On any other Tuesday
January 31, 2018 3:26 PM   Subscribe

On the second Tuesday in June, I start to feel fluish... What I know about the next week is mostly pieced together from what I’ve been told and what’s listed on some of the 100-plus insurance claims filed on my behalf.

Molly Osberg on illness, fortune, and the American health care system.

Molly Osberg previously on MetaFilter.
posted by Iris Gambol (107 comments total) 45 users marked this as a favorite
 
god this is fucking horrifying. idk what i'm going to do or where i'm going to go when my health insurance runs out and i don't like to think about it even briefly because the stress will probably explode my heart and my brain simultaneously.
posted by poffin boffin at 4:00 PM on January 31, 2018 [8 favorites]


Literally nothing in this article - aside from the act of getting sick itself - is anything myself or my Canadian loved ones have been through or have to worry about.
posted by The Card Cheat at 4:01 PM on January 31, 2018 [32 favorites]


Jesus, what an appalling system. I've been through serious illness and can't imagine how much worse adding even financial stress would be, much less the stark choices the uninsured or underinsured have to make. Meanwhile north of the border, last night I walked out of the hospital pharmacy with what an online pharmacy search tells me was $2,189 worth of medication. My out-of-pocket cost was $3.25, for the bus fare.
posted by Homeboy Trouble at 4:05 PM on January 31, 2018 [6 favorites]


My surgeon...doesn’t get involved in insurance-related issues, obviously; he has paper-pushers for that. “What I do know,” he wrote in an email, “is that insurance can limit and make our lives difficult, as they commonly deny patients access and healthcare they deserve.”

Convenient that the surgeon totally ignores that one of the major reasons insurers (for which I have nothing but contempt) deny access are the stratospheric fees surgeons charge for their services. It’s such a vicious circle...doctors blame the insurers, the insurers blame the doctors (and hospitals, pharma, etc.) Repeat ad nauseum.

Last summer, a doctor wanted me to get some imaging done on my chest. I dutifully searched my ACA insurer’s website to find an in-network imaging center. I found one nearby and had the pictures done. Then, I got a rather large bill. It turns out that, while the imaging center was in-network, the radiologist who looked at my pictures wasn’t, even though he worked at the in-network imaging center. After a few very angry calls, I was able to get the bill reduced but, seriously, W.T.F? As if I had any effin’ control over who read my pics? Way to go, free market!
posted by Thorzdad at 4:09 PM on January 31, 2018 [67 favorites]


Jesus, what an appalling system.

Yes, but have you considered that all the paperwork it generates keeps thousands of hard-working Americans employed?
posted by indubitable at 4:13 PM on January 31, 2018 [27 favorites]


It has been, several times, my sad duty to explain how all this works to Canadian friends who have moved to the US, and every time it has taken me *forever* to convince them that I'm serious, that this is really how their health insurance is going to work. Like, they vaguely knew it was going to be bad... but they're always shocked to discover just how confusing and expensive and Kafkaesque it all actually is, and how little is covered compared to what you pay.

Presently I'm living in dread of the bills for a recent procedure. I should be feeling relieved by the fact that the diagnosis now is Apparently Not Cancer, but I'm worried that the insurer will say 'well you didn't need a biopsy then, that was a clear misdiagnosis!' and deny the claim. Despite trying, I could never get even a rough estimate of the procedure's cost, or what the insurance would cover when accepting the claim. I could owe a couple hundred bucks. I could owe a couple thousand! And this is with 'good' insurance.
posted by halation at 4:17 PM on January 31, 2018 [15 favorites]


Thorzdad, I had that happen to me with an ER visit. Hospital: in-network, doctor: out-of-network, me: concussed.

It's a frequent enough situation that my state actually has a law saying that your insurance has to pay up in this circumstance. My insurance did not get that memo and I had to dispute the claim denial. (They did pay after a strongly worded letter citing the law. All of this was possible because of my level of education and privilege, and also the ability to pay the doctor out of pocket while waiting for insurance to step up, thus avoiding the bill going to collection and adding a whole other layer of shittiness to the situation.)
posted by soren_lorensen at 4:21 PM on January 31, 2018 [27 favorites]


There are millions, many millions, of Americans who would read this story, this best possible scenario, and think, yep, this is the system working as designed!

And they’re also generally convinced that the system is zero sum, operating at peak capacity already, so providing treatment to those who can’t get it now would mean that nobody would get this kind of care. Which is a terrible lie they’ve been told so many times that I don’t know how you even combat it.

Healthcare in the US just makes me so sad. I choose to believe that people are mostly misled rather than selfish and cruel, but some days it’s tough.
posted by uncleozzy at 4:26 PM on January 31, 2018 [28 favorites]


I am a small business owner, and I have pretty good health insurance, for which I pay, and my employees have it to, for which I also pay and of course so do they.

I also have a health condition -- epilepsy -- that will rapidly (and hilariously) kill me if I don't take a very specific medication.

My insurance "covers" this medication. By which they mean they pay $14 a month of the $958 a month medication costs me, until about the middle of the year when they suddenly start paying more, and then, some months, when they decide to pay it all and I mysteriously get handed the medication for free. I never know. I just have to have a thousand dollars ready each time I go to CVS. Just in case.

Happily that's something I can do without ending up in the poorhouse. I'm tired of fighting with them or even trying to get a straight answer. I've stopped.

If I didn't have the enormous good fortune to be able to pay that money out of my own pocket when my insurer arbitrarily decides I have to do that, I don't know what I'd do.

Die, I guess.
posted by The Bellman at 4:28 PM on January 31, 2018 [40 favorites]


I hope historical retrospect is able to interpret our system here in the US with the disrespect and horror it deserves. Massive systemic quasi-feudal bureaucratic Russian roulette.
posted by fast ein Maedchen at 4:29 PM on January 31, 2018 [11 favorites]


I had that happen to me with an ER visit. Hospital: in-network, doctor: out-of-network, me: concussed.

People don’t realize that hospitals are pretty much empty boxes where, except for a few nurses, everyone you encounter is actually affiliated with one form or another of an independent medical group. They aren’t hospital employees and, thus, don’t fall under the umbrella of the hospital’s “in-network” status. It’s such a racket.
posted by Thorzdad at 4:30 PM on January 31, 2018 [42 favorites]


The reason that this system persists in the US is that everyone who could change the system has great insurance and simply never hits any of these bumps in the road to recovery. I have pretty good insurance, I got my nearly-exploded gallbladder removed on short notice and I never saw a bill. Well, maybe I saw a couple co-pay bills. And it was completely opaque as to why I got them - they came from some agency that wasn't anywhere I had ever actually visited and they specified very little except how much to pay and where to send the money.

