrally by the government, with the responsibility for implementing it being done within regional boards (these are the local-area health authorities, covering GP practices as well as hospitals etc). The current guideline is 18 weeks from referral to treatment for most things (some procedures have different guidelines for various reasons), and the expectation is that 90% of patient journeys will fall within that. Latest figures available put the figure at 87.2%. That's an 18-week maximum, though - most patients will be seen sooner, but again, it varies depending on what you need and where you live. And because we collect huge amounts of data on this, we can track how well it's working for particular boards, procedures, clinical areas, and so on. I have a paper on my desk right now which outlines the median wait times for particular joint replacements, compared with demand over time and performance 10 years ago. We keep a close eye on this, is what I'm saying.
So, I would not say that waiting times are never an issue. But I have noticed that in online discussions about the US healthcare system vs. ones more like the NHS, there is always a lot of concern about horrendous waiting times and rationing of procedures (and that's before we get onto the Death Panels!), mostly made up of anecdotal horror stories and vague perceptions about how this kind of health service works. But one of the significant advantages of having a centralised, nationally-run healthcare system is that we can really monitor how well our system is performing, based on the data we collect. So I could tell you anecdotally how long it took me to go from "what is this agonising pain in my stomach?", to GP care, to X-ray, to surgery to remove my gall bladder - but it won't be anywhere near as useful as the national-level data collected every year.
* Not 100%, partially because it can be more clinically appropriate to delay treatment in some cases, and partially because, well, sometimes things get in the way and resources have to be reassigned to take account of e.g. major trauma incidents, hospital operating theatre being unexpectedly closed for some reason, epidemics of Whistling Martian Monkey Flu, etc etc etc.
posted by Catseye at 3:24 AM on January 18, 2016 [3 favorites]
I'm in Scotland, so, NHS, but not exactly the same as the systems in England/Wales/Northern Ireland. Also I work for the government (just as a disclaimer - I am far from an expert on health system finances!) so have a particular perspective on how this sort of stuff works.
Yes, the system here is that you go through your GP for referrals to specialists - your GP would typically be your first point of contact with the medical service for non-emergency situations. How long it takes to get an appointment varies between GP practices. Mine has a system where you can phone up at 8am and get an appointment for that day, or you can phone up later and get an appointment scheduled for further ahead (a few days to a week). They also do same-day appointments where possible for more urgent things. If it's more routine, though, and it's a busy time of year (i.e. winter), you can be waiting a while. Compared to other systems, GPs are a massive, massive part of care here, and they deal directly with issues that in other systems would require a specialist. So, I don't see a paediatrician for my kid, or a gynaecologist for cervical screening and contraception - I just see my GP.
Waiting times for secondary care will vary hugely depending on what procedure/specialist you need, where you live, and how urgent your situation is considered.
We do measure this, though, and set down expectations and guidelines around waiting times. This is done centrally by the government, with the responsibility for implementing it being done within regional boards (these are the local-area health authorities, covering GP practices as well as hospitals etc). The current guideline is 18 weeks from referral to treatment for most things (some procedures have different guidelines for various reasons), and the expectation is that 90% of patient journeys will fall within that. Latest figures available put the figure at 87.2%. That's an 18-week maximum, though - most patients will be seen sooner, but again, it varies depending on what you need and where you live. And because we collect huge amounts of data on this, we can track how well it's working for particular boards, procedures, clinical areas, and so on. I have a paper on my desk right now which outlines the median wait times for particular joint replacements, compared with demand over time and performance 10 years ago. We keep a close eye on this, is what I'm saying.
So, I would not say that waiting times are never an issue. But I have noticed that in online discussions about the US healthcare system vs. ones more like the NHS, there is always a lot of concern about horrendous waiting times and rationing of procedures (and that's before we get onto the Death Panels!), mostly made up of anecdotal horror stories and vague perceptions about how this kind of health service works. But one of the significant advantages of having a centralised, nationally-run healthcare system is that we can really monitor how well our system is performing, based on the data we collect. So I could tell you anecdotally how long it took me to go from "what is this agonising pain in my stomach?", to GP care, to X-ray, to surgery to remove my gall bladder - but it won't be anywhere near as useful as the national-level data collected every year.
* Not 100%, partially because it can be more clinically appropriate to delay treatment in some cases, and partially because, well, sometimes things get in the way and resources have to be reassigned to take account of e.g. major trauma incidents, hospital operating theatre being unexpectedly closed for some reason, epidemics of Whistling Martian Monkey Flu, etc etc etc.
posted by Catseye at 3:24 AM on January 18, 2016 [3 favorites]
It is completely possible to die waiting for treatment in the NHS. My father waited five months to get his brain tumour diagnosed, even though the standard was supposed to be no longer than two weeks.
It was hard to explain to him while he was lying in a ward in the local hospital waiting to be transferred to a specialist centre. He was 13th on the emergency list, and he was saying things like "well if it takes them a day to do the surgery on someone, and they work 5 days a week, then it'll be my turn in about two and a half weeks..." But it didn't work like that. What it meant was that 13 people had to complete their treatment or die before he could be seen.
Fortunately I had a friend who was in a high position in the NHS at the time and she knew someone at the other specialist hospital in the same area, which had no emergency list. She pulled a string for me and I persuaded the local consultant to transfer him to this other hospital immediately. He was over there within a few days, and a week later they finally got round to his biopsy. Of course, the tumour had grown enormously within the intervening five months. My friend said to me, "I used to think the NHS was all right when the chips were down, but this situation leaves me disillusioned."
Even with no upfront costs, of course, it was expensive to do all that travelling to and from hospitals (remember commuting here costs 20% of the average income), which I had to do very often in order to get any information at all - doctors won't give it to you unless you attend in person and wait all day to see if they may or may not appear. And they only give it very reluctantly so you might have to spend several days waiting in order to get the information you need. And I had just started a new job when all this happened, so taking time off was very worrying to me (the nurses were disgusted with me for expressing this concern, but I was the main breadwinner of the family and my father was so deeply in debt that the whole family was in extreme financial danger). Because his condition caused him aphasia, my father couldn't tell me anything, and my mother couldn't really understand anything the doctors told her either nor retain it long enough to tell it to me. On the phone when he finally got his diagnosis he was saying to me "I, I, two years. Two years." But it turned out that two years was the longest recorded case of anyone surviving with his condition, and it was part of his metaphysical worldview that if you believe things they happen. So he had to express faith that he would live for two years in order to make it true.
He was referred for radiotherapy, and the ambulance arrived to collect him for his first appointment a few weeks after he was sent home. The paramedic looked crestfallen when I explained to her that we were busy preparing for his funeral that afternoon.
He was past retirement age at the time, which is known to make a big difference to the speed and quality of care one gets. And as my line manager at work explained to me, my Dad was a nonproductive citizen who probably hadn't paid enough taxes during his lifetime anyway, so what he got was undoubtedly better than he deserved. There most definitely is rationing, and the cost calculation of a given treatment takes into account factors like the addition to your lifespan that the treatment would bring, versus age and number of dependent children. For example, a parent of two children in their thirties, a few years ago would have a year of life valued at about £30K per and the decision to give or withhold a particular treatment would be considered against that. If a patient is in their 60s, already retired, with no dependent children, well you do the math. I seriously doubt they - not any individual, but the system as a whole - ever genuinely intended to treat him.
And you know what? STILL better than the US system.
posted by tel3path at 5:02 AM on January 18, 2016 [1 favorite]
It was hard to explain to him while he was lying in a ward in the local hospital waiting to be transferred to a specialist centre. He was 13th on the emergency list, and he was saying things like "well if it takes them a day to do the surgery on someone, and they work 5 days a week, then it'll be my turn in about two and a half weeks..." But it didn't work like that. What it meant was that 13 people had to complete their treatment or die before he could be seen.
Fortunately I had a friend who was in a high position in the NHS at the time and she knew someone at the other specialist hospital in the same area, which had no emergency list. She pulled a string for me and I persuaded the local consultant to transfer him to this other hospital immediately. He was over there within a few days, and a week later they finally got round to his biopsy. Of course, the tumour had grown enormously within the intervening five months. My friend said to me, "I used to think the NHS was all right when the chips were down, but this situation leaves me disillusioned."