It’s such a vicious circle...doctors blame the insurers, the insurers blame the doctors (and hospitals, pharma, etc.) Repeat ad nauseum.

The way that Canada solves this issue, while seeming logical to Canadians, seems insane even to fairly left-leaning Americans. The government dictates how much you're going to get paid to perform a given procedure. Well, a board of doctors the doctors appoint tells the government what the government is going to pay. I think that's it. But this is basically Chavez nationalizing oil companies and factories in the eyes of Americans. Now, never mind that insurance companies do exactly the same thing (which is why some doctors don't take insurance), when the government does it it's socialism.

Regardless, America still has a lot of pretty good doctors and a LOT of capital to invest in health facilities, something Canada seems to lack. I recall Toronto's hospitals as being pretty beat-up while my local US doctor's office has an immense $1M Dale Chihuly sculpture in the lobby.

Anyway, good luck Americans. Like the author of the article, you're going to need it.
posted by GuyZero at 4:35 PM on January 31, 2018 [14 favorites]


Oh hey, my medical provider even has a blog post about the sculpture.

" Ed Dowd, who donated $4.1 million to build the light-filled atrium, $1 million of which went toward the Chihuly sculpture, entitled Joyous. “I wanted the atrium and the sculpture to convey the dignity, strength, confidence and capabilities of this fine medical organization,” says Dowd who made this gift in honor of his longtime physician Dr. Phil Brosterhous, now chief medical officer at PAMF."

Everyone I've met there seems really nice but it's batshit crazy that they spent $1M on a fucking sculpture, but that's healthcare in the US. The rich get 10x what they need, the poor get Vicodin.
posted by GuyZero at 4:38 PM on January 31, 2018 [27 favorites]


The classic example of the “Surprise! That provider’s our-of-network!” cruel joke is the anaesthesiologist. I’ve had to argue about those on at least four separate occasions. The medical deductibles. The sneak attack billing by people you never saw. And don’t get me started on dealing with those ambulance companies...

Compared to when I lived in France and two of my friends were hispitalized: one with an appendicitis, one with a broken toe. The extraordinary LACK of bureaucratic and financial bullshit they had to endure was astonishing. A real eye-opener.
posted by darkstar at 4:45 PM on January 31, 2018 [14 favorites]


Yeah, I’ll take a somewhat beat-up hospital over a gorgeous one I can’t afford to use.
posted by The Card Cheat at 4:50 PM on January 31, 2018 [37 favorites]


Bah! “out-of-network”
posted by darkstar at 4:53 PM on January 31, 2018 [1 favorite]


My company got brought by another company, who switched us to their single nation-wide insurance provider, meaning I lost my Kaiser coverage that I had been under for a decade plus. And I have been avoiding doing any of the minor but important ongoing health checkups and tests I need to have, because I so dread the nightmare of dealing with an insurance company again, and their endless ability to find a reason why you owe them thousands of dollars.
posted by tavella at 4:54 PM on January 31, 2018 [6 favorites]


Yeah, I’ll take a somewhat beat-up hospital over a gorgeous one I can’t afford to use.

Drop by St Joesph's Health Center (in my old'hood) with a $1M cheque and I'm pretty sure they wouldn't spend it on a lobby sculpture, that's for sure.
posted by GuyZero at 4:54 PM on January 31, 2018 [10 favorites]


I kept waiting for, "But none of this has happened to anyone I know, because I live in a civilized country."
posted by clawsoon at 5:00 PM on January 31, 2018 [3 favorites]


to convey the dignity, strength, confidence and capabilities of this fine medical organization

yeah how about the dignity strength and confidence of not dying in the fucking gutter from a treatable condition because you're uninsured, what about that broseph
posted by poffin boffin at 5:02 PM on January 31, 2018 [38 favorites]


GuyZero: The way that Canada solves this issue, while seeming logical to Canadians, seems insane even to fairly left-leaning Americans. The government dictates how much you're going to get paid to perform a given procedure. Well, a board of doctors the doctors appoint tells the government what the government is going to pay. I think that's it. But this is basically Chavez nationalizing oil companies and factories in the eyes of Americans.

It wasn't logical to Canadian doctors at first; they went on strike for three weeks when Tommy Douglas introduced Canada's first fully socialized medical system, yelling all the while about the slippery slope of socialism.

But they adjusted.
posted by clawsoon at 5:14 PM on January 31, 2018 [32 favorites]


yeah how about the dignity strength and confidence of not dying in the fucking gutter from a treatable condition because you're uninsured, what about that broseph

in palo alto, gutter real estate starts at $1.5 million
posted by indubitable at 5:20 PM on January 31, 2018 [9 favorites]


Absolutely terrifying. Moreso that this is the planned future model for Australian healthcare.
posted by turbid dahlia at 5:20 PM on January 31, 2018 [8 favorites]


when i lived in europe and realized i should probably figure out some kind of medical insurance, i nervously went down to the local winterthur office and explained my situation. the insurance agent was very kind and helpful but sadly informed me that since i was not a legal resident, i would need private insurance as the state would obviously not wish to cover me.

i was totally prepared for this expense and grandly asked to see the best possible plan they had on offer, one that would cover every possible medical condition fully and without exceptions. he gingerly handed me the relevant printouts and apologized for the exorbitant costs of the €60/month plan i immediately signed up for and paid the full year in advance.

the local private hospital which accepted only private insurance plans had a 1:1 patient to nurse ratio and only private rooms, something i never experienced in the US even on my dad's health insurance when he was a vp in big pharma.

sometimes i got prescriptions which were not fully covered by this majestic rolls royce of plans and the pharmacists would regretfully bill me €1,30. i'm sure they wanted to ask me why i was laughing wildly every time they did so but fortunately no one ever did.
posted by poffin boffin at 5:20 PM on January 31, 2018 [134 favorites]


Oh the hue and cry when Tulsa decided it would be cheaper to stop hounding people for money and just charge all the city utility customers a couple bucks a month and leave it at that. If they manage to get an insurance claim paid for your transport, fantastic, if not, the new policy was to just write it off.

The whining about having to pay other people's way was very, very loud. Never mind that the vast majority of their billings were completely unaffected since Medicare and Medicaid don't fight about them so we were barely even paying for the ambulances through the new fee but making everyone in town to have one less thing to worry about.
posted by wierdo at 5:22 PM on January 31, 2018 [9 favorites]


I've been insured all my life, and I've still been one short step ahead of the creditors since I was 14. I will never have the credit to buy a house or car by myself. I guess that doesn't matter, because if I had enough money to do that it would have to go to the old medical bills.