Even with no upfront costs, of course, it was expensive to do all that travelling to and from hospitals (remember commuting here costs 20% of the average income), which I had to do very often in order to get any information at all - doctors won't give it to you unless you attend in person and wait all day to see if they may or may not appear. And they only give it very reluctantly so you might have to spend several days waiting in order to get the information you need. And I had just started a new job when all this happened, so taking time off was very worrying to me (the nurses were disgusted with me for expressing this concern, but I was the main breadwinner of the family and my father was so deeply in debt that the whole family was in extreme financial danger). Because his condition caused him aphasia, my father couldn't tell me anything, and my mother couldn't really understand anything the doctors told her either nor retain it long enough to tell it to me. On the phone when he finally got his diagnosis he was saying to me "I, I, two years. Two years." But it turned out that two years was the longest recorded case of anyone surviving with his condition, and it was part of his metaphysical worldview that if you believe things they happen. So he had to express faith that he would live for two years in order to make it true.
He was referred for radiotherapy, and the ambulance arrived to collect him for his first appointment a few weeks after he was sent home. The paramedic looked crestfallen when I explained to her that we were busy preparing for his funeral that afternoon.
He was past retirement age at the time, which is known to make a big difference to the speed and quality of care one gets. And as my line manager at work explained to me, my Dad was a nonproductive citizen who probably hadn't paid enough taxes during his lifetime anyway, so what he got was undoubtedly better than he deserved. There most definitely is rationing, and the cost calculation of a given treatment takes into account factors like the addition to your lifespan that the treatment would bring, versus age and number of dependent children. For example, a parent of two children in their thirties, a few years ago would have a year of life valued at about £30K per and the decision to give or withhold a particular treatment would be considered against that. If a patient is in their 60s, already retired, with no dependent children, well you do the math. I seriously doubt they - not any individual, but the system as a whole - ever genuinely intended to treat him.
And you know what? STILL better than the US system.
posted by tel3path at 5:02 AM on January 18, 2016 [1 favorite]
I want to clarify regarding medical bankruptcies in Canada. I don't personally know of anyone who filed for bankruptcy due to medical expenses, but I know that when medical emergencies arise, it's the incidentals that we worry about, not actual doctors fees.
A co-worker's three year old was diagnosed with cancer last week, and the office is fundraising like mad already. Even though we have great insurance through our employer and the hospital costs are covered by the province, there are a lot of added costs that insurance doesn't cover. The family will have to go to another province to get treatment, when you've got a seriously ill youngster, you can't wait to find deals on flights and hotels to travel and you don't need the stress of worrying about bills. Those costs add up in a hurry. I suspect most so called "medical bankruptcies" here are caused by those kinds of incidental costs, and they still shouldn't happen as often as they do.
posted by peppermind at 5:25 AM on January 18, 2016 [2 favorites]
A co-worker's three year old was diagnosed with cancer last week, and the office is fundraising like mad already. Even though we have great insurance through our employer and the hospital costs are covered by the province, there are a lot of added costs that insurance doesn't cover. The family will have to go to another province to get treatment, when you've got a seriously ill youngster, you can't wait to find deals on flights and hotels to travel and you don't need the stress of worrying about bills. Those costs add up in a hurry. I suspect most so called "medical bankruptcies" here are caused by those kinds of incidental costs, and they still shouldn't happen as often as they do.
posted by peppermind at 5:25 AM on January 18, 2016 [2 favorites]
My parents still like to tell the story of how I was born a week early, so my father's employer-based health coverage hadn't kicked in yet since he had just started working at that job, so I cost $4000 to be born. Whatta country.
posted by chainsofreedom at 7:07 AM on January 18, 2016
posted by chainsofreedom at 7:07 AM on January 18, 2016
It is completely possible to die waiting for treatment in the NHS.
It's possible to die waiting for care anywhere. In the US I waited 3 months for an ophthalmologist appointment that ended up diagnosing something very serious (fortunately the very serious diagnoses came instead of an even deadlier possibility, but had the deadlier possibility been real, who knows what losing that 3 months could have meant). Anyway, why didn't I just go to an ophthalmologist who would see me sooner? Because I had insurance that said I had to go to this one health clinic to start, and that one health clinic had one ophthalmologist. I wasn't allowed to go anywhere else without having to pay for it.
So the reasons for waiting are different. Under single payer systems you're waiting because the doctor who you need or have decided to see is seeing other equally or more urgent patients. Under a non-single payer system (like the UK, which is not single payer since some patients pay privately to get into a whole other line) you wait either because you lack the freedom to see a doctor who can see you sooner or because you are denied access all together.
I would guess that the number of people who die waiting for care in the US is WAY higher than under any single payer system. Make no mistake, people who die because they don't have access to a doctor and wait til things get bad before they make that initial appointment are people who died waiting for treatment. Someone who dies of a heart attack who who never had a GP tell them their blood pressure was high at a regular old non-urgent appointment is someone who died waiting for treatment. A person who breaks a hip and then dies of pneumonia or a blood clot from lying in bed because they never had a bone density test that would have resulted in diagnosing and treating their osteoporosis died waiting for treatment.
Any real statistics on wait times need to include the people waiting "in line" and the people waiting next to the line because they are not allowed in line or are afraid to get in line. I've often said I would love to see something comparative statistics on things like wait time for hip replacements that measure wait time starting from the first day a person avoided walking because their hip hurt AND included everyone in that category -- so the person with no insurance who has limped around for 10 years needs to be counted as a person waiting 10 years for hip replacement surgery, because that's what they are. That's a more honest way of measuring these things and I have no doubt that single-payer would have lower wait times with that less misleading measure.
posted by If only I had a penguin... at 7:14 AM on January 18, 2016 [10 favorites]
It's possible to die waiting for care anywhere. In the US I waited 3 months for an ophthalmologist appointment that ended up diagnosing something very serious (fortunately the very serious diagnoses came instead of an even deadlier possibility, but had the deadlier possibility been real, who knows what losing that 3 months could have meant). Anyway, why didn't I just go to an ophthalmologist who would see me sooner? Because I had insurance that said I had to go to this one health clinic to start, and that one health clinic had one ophthalmologist. I wasn't allowed to go anywhere else without having to pay for it.
So the reasons for waiting are different. Under single payer systems you're waiting because the doctor who you need or have decided to see is seeing other equally or more urgent patients. Under a non-single payer system (like the UK, which is not single payer since some patients pay privately to get into a whole other line) you wait either because you lack the freedom to see a doctor who can see you sooner or because you are denied access all together.
I would guess that the number of people who die waiting for care in the US is WAY higher than under any single payer system. Make no mistake, people who die because they don't have access to a doctor and wait til things get bad before they make that initial appointment are people who died waiting for treatment. Someone who dies of a heart attack who who never had a GP tell them their blood pressure was high at a regular old non-urgent appointment is someone who died waiting for treatment. A person who breaks a hip and then dies of pneumonia or a blood clot from lying in bed because they never had a bone density test that would have resulted in diagnosing and treating their osteoporosis died waiting for treatment.
Any real statistics on wait times need to include the people waiting "in line" and the people waiting next to the line because they are not allowed in line or are afraid to get in line. I've often said I would love to see something comparative statistics on things like wait time for hip replacements that measure wait time starting from the first day a person avoided walking because their hip hurt AND included everyone in that category -- so the person with no insurance who has limped around for 10 years needs to be counted as a person waiting 10 years for hip replacement surgery, because that's what they are. That's a more honest way of measuring these things and I have no doubt that single-payer would have lower wait times with that less misleading measure.
posted by If only I had a penguin... at 7:14 AM on January 18, 2016 [10 favorites]
If you're going to the same medical provider more than once, ask each and every time if they are still in network.