And yes, just like the author, I'm still getting bills from doctors I have no memory of seeing, or who stopped by my room and said, "How are you feeling today? Good, good."

I would try to emigrate, but I've never been able to afford the kind of education that would qualify me to work in another country, because ALL THE MONEY goes to medical bills.
posted by The Underpants Monster at 5:31 PM on January 31, 2018 [12 favorites]


I'm shocked that the health care I'm getting at the local Indian Health Center is better and so much cheaper than the fancy work-provided health care I used to have. But one of the reasons I'm going to file for bankruptcy is the medical bills that piled up between losing that work health care and signing up at the clinic on the reservation.
posted by elsietheeel at 5:49 PM on January 31, 2018 [4 favorites]


The way that Canada solves this issue, while seeming logical to Canadians, seems insane even to fairly left-leaning Americans. The government dictates how much you're going to get paid to perform a given procedure. Well, a board of doctors the doctors appoint tells the government what the government is going to pay. I think that's it.

This seems sane and exactly how it should be. I am a left-leaning American. I would suggest an improvement might be adding a representative council of working-class people to have a similar level of oversight with the docs.
posted by mwhybark at 5:51 PM on January 31, 2018 [13 favorites]


Regardless, America still has a lot of pretty good doctors and a LOT of capital to invest in health facilities, something Canada seems to lack. I recall Toronto's hospitals as being pretty beat-up while my local US doctor's office has an immense $1M Dale Chihuly sculpture in the lobby.

So I got really sick over the holidays, necessitating an ER visit on Christmas Eve, said ER (St. Michael's) being a little on the beat up side, and a busy downtown Toronto one to boot. Also under construction. Anyhow.

Rather than a Chihuly in the lobby, they did have naloxone kits. I found this out when a gentleman came in off the street and popped his head over my shoulder while I was giving my particulars to the triage nurse and asked her if they had any kits left.

They did, and he was given one, no questions asked, no charge, and off he went. Hopefully he or one of his friends didn't need to use it that night, but at least he had one just in case.

I liked the free naloxone kits better than the idea of sprucing up the (admittedly beat up) waiting room with Chihuly.

Oh, and. The time between arriving and getting a bed in the ER and hooked up to an IV while waiting to be seen by a doctor? About ten minutes.

When this was all said an done with, including two follow-up appointments and further testing, I was out of pocket $5.27CAD, for a prescription my work drug coverage mostly handled. Had I been on the hook for the full amount, it would have been about $30.

People who want to dissuade you from single-payer insurance or public health care want you dead. But only after they've made as much money off your suffering as they can.
posted by mandolin conspiracy at 5:52 PM on January 31, 2018 [88 favorites]


The reason that this system persists in the US is that everyone who could change the system has great insurance

This part is changing very rapidly. I work at an international megacorporation where few people make less than six figures, and HR is pushing everyone into a high-deductible minimal-coverage non-health-insurance plan. (Real health insurance is still available if you check the right box and pay a little extra, but many people haven't figured that out yet, and it will probably go away.) More and more upper-income families are discovering the joys of the terrible system that others have been dealing with for decades at this point. I think it's only a matter of time before they start advocating for single payer en masse.
posted by miyabo at 6:07 PM on January 31, 2018 [14 favorites]


I would suggest an improvement might be adding a representative council of working-class people to have a similar level of oversight with the docs.

You think doctors - DOCTORS - are going to take oversight from civilians? No. Trump will nationalize Exxon first.

I liked the free naloxone kits better than the idea of sprucing up the (admittedly beat up) waiting room with Chihuly.

In fairness, most US medical centers look more-or-less like St Mikes or St Joes and lack multi-million dollar lobbies, but the ridiculousness of it never fails to amaze me.
posted by GuyZero at 6:09 PM on January 31, 2018 [1 favorite]


The government dictates how much you're going to get paid to perform a given procedure.

Yeah, sane healthcare systems need strong government controls. Healthcare does not work as a "free market".

The important point isn't single payer vs. insurance mandate, it's government control vs not. Japan does not have single payer, but it has a functioning healthcare system because of strong government intervention. (Germany is similar, to my understanding).

Given how half of Americans think of government (as an evil monster that should be destroyed), it's tough to imagine how this will be fixed.

It's equally tough to explain this to people from other countries, as people have noted. My wife is still quite shocked at how it works here, and can't understand why so many poor people vote against healthcare. I (and therefore she as well) have a "cadillac" health plan through my employer so I'm one of the very lucky few, but I know so many people who have had nightmares with the health system. Given the amount of healthcare I use, I'd be one of them were it not for my job.
posted by thefoxgod at 6:10 PM on January 31, 2018 [14 favorites]


In fairness, most US medical centers look more-or-less like St Mikes or St Joes and lack multi-million dollar lobbies, but the ridiculousness of it never fails to amaze me.

Oh, no argument with you. I checked out the photos you posted. That's fuckin' bananas, but results not typical.
posted by mandolin conspiracy at 6:21 PM on January 31, 2018


...a "cadillac" health plan through my employer

I think we should not legitimize the GOP bullshit labeling of half-decent coverage as "Cadillac" insurance.
posted by thelonius at 6:32 PM on January 31, 2018 [13 favorites]


Yeah, thats fair. It's the kind of insurance everyone should have.

As an example, the copays I have on care are comparable to the total uninsured cost in Japan. When I showed my wife what the actual full charge was (much more than 10x) she asked how anyone affords it (in a "I don't even understand how this could be true" tone).

Indeed.
posted by thefoxgod at 6:37 PM on January 31, 2018 [6 favorites]


Reading this article right after my partner did something to their back that's left them in intense pain is... great. It's probably just a sprain (all they did was twist at a weird angle), but if it's not...

We still haven't paid off the LAST emergency bill, from August, when they had unexplained intense stomach pain. Doctors never figured out what it was or did anything to alleviate the pain but we owe them 3k now, so that's fun I guess. Which in the face of some of these medical bills really isn't a lot, but it's almost two month's pay for me. My budget doesn't stretch that far.

Unfortunately Canada hates disabled people so I can't even dream of someday escaping to somewhere with better healthcare.
posted by brook horse at 6:37 PM on January 31, 2018 [4 favorites]


Another Canadian chiming in with a polite wtf?

This sounds barbarous. Isn’t it the standard in modern industrialized nations to fund universal health care as a basic human dignity? And the richest nation among us doesn’t do this for its people???

Holy smokes.

(Wife is an athlete in a brutal team sport. I have seen many of her sportmates broken and then fixed over the years, and the support they received on a timely basis. We live rurally. Lots of experience with the underfunded end of health care, didn’t know it could be that bad!)
posted by Construction Concern at 6:41 PM on January 31, 2018 [3 favorites]


And the richest nation among us doesn’t do this for its people???