Additionally, if you have an Exchange policy from one of the large insurers (United Health, Anthem, etc), make sure they are specifically in-network for the Exchange policies. I've found doctors who are in-network for the insurer's regular network, but out-of-network for the more limited Exchange network. Same insurance company, different networks.
posted by Thorzdad at 8:48 AM on January 18, 2016
Additionally, if you have an Exchange policy from one of the large insurers (United Health, Anthem, etc), make sure they are specifically in-network for the Exchange policies. I've found doctors who are in-network for the insurer's regular network, but out-of-network for the more limited Exchange network. Same insurance company, different networks.
posted by Thorzdad at 8:48 AM on January 18, 2016
JackFlash: "If it makes you feel any better, there is almost no country in the world that provides government dental coverage for adults. Not Canada, not the UK, not Germany, not Scandinavia. Everywhere it is add-on private insurance or self-payment."
I live in Finland. My dental care is heavily subsidized by the government. So it's not free but very cheap compared to private dentists (never paid more than 60-70 euros, usually much less). Little bit of googling told me that Sweden and Norway have similar systems and also have a yearly payment ceilings (200-300€) after which the care is free. Children and many other groups get their care free.
posted by severiina at 9:08 AM on January 18, 2016
I live in Finland. My dental care is heavily subsidized by the government. So it's not free but very cheap compared to private dentists (never paid more than 60-70 euros, usually much less). Little bit of googling told me that Sweden and Norway have similar systems and also have a yearly payment ceilings (200-300€) after which the care is free. Children and many other groups get their care free.
posted by severiina at 9:08 AM on January 18, 2016
Any real statistics on wait times need to include the people waiting "in line" and the people waiting next to the line because they are not allowed in line or are afraid to get in line.
Yes, this. That's why I said the UK system was still better than the US system.
I'm still haunted by that ask from years ago where someone was asking if she should go to the ER, and we all screamed YES GO TO THE ER. She eventually did, after a very long time, and there's been no activity from her since. At all.
Some years ago, before NHS dentistry lost a substantial amount of subsidy, I was lucky enough to receive treatment on the NHS that isn't normally covered. The dentist in question went entirely private midstream (not affecting the cost of that treatment) and I stuck with him. I took out dental insurance, despite not being able to afford it, because at least that way I would always get dental care despite being in debt. My mother nagged me about it, to the point where one day she came out with the inspired idea, "hey! why don't you *save* for your dental care!" and I had to explain that if I couldn't afford the premiums I therefore also couldn't afford to save (premiums x 5) per month to make sure I had enough money for a six-month checkup. The only possible way that would go would be that I'd give up dental care altogether.
My friend, who earns the national median income, just doesn't have optical or dental care because she can't afford them. End of story.
posted by tel3path at 10:01 AM on January 18, 2016 [2 favorites]
Yes, this. That's why I said the UK system was still better than the US system.
I'm still haunted by that ask from years ago where someone was asking if she should go to the ER, and we all screamed YES GO TO THE ER. She eventually did, after a very long time, and there's been no activity from her since. At all.
Some years ago, before NHS dentistry lost a substantial amount of subsidy, I was lucky enough to receive treatment on the NHS that isn't normally covered. The dentist in question went entirely private midstream (not affecting the cost of that treatment) and I stuck with him. I took out dental insurance, despite not being able to afford it, because at least that way I would always get dental care despite being in debt. My mother nagged me about it, to the point where one day she came out with the inspired idea, "hey! why don't you *save* for your dental care!" and I had to explain that if I couldn't afford the premiums I therefore also couldn't afford to save (premiums x 5) per month to make sure I had enough money for a six-month checkup. The only possible way that would go would be that I'd give up dental care altogether.
My friend, who earns the national median income, just doesn't have optical or dental care because she can't afford them. End of story.
posted by tel3path at 10:01 AM on January 18, 2016 [2 favorites]
I'm still haunted by that ask from years ago where someone was asking if she should go to the ER, and we all screamed YES GO TO THE ER. She eventually did, after a very long time, and there's been no activity from her since. At all.
OMG. I'm going to have nightmares about this. Please tell me that account was never very active before, either. Or maybe after revealing her medical info she decided to get a new account where she could resume her private-pseudonymity without everyone knowing her business. I'm going to cling to that possibility.
posted by If only I had a penguin... at 10:45 AM on January 18, 2016
OMG. I'm going to have nightmares about this. Please tell me that account was never very active before, either. Or maybe after revealing her medical info she decided to get a new account where she could resume her private-pseudonymity without everyone knowing her business. I'm going to cling to that possibility.
posted by If only I had a penguin... at 10:45 AM on January 18, 2016
I'm sorry I can't reassure you. Her last ever activity was a promise to update once she got back from the hospital.
posted by tel3path at 12:14 PM on January 18, 2016
posted by tel3path at 12:14 PM on January 18, 2016
there is almost no country in the world that provides government dental coverage for adults. Not Canada
Dental coverage is enshrined in the federal Canada Health Act, but it's up to the individual provinces to decide whether they want to include as part of a provincial insurance plan. In BC some low income, children, and people with disabilities are covered, if you want to call it that. Other provinces have similar plans to BC's. And, the feds provide dental coverage to some groups as well.
posted by squeak at 3:05 PM on January 18, 2016
Dental coverage is enshrined in the federal Canada Health Act, but it's up to the individual provinces to decide whether they want to include as part of a provincial insurance plan. In BC some low income, children, and people with disabilities are covered, if you want to call it that. Other provinces have similar plans to BC's. And, the feds provide dental coverage to some groups as well.
posted by squeak at 3:05 PM on January 18, 2016
I'm not anti-single-payer but I'm a little skeptical about it and this isn't my fear. My fear is rationing and increased waiting times for specialists and non-emergency procedures. I already have to wait 5 months to see a psychiatrist and I have insurance. I don't see how that's going to be even better on single payer. I suppose one of the furriners can jump in here - without paying privately, how long does it take you to see a specialist? I know Canadians have to go through their GP first. I can see my GP on Tuesday if I call on Monday - can you?
In Canada - Working through these in reverse:
- our Dr's clinic is pretty good; I can generally get an appointment within a few days. If it's more urgent, they will either see me sooner, or direct me to an ER or an Urgent Care center. There are also many walk-in clinics where i can be seen just by showing up, though I might wait an hour or two. AND, there's a phone hotline and a website where I can call, describe my issue, and they'll suggest the best course of action.
- Specialists: depends on the requirement. If the need is immediate, you generally get seen immediately. Cancer, cardiac and other care of life-threatening conditions is fairly prompt. Where the need is less urgent, yes there can sometimes be a wait (eg 6 months to year for a hip replacement). There are mitigating strategies for this: sometimes, if you're willing to travel, they can get you into another region that might have shorter wait times. Another consideration: if you are seeing your Dr regularly (and why wouldn't you?), s/he will be monitoring your need, and will put you into the queue at a reasonable point, so you do get that hip replacement before life is hell. (between them, my Mom and Dad had one hip and two knees done and these were life-changers)
- Psychiatry - it can still sometimes take a long time to get seen by one. But there are many options: emergency cases or crises are handled at the psychiatric equivalent of an ER, there are help lines and counselling services, many GPs are competent with minor or uncomplicated requirements, and psychologists are available privately as appropriate.
- Rationing - Jesus H Christ. No we do not have death panels. My father-in-law, who had numerous health issues including failed kidneys, still got a quintuple-bypass in hours, after a heart-attack at age 82. I've heard of rare cases where if the approved treatment wasn't available in Canada, or wait times were excessive, the Canadian system would pay for that person's travel and treatment in the US.
I cannot imagine living under the US system of health care, even though I am above-average healthy. Single payer universal care is not only morally superior, it's less expensive overall.
posted by Artful Codger at 4:16 PM on January 18, 2016
In Canada - Working through these in reverse:
- our Dr's clinic is pretty good; I can generally get an appointment within a few days. If it's more urgent, they will either see me sooner, or direct me to an ER or an Urgent Care center. There are also many walk-in clinics where i can be seen just by showing up, though I might wait an hour or two. AND, there's a phone hotline and a website where I can call, describe my issue, and they'll suggest the best course of action.