Screwing people over is part of how it got so rich.
posted by The Underpants Monster at 7:00 PM on January 31, 2018 [35 favorites]


Yet another Canadian chiming in to say that the doctor's offices I go to in the US--with more regularity than I would prefer, all things considered--look exactly like those I used to visit in Canada except that here, after a month or so, I get a bill for an amount of money that is essentially random, as far as either myself or my spouse (both with science PhDs) can predict.
posted by quaking fajita at 7:04 PM on January 31, 2018 [9 favorites]


Long gone are the days where I can't imagine that I wasn't born in the "best" country on the planet.
posted by KleenexMakesaVeryGoodHat at 7:17 PM on January 31, 2018 [4 favorites]


More and more upper-income families are discovering the joys of the terrible system that others have been dealing with for decades at this point. I think it's only a matter of time before they start advocating for single payer en masse.

Or they'll just blame the shitiness on Obamacare.
posted by MikeKD at 7:31 PM on January 31, 2018 [4 favorites]


Ug. For a variety of reasons all this shit is coming down hard on my wife and I this week. It’s a long messy story, as all US health care stories are, but the short of it is that both of us are poor people doctors and we are being badgered in very real material ways to work harder and make more money by administrators in suits who have no regard for patient safety or service. The whole conversation at dinner was about how the choice facing us right now is become part of the meat grinder money machine or leave medicine. I’m strongly leaning towards leaving medicine. It’s clear that if you hold onto any kind of personal mission about doing the right thing, they are going to stream roll you. It’s long past time for doctors and nurses who care to push back, HARD. I mean, I guess I’ve been doing this for years, but now my career is literally on the line and I’ve got fuck all to lose.

The reason that this system persists in the US is that everyone who could change the system has great insurance and simply never hits any of these bumps in the road to recovery.

Honestly, it’s more that the people who care about saving lives and public health don’t have a seat at the table. All important health care decisions are made by executives within hospitals and multi specialty groups arguing with executives at insurance companies, and it’s all about money with no one ultimately giving a fuck about the purpose of health care. And so far there’s enough doctors getting rich off this, that there’s no unified block of them to stand up. It’s true that most of us, even the neurosurgeons and cardiologists, aren’t very involved in the insurance mess. We can’t be, we don’t have time. All the doctors see is their paycheck and their workload. In primary care, even if I could ignore what’s in my patients’ best interest, the paycheck:workload ratio has worsened every year and for my own sanity I have to look around and wonder why. I’m now 16 years into practice, and my income in actual dollars this year (not inflation adjusted) is *less* than my first year in practice while my work hours have never been higher.

I don’t expect anyone to feel sorry for me, I get to do an amazing job and I’m financially ok right now, but I just bring it up to say that all the shit that’s causing people to die and get financially ruined is also imploding on the inside and starting to destroy the people who actually do the work of medicine.

Fuck capitalism y’all.
posted by Slarty Bartfast at 7:35 PM on January 31, 2018 [64 favorites]


All important health care decisions are made by executives within hospitals and multi specialty groups arguing with executives at insurance companies, and it’s all about money with no one ultimately giving a fuck about the purpose of health care.

yeah, capitalism exactly. capital does not exist to serve human needs, it exists to grow capital. even those executives are merely managers of capital, subject to the peculiar pressures of the faceless, abstract system just like everyone else.
posted by indubitable at 7:48 PM on January 31, 2018 [13 favorites]


These days, It seems like every bit of news I hear from the US makes me think about the way Deadwood ended.
posted by bonobothegreat at 7:56 PM on January 31, 2018 [4 favorites]


brook horse: "Unfortunately Canada hates disabled people so I can't even dream of someday escaping to somewhere with better healthcare."

Believe me, I hear you. We're working on it, so don't give up on us yet. posted by Secret Sparrow at 7:58 PM on January 31, 2018 [9 favorites]


everyone you encounter is actually affiliated with one form or another of an independent medical group

In California it's actually against the law for hospitals to hire physicians directly. The only exception is for the 34 rural critical-access hospitals covered by Assembly Bill 2024.
posted by jesourie at 8:03 PM on January 31, 2018 [2 favorites]


I don't even want to imagine what would have happened to me and my family if I'd had the poor luck to be born in the U.S. instead of Canada. I spent the first several months of my life in a Neonatal Intensive Care Unit - that costs roughly a million dollars.

I'm incredibly grateful for the healthcare my country provides, and still I think we deserve more: universal pharmacare, optical, dental, physiotherapy, better access to mental health care, improved home care for the elderly, more financial support for people who are disabled, etc...
posted by Secret Sparrow at 8:19 PM on January 31, 2018 [6 favorites]


In California it's actually against the law for hospitals to hire physicians directly. The only exception is for the 34 rural critical-access hospitals covered by Assembly Bill 2024.

I mean, that's the law. But the reality is more of a "wink, wink" separation between the insurance co, the doctors, and the hospital. When I go to the ER at my local Kaiser Permamente, I'm technically walking into a building owned by the Kaiser Foundation of Hospitals, to see a doctor that belongs to The Permanente Medical Group, to receive services paid for by the Kaiser Foundation Health Plan. But it's really just "Kaiser".

Specifically, I pay $75 to get admitted and I never even see a piece of paper for any of transactions of the three parts.
posted by sideshow at 8:29 PM on January 31, 2018 [4 favorites]


Kaiser certainly isn't perfect, but they provide good care to tens of millions of people at significantly lower cost than other providers (about 25% less on average last time I checked, and increasing more slowly). HMOs got a bad reputation in the 90s for reasons I don't fully understand though, and most Americans are afraid of them now.
posted by miyabo at 9:17 PM on January 31, 2018 [8 favorites]


I worked for Kaiser 15+ years ago (and remain a Kaiser member now, 25 years later, for my own and my spouse's healthcare), and my impression was that the distinction between the not-for-profit side (Kaiser Foundation Hospitals/KFH, Kaiser Foundation Health Plan/KFHP) and the for-profit side (The Permanente Medical Group/TPMG) was largely imposed by outside forces. If a practitioner is trying to exploit the system for all they can get, signing on with a mostly-not-for-profit system doesn't seem like the most lucrative option.
posted by Lexica at 9:26 PM on January 31, 2018 [1 favorite]


These days, It seems like every bit of news I hear from the US makes me think about the way Deadwood ended.

There are two senses, both quite apt, in which this may be taken.
posted by thelonius at 10:02 PM on January 31, 2018 [1 favorite]


I went without health insurance for ten years, and her kind of a story was what I thought about all the time.

I'll tell a true story with some kinda gross details (fair warning for the very faint of heart).

Just after Christmas, I got insanely, brutally sick. I've never sicker in my life. I was projectile vomiting, projectile, uh, rear end. Violently sick every few minutes for 8 hours straight. I started passing out. I desperately wanted to go to the hospital, but we were terrified about having to pay. All I could think about was when a friend's uncle went to the hospital and ended up costing his family hundreds of thousands of dollars.

So it was that during the single most terrifying experience of my life, I felt like I had no recourse whatsoever. I had to weigh my own comfort against the real concern that I'd be in debt for the rest of my life. So I sucked it up and suffered through it.

I did nothing but drink water and pedialyte after that. I didn't pee for two full days. On the third day I shit some weird flakes of black stuff. I called a friend, a nurse, and asked him what that meant. He said it was probably not a good sign. I didn't eat solid food for about a week. I just hung out watching stupid TV (I watched pretty much the entire Twilight Zone marathon around New Year's). I'm not sure exactly how much weight I lost, but it was between 15 and 20 pounds. But I recovered, physically.

For the next few months, I was scared to leave the house. I kept thinking I would get sick like that again and have nowhere to go. Some days I'd be OK, but some days I'd get a little ways out and have to turn around because I started feeling nauseous. I got wildly obsessive-compulsive. There were times that I would cook entire meals for myself and then reluctantly throw them in the trash, because I wasn't sure if I'd made some mistake that might make me sick again. I started seeing a psychiatrist, who prescribed me Xanax, but I was paying out of pocket and couldn't afford any more (fun fact! That medical debt is still on my credit report).

Years later, when I went in for counseling at the free clinic, they diagnosed me with PTSD. I'm still wildly obsessive about food. People don't want me around when they're cooking. They tease me about how something is really totally fine to eat. I've cried because I knew something was probably safe to eat, but I still couldn't trust it. Sometimes I just couldn't know for sure that I wouldn't get sick again. Even now, my single biggest fear is that I'll get sick like that again. It literally dominates all my thoughts. My girlfriend knows what I mean when I say "I can't get sick again."

The truly agonizing thing about this story is that I don't even think I was all that sick, in the grand scheme of things. I mean, I was violently ill, but it's not like I went into a coma. Maybe I just had norovirus, or something. But I had absolutely no safe place to retreat to. Looking back, I probably could have gone to the hospital and just argued that I couldn't pay. But I didn't know that then. So I also feel sort of guilty about it all, that it was just my stupidity or ignorance that kept me from going ("everyone knows you can got to the ER for free!"). What a fucked up country to live in where you get violently ill and refuse to see a doctor because you think you're going to bankrupt your whole family. Even if I was mistaken at the time, only here would that be remotely plausible.

When I started going to my university in 2015, I finally got real insurance, where I could go see a doctor any time, not some clinic on the other side of the city that I couldn't get to. I went to the doctor like 30 times in the first couple years. Slightest problem, hey, I can get attention and it only costs $15 each visit! I don't go as often now. Here and there I found faults. I have stomach issues, but it's a $300 copay to get an endoscopy. I've been getting massive headaches, but it's a $300 copay for an MRI. And the thing is, I can pay for the MRI without being homeless, but I have to seriously weigh whether it's truly necessary to get one. There's nothing more aggravating than paying through the nose for a medical test that comes out negative, even when that should be good news. You never want to spend $300 to go back to the drawing board.

Anyway, this is where I'm at now. I got off kind of easy in one sense, because I never had systemic organ failure like this author did. In another sense, I've been carrying this with me for seven years now., and I can tell you that it sucks. I'm especially angry that this is one of millions of stories that wouldn't make any sense in literally any other country. Only in this shitty place would I be stuck with this shitty burden.
posted by shapes that haunt the dusk at 1:31 AM on February 1, 2018 [27 favorites]


Whoops, somehow I deleted the part where I said "just after Christmas 2010." That all happened more than seven years ago.
posted by shapes that haunt the dusk at 1:41 AM on February 1, 2018


This is triggering for me. Not because of my chronic health issues, but that my auditor-and-systems-analyst experience has shown me that it's a case of "shooting yourself in the foot". We have the IT infrastructure ( The VA's Vista platform ) and we have the payment infrastructure ( Universal Medicare ) and every g-ddamned "negative outcome" story we hear about DOES. NOT. NEED. TO. HAPPEN.
posted by mikelieman at 1:47 AM on February 1, 2018 [6 favorites]


I’m now 16 years into practice, and my income in actual dollars this year (not inflation adjusted) is *less* than my first year in practice while my work hours have never been higher.

This is the vampirism / parasitism of late stage capitalism in action. I know it sounds overly dramatic but seriously, FFS, I want to see all these useless MBA suits up against the wall. The only value they bring to anything is marketing and spin and it is not worth the obscene skimming they are doing off the top.

I am not anywhere near your level of professionalism, but similar deal: I made more money (in dollars, not inflation adjusted) when I started work as a teacher trainer 18 years ago than I do now.

Supposedly the economy has been growing exponentially since all of these "efficiencies", but it is all sucked away by the parasitical capitalist classes while people doing useful and productive work are getting ground down.

I am a tail end baby boomer (1968) so I have always thought of it as "them", not "us", but man what a shameful shitty job this age cohort has done on the world. I pray that the new people will get woke and get behind socialism, because capitalism is completely fucking broken.
posted by Meatbomb at 1:55 AM on February 1, 2018 [5 favorites]


If you want to see where all that shiny, shiny GDP is going you can have a look at the GINI coeffcient for inequality in income distribution and how the US stacks up against the competition (spoiler: not great).
posted by Harald74 at 2:09 AM on February 1, 2018 [2 favorites]


The classic example of the “Surprise! That provider’s our-of-network!” cruel joke is the anaesthesiologist. I’ve had to argue about those on at least four separate occasions. The medical deductibles. The sneak attack billing by people you never saw. And don’t get me started on dealing with those ambulance companies...

My favorite two personal examples of this was when I broke my foot. I took pains to consult with my regular (in-network) doctor, who took pains to refer me to an in-network x-ray technician, followed by an in-network orthopedist. And then gave me a list of in-network physical therapists from which I could choose one for follow-up care.

However.

1. When I went to speak to my insurance company about getting a form for the physical therapist, they rejected my initial choice for being "out of network". I asked what they meant, pointing out that my doctor had given me a list of in-network physical therapists. They agreed that I had selected someone from the list my doctor had given me, but they added that there was a second, additional list, which my physical therapist also had to be on - a list about which my own doctor knew nothing. Fortunately, they were able to send me that list - there was enough of an overlap that I was still able to pick someone, but I still don't know why they didn't share that list with my doctor.

2. When I was at the orthopedists, it was ascertained that I'd only need a boot cast for a few weeks; they put one on me and I hobbled around a bit, my orthopedist and I realized that it would do me fine and I wouldn't need a cast. Hooray! As my orthopedist stepped out of the room to write up the "prescription" for that, a hospital billing rep sat down with me and broke it to me that: my orthopedist was in-network for my insurance, and so was the hospital we were sitting in. However - the company that made the cast was not in my network, and so she wanted to know how much of my deductible I'd used.

I hadn't reached my deductible yet. She winced a bit, and then fortunately said - "yeah, so we have two options. Number one - we use your insurance, and you'll get charged about $500 for the cast since you haven't reached your deductible yet."

"YOU'RE KIDDING."

"....Or.....we pretend you don't have insurance and you only pay $100." It seemed that they had that option for people becuase they thought that that surprise was stupid.


As for the emergency-room insurance surprises - back in 1996 I was brought to St. Vincent's hospital because of an emergency-surgery situation. A couple weeks later I got a hefty bill for it; but I had insurance, and called the company to ask what the hell. "...Well, St. Vincent's is out of network and you don't have a referral."

Fortunately I was brought in for emergency surgery to help with ovarian torsion, which is dramatic, alarming, and icky enough that when I ranted that there wasn't any way I could have called my doctor for a referral at 2 am on a Saturday, and I had a twisted ovary that they needed to fix right away so there was no time, the guy on the phone was creeped out enough that he just said "uh....yeah, you're right, we'll drop all the charges" fast just to get the hell off the phone.
posted by EmpressCallipygos at 4:42 AM on February 1, 2018 [16 favorites]


Regarding chihuly sculptures as some kind of sign of the awfulness of medical care in the US:

Mayo Clinic has a chihuly sculpture.

My trans-related surgery cost 73 thousand dollars and my bill: 53 dollars.

But that’s because everyone who works at Mayo works FOR mayo and I as the patient really really did appreciate getting to recover in basically a fucking beautiful art museum. For cheap.
posted by Annika Cicada at 4:59 AM on February 1, 2018 [11 favorites]


So I'm an American living in the UK long-term (and with any luck at all, permanently). Even after ten years, I still run into the occasional British person asking me "Oh god, why would you want to live here?".

I'm gonna print this out and keep copies of it to show those people.
posted by Mr. Bad Example at 5:11 AM on February 1, 2018 [10 favorites]


My sister was a paramedic and is now an ER nurse at a busy teaching hospital with cutting edge tech. She has insurance and the hospital takes care of its own. And yet there's a list of traumas she's given her husband that if they befall her, he's to let her die because the alternative would bury him and her kids in debt until their own deaths.

I think that says a lot about the American health system.
posted by 80 Cats in a Dog Suit at 5:32 AM on February 1, 2018 [12 favorites]


I live in the USA. I have "good" insurance. My employer offers a choice of three plans. I choose based on the max out-of-pocket number rather than the deductible. Max out-of-pocket is the true cost; they will get every dime of that max out of us. It turns out there is a loophole in the out of pocket max that it doubles for out of network providers. I am conscientious about picking in-network providers and I have never actually been sick enough to be hampered in trying to manage the stuff. Even so I end up with substantial out-of-network bills, as well. Stealth out-of-network stuff is everywhere and no matter how you try you can't avoid it.

My doctor wants me to have an MRI. These MRIs cost me thousands out of pocket, every time. I am refusing to have it.

We are currently doing our taxes. Medical expenses are deductible if they are more than 7.5 percent of income. So I am having to dig into all this paperwork to figure out what the total is, and pretty sure it'll be worth the paper chase to get this deduction.

So yeah, ticking all the boxes. "Good" insurance. Paying more than 7.5% of income for medical stuff despite having good insurance and not even being dramatically sick. AND not getting specific medical care the doctor recommends, because I can't afford it.

And I'm one of the lucky ones.
posted by elizilla at 5:38 AM on February 1, 2018 [3 favorites]


I am a tail end baby boomer (1968)

You are Gen X, homeslice.
posted by thelonius at 5:52 AM on February 1, 2018 [21 favorites]


Last summer, a doctor wanted me to get some imaging done on my chest. I dutifully searched my ACA insurer’s website to find an in-network imaging center. I found one nearby and had the pictures done. Then, I got a rather large bill. It turns out that, while the imaging center was in-network, the radiologist who looked at my pictures wasn’t, even though he worked at the in-network imaging center. After a few very angry calls, I was able to get the bill reduced but, seriously, W.T.F? As if I had any effin’ control over who read my pics? Way to go, free market!

In the US, on any issue involving money, the default position is to steal your savings and assets, sometimes to the point of bankruptcy or homelessness. That is the default position, always, so expect to either raise hell (w or w/o lawyers) or be screwed over, because common sense protections have been declared by government (aka wall street) to be unpatriotic.

And I agree that doctors dodge responsibility. They are just as culpable as lawyers, insurance companies, lobbyist, and politicians. It's a rat's nest of greed and corruption.
posted by Beholder at 5:52 AM on February 1, 2018 [2 favorites]


My sister was a paramedic and is now an ER nurse at a busy teaching hospital with cutting edge tech. She has insurance and the hospital takes care of its own. And yet there's a list of traumas she's given her husband that if they befall her, he's to let her die because the alternative would bury him and her kids in debt until their own deaths.

I think that says a lot about the American health system.


This is terrifying.
posted by Beholder at 5:57 AM on February 1, 2018 [6 favorites]


I am a tail end baby boomer (1968) so I have always thought of it as "them", not "us", but man what a shameful shitty job this age cohort has done on the world. I pray that the new people will get woke and get behind socialism, because capitalism is completely fucking broken.

Capitalism isn't broken. It's working exactly as intended. Anyway, I have to stop reading/posting in this thread. It's literally making me ill.
posted by Beholder at 6:01 AM on February 1, 2018 [4 favorites]


While it pales in comparison to the horror stories in this thread; I'll never forget when a buddy of mine (both of us Canadians) passed out in a service station in Oklahoma and when he woke up in the ambulance the EMT asked him "Which hospital he wanted to go to?". "Uh, the closest one?" Like what kind of question is that? Wasn't until we got talking with the hospital people that we found out why.
posted by Mitheral at 6:07 AM on February 1, 2018 [8 favorites]


Isn’t it the standard in modern industrialized nations to fund universal health care as a basic human dignity? And the richest nation among us doesn’t do this for its people???

And, therein, lies the essential schizophrenic nature of the image of America so many citizens hold (and politicians exploit.) On one hand, "Fuck, yeah! America! Greatest, richest nation evar!" On the other hand, "There's just not enough money to go around, so we simply must limit vital services."
posted by Thorzdad at 6:10 AM on February 1, 2018 [5 favorites]


I have three insurance plans I can choose from through work. I have the one with the highest premium and lowest deductible ($2000) because I have several chronic health conditions. I just never know when they're going to decide to apply the deductible. Like right now, I KNOW I have a sinus infection and I KNOW I have something funky going on with my inner ear that's made the last few weeks miserable. I've already had my GP look at my ear during my physical last month, so I know the next step is seeing an ENT. But the long January rained down a heap of unexpected financial things, so I've been avoiding the ENT because I don't know if it's going to cost me the $25 specialist co-pay, or if I'm going to get a surprise $800 bill for whatever tests they need to do.

On the other hand, I usually meet my deductible by June, so the second half of the year is when I schedule all my specialist visits and expensive tests and stockpile my migraine meds ($25 for 6). If I had a third hand, I'd use it to point out that I haven't actually paid my deductible bills in three years because I've spent most of that time on unpaid medical leave and I just got a lawyer's notice I need to deal with, and I'm one of the lucky ones.
posted by Ruki at 6:40 AM on February 1, 2018 [2 favorites]


Slarty Bartfast: It’s a long messy story, as all US health care stories are, but the short of it is that both of us are poor people doctors and we are being badgered in very real material ways to work harder and make more money by administrators in suits who have no regard for patient safety or service. The whole conversation at dinner was about how the choice facing us right now is become part of the meat grinder money machine or leave medicine.

I don't want my doctor thinking about billing procedures and balance sheets. I want them thinking about medical best practises. I want them thinking about my medical problems. How many medical mistakes are made by the best, most caring and dedicated doctors because of the cognitive load of tracking which specialists are "in-network" and how much of a financial burden they might be subjecting their patients to?

A doctor should be free to care about the physical and mental health of their patients without having to worry whether they're bankrupting their patients.
posted by clawsoon at 6:59 AM on February 1, 2018 [6 favorites]


Tangential: Can anyone direct me to an explanation of the argument for universal health care as a basic human dignity? I'm going to be teaching a bioethics class and I don't expect all of my American-raised students to have this intuition. Some days, American-raised I don't even have it, although I don't need the intuition as I have the commitment.

Just. There's this whole American individualism, "we're all on our own", "your misfortune is not my problem" way of thinking that I want to get past and its one of the only areas where I feel like people either get it or don't, and we don't do enough actual scaffolding to make people understand why someone else's medical problem is something I should help pay for.

Again, *I* am not a barbarian. I believe in universal health care. I just don't feel like I am familiar enough with the underlying justification to make the case to others, and I'd like to be better at it.

Thanks!
posted by allthinky at 7:04 AM on February 1, 2018 [3 favorites]


Allthinky: I saw a rant by a Canadian conservative in the National Review comments section recently that you might find helpful. I didn't find it when I looked just now, but the bit that stuck out for me was comparing medical care to the military. The military doesn't pick and choose which Americans it's defending; it defends all of them. Likewise, the medical system shouldn't pick and choose which Americans it defends against disease and disaster; it should defend all of them.
posted by clawsoon at 7:16 AM on February 1, 2018 [10 favorites]


I think of universal healthcare as an aspect of freedom - you should have the freedom to not die from an easily treatable disease and the freedom to not bankrupt your family because you needed surgery. There's the ideal of American individualism but there's also the ideal of American equality- that *everyone* has a chance to work hard and make the life they want. Those without healthcare don't have that chance if they have crushing medical debt or have to live with illness because they can't afford to get treatment.
posted by TheLateGreatAbrahamLincoln at 7:56 AM on February 1, 2018 [5 favorites]


Those without healthcare don't have that chance if they have crushing medical debt or have to live with illness because they can't afford to get treatment.

Yeah, but in America if you get sick, it's your fault. (Except for me. When I get sick, it's just bad luck.) God is punishing you. You didn't eat enough whole grains. You should have had more positive thoughts. You shouldn't work so hard. Or, you should have worked harder and been more self-sacrificing. You should have eaten goji berries when I told you to.

Or even more insidious: God is giving you some kind of fucked-up booby prize from which you are supposed to learn valuable life lessons. Your suffering makes me question my belief in an all-powerful loving God so shhhhhh just suffer and don't talk about it.

Until we jettison all of this obnoxious religious and quasi-religious magical thinking we won't get anywhere with health care.
posted by soren_lorensen at 8:05 AM on February 1, 2018 [13 favorites]


It's right in the Declaration of Independence: "life, liberty, and the pursuit of happiness."
posted by cooker girl at 8:09 AM on February 1, 2018 [4 favorites]


It's strange, the way I was taught "there, but for the grace of God, go I", back in pre-Thatcher England, that was the moral base of the NHS and the whole social security system. Now I can't find anything on the webs that supports that memory. A distant memory of what a small girl heard from her history teacher is hardly an argument, but there you go.
posted by mumimor at 8:20 AM on February 1, 2018 [1 favorite]


It's right in the Declaration of Independence: "life, liberty, and the pursuit of happiness."

It's also in the Preamble to the US Constitution, to "promote the general welfare", as a reason that the whole constitutional form of government for the country was established. There is nothing more fundamental to the "general welfare" of a country's citizens than their basic health.
posted by darkstar at 8:32 AM on February 1, 2018 [6 favorites]


Man who won $1M New York Lottery game dies weeks later

One of the first things this guy did after winning the lottery was to visit a doctor, because he hadn't been able to afford to earlier. He was diagnosed with stage 4 cancer :(
posted by sevenyearlurk at 8:37 AM on February 1, 2018 [11 favorites]


Why The U.S., One Of The World’s Richest Countries, Struggles With Diseases Of Poverty
Back when the US became the leader of the free world, after WW2, all countries had this type of problems. I clearly remember visiting extremely poor families with my grandmother in Denmark, and I remember having friends living in poverty in rural England. But with help from the US, most Western countries solved these problems, introducing universal healthcare and social security. What the US did for us, they didn't do for themselves.
The USSR played this game too. Cuba famously has excellent healthcare for all, and exports it to the whole world.
The American approach is unique, in the worst way.

Apart from the ethical aspects of this, there are obvious economic aspects of universal healthcare: you will have a larger workforce and fewer dependents. Entrepreneurship is easier. And the big thing: the cost of healthcare will go down. All countries with universal healthcare have lower costs than the US.

The next big thing is preventive care. And countries with universal care are better prepared for implementing preventive care than those without, since universal healthcare by default has access to more citizens.
posted by mumimor at 8:56 AM on February 1, 2018 [4 favorites]


The whole conversation at dinner was about how the choice facing us right now is become part of the meat grinder money machine or leave medicine. I’m strongly leaning towards leaving medicine.
posted by Slarty Bartfast


A doctor friend of mine was pretty much in the same position. He rejoined the Army to serve as a physician (he'd been a junior officer out of college, then went to med school after his service). I'm not suggesting that you should join the army; I'm suggesting that a lot of doctors share your feelings.
posted by workerant at 9:06 AM on February 1, 2018 [1 favorite]


I spent yesterday afternoon (and will spend tomorrow afternoon) volunteering at a Remote Area Medical clinic being held in Knoxville, TN. Thousands of people come to these clinics to receive free healthcare; many of them drive hundreds of miles, sleep in their cars and spend several days waiting for care. I probably don't need to say this, but the people willing to do this are very desperate.

I talked to twentysomethings who have terrible vision but can't afford glasses. There are people waiting to have the last of their teeth pulled and a set of dentures made, because there's no way they could buy that for themselves. There's a women's health mini-clinic, providing PAP tests and pelvic exams and contraception. There are old people and little children. Church ministries donate food and water for the patients, caregivers and volunteers.

Seeing this kind of desperation close-up is humbling and enraging. We are failing so many of our countrymen in such a fundamental way that it seems premeditated.
posted by workerant at 9:16 AM on February 1, 2018 [13 favorites]


Civilized healthcare : American medical system
Civilized military : ?
posted by clawsoon at 9:35 AM on February 1, 2018


workerant...The really sick thing is that many conservatives/libertarians will point to all of that volunteer healthcare and pronounce it as proof that the American system works. That people will find a way and there's no need for government involvement.
posted by Thorzdad at 11:28 AM on February 1, 2018 [6 favorites]


About a year ago, I got a little sick. I mean, it was just a boil on my scrotum. Had it before. Know what to do. You know how it goes when you get one of these skin things.

Except.

I had been laid off earlier in January, and due to the magic of how the insurance worked, I wouldn't have insurance until March 1. So here I am in February, unemployed. And this boil just got larger and more painful. It began to express, but slowly, and didn't get smaller. So I went to urgent care and they gave me antibiotics. And... it still didn't help. And it got more painful.

I go to a different urgent care - this one a 24-hour one - and the guy takes one glance at my bits and goes "We're refunding you your money, go to the ER now." So I went. Turns out that a second bacterium had gotten in there and I now have Fournier's Gangrene. At 11:30 PM on a Saturday night, I get rushed into surgery to deal with it. I am in the hospital until Wednesday. I spend Sunday and most of Monday on a triple-antibiotic cocktail that makes me nauseous and unable to eat anything at all for most of Monday. I get diagnosed as a full-on you-need-to-take-shots diabetic, just to add to the fun of it. And then they discharge me and tell me I have to come back in three weeks to get the skin sewn back together, as there's a hole in me about two inches across.

I have no insurance. But they did it anyway because I came in through the ER.

I currently am in default for about $90,000 in medical bills. I will probably never be able to pay them off.

And there are people out there who say that it might have been better if I died than ran up that debt. To those people, and people who want to dismantle Medicaid and Medicare and think there's something wrong with single-payer and that for-profit medicine is the only way things should be, I say:

Go fuck yourselves up the urethra with a cactus.
posted by mephron at 12:25 PM on February 1, 2018 [35 favorites]


One of the first things this guy did after winning the lottery was to visit a doctor, because he hadn't been able to afford to earlier. He was diagnosed with stage 4 cancer :(

If the next Democratic National Convention just spent two nights reeling off example after example of how good people are getting chewed up in the American Dream/Nightmare, Republicans would be toast.
posted by Beholder at 2:39 PM on February 1, 2018 [3 favorites]


If the next Democratic National Convention just spent two nights reeling off example after example of how good people are getting chewed up in the American Dream/Nightmare, Republicans would be toast.

If the next Democrat Senator got up during floor debate and spent two hours reeling off example after example of how good people are getting chewed up in the American Dream/Nightmare, Republicans would lose votes.
posted by EmpressCallipygos at 3:07 PM on February 1, 2018 [2 favorites]


If the next Democratic National Convention just spent two nights reeling off example after example of how good people are getting chewed up in the American Dream/Nightmare, Republicans would be toast.

What solutions does the Democratic Party have on health care? The things that happened in Molly Osberg's essay were during Obama's presidency. Make universal health care a party platform and then maybe the Republicans will have to worry.
posted by any portmanteau in a storm at 3:39 PM on February 1, 2018 [2 favorites]


If the next Democratic National Convention just spent two nights reeling off example after example...

If the next Democrat Senator got up during floor debate...


Y'all are living in some pre-Fox-News dreamscape where "the people" give a shit about what's true or can even discern it.
posted by tzikeh at 3:49 PM on February 1, 2018 [9 favorites]


I don't understand why even your most progressive states don't have universal healthcare. I was just reading about the attempt in Vermont, and I don't get why it stalled.
posted by clawsoon at 3:52 PM on February 1, 2018


Make universal health care a party platform and then maybe the Republicans will have to worry.

They literally did that.
posted by thefoxgod at 3:56 PM on February 1, 2018 [6 favorites]


I've heard it said that a party platform is where you put stuff that you never intend to do but is needed to keep party activists happy and feeling heard. Maybe primary challenges based on healthcare commitments is where the real action will be at?
posted by clawsoon at 4:20 PM on February 1, 2018


It's not quite true in Ontario that the government sets what a doctor may charge.
A doctor may charge anything that they want.
But the government will only pay x amount.

For example the government will pay $100 for this procedure.
If a doctor charges $120 he cannot bill the government $100 and an additional $20 to the patient.
He either takes $100 from the government as payment in full ,or charges the patient the full $120.
It's his choice.
Any doctor may opt out of the government plan and go his own way

It's called extra billing, and even in socialist Canuckistan there are idiots who think that's not a bad idea.
posted by yyz at 4:54 PM on February 1, 2018 [2 favorites]


Make universal health care a party platform and then maybe the Republicans will have to worry.

They literally did that.


It seems that we are not speaking about the same thing when we say universal health care. When I say it I mean that if anyone is sick or injured or having a baby they can go to a doctor or hospital and get treated and not have to pay for anything except maybe parking. From your link this is what the Democrats mean:
" Democrats will never falter in our generations-long fight to guarantee health care as a fundamental right for every American. As part of that guarantee, Americans should be able to access public coverage through a public option, and those over 55 should be able to opt in to Medicare. Democrats will empower the states, which