- Specialists: depends on the requirement. If the need is immediate, you generally get seen immediately. Cancer, cardiac and other care of life-threatening conditions is fairly prompt. Where the need is less urgent, yes there can sometimes be a wait (eg 6 months to year for a hip replacement). There are mitigating strategies for this: sometimes, if you're willing to travel, they can get you into another region that might have shorter wait times. Another consideration: if you are seeing your Dr regularly (and why wouldn't you?), s/he will be monitoring your need, and will put you into the queue at a reasonable point, so you do get that hip replacement before life is hell. (between them, my Mom and Dad had one hip and two knees done and these were life-changers)
- Psychiatry - it can still sometimes take a long time to get seen by one. But there are many options: emergency cases or crises are handled at the psychiatric equivalent of an ER, there are help lines and counselling services, many GPs are competent with minor or uncomplicated requirements, and psychologists are available privately as appropriate.
- Rationing - Jesus H Christ. No we do not have death panels. My father-in-law, who had numerous health issues including failed kidneys, still got a quintuple-bypass in hours, after a heart-attack at age 82. I've heard of rare cases where if the approved treatment wasn't available in Canada, or wait times were excessive, the Canadian system would pay for that person's travel and treatment in the US.
I cannot imagine living under the US system of health care, even though I am above-average healthy. Single payer universal care is not only morally superior, it's less expensive overall.
posted by Artful Codger at 4:16 PM on January 18, 2016
I cannot imagine living under the US system of health care, even though I am above-average healthy.
I think this is the key point. Among people who have tried both, which do they prefer. I've heard plenty of people who lived in both Canada and the US (including both Canadians and Americans, so it's not about familiarity) say they prefer the Canadian system. I've read articles by Americans living in other countries, too (France comes to mind) and again, the other country is always preferred.
I've never heard anyone who's used both systems say "Gee, I sure do love the whole in-network/out-of-network, co-pay, deductable, the price-isn't-actually-what-anyone-pays-unless-they're-poor, insurance companies approve or veto this or that, exemptions and lifetime limits, switch doctors every time you get a new job or the insurance company's network changes, limited enrollment periods, filling out forms, getting pointless mail from the insurance company, and talking to friendly CSRs on the phone. The just walk into the doctor's office have your appointment and walk out system really can't beat that."
Count the number of AskMes about accessing healthcare in the US vs. other places. Sure most users are in the US, but the ratio is still WAY out of whack. If the patient experience were really so much better -- even only accounting for people with insurance -- in the US, wouldn't every nutjob conservative politician and source be trotting out people talking about how they'd left the US and came running back for the fabulous insurance experience?
posted by If only I had a penguin... at 5:11 PM on January 18, 2016 [5 favorites]
I think this is the key point. Among people who have tried both, which do they prefer. I've heard plenty of people who lived in both Canada and the US (including both Canadians and Americans, so it's not about familiarity) say they prefer the Canadian system. I've read articles by Americans living in other countries, too (France comes to mind) and again, the other country is always preferred.
I've never heard anyone who's used both systems say "Gee, I sure do love the whole in-network/out-of-network, co-pay, deductable, the price-isn't-actually-what-anyone-pays-unless-they're-poor, insurance companies approve or veto this or that, exemptions and lifetime limits, switch doctors every time you get a new job or the insurance company's network changes, limited enrollment periods, filling out forms, getting pointless mail from the insurance company, and talking to friendly CSRs on the phone. The just walk into the doctor's office have your appointment and walk out system really can't beat that."
Count the number of AskMes about accessing healthcare in the US vs. other places. Sure most users are in the US, but the ratio is still WAY out of whack. If the patient experience were really so much better -- even only accounting for people with insurance -- in the US, wouldn't every nutjob conservative politician and source be trotting out people talking about how they'd left the US and came running back for the fabulous insurance experience?
posted by If only I had a penguin... at 5:11 PM on January 18, 2016 [5 favorites]
Dental coverage is enshrined in the federal Canada Health Act, but it's up to the individual provinces to decide whether they want to include as part of a provincial insurance plan.
Wynne has been making noises about putting all preventive and restorative dentistry into OHIP coverage.
posted by feckless fecal fear mongering at 7:26 AM on January 19, 2016
Wynne has been making noises about putting all preventive and restorative dentistry into OHIP coverage.
posted by feckless fecal fear mongering at 7:26 AM on January 19, 2016
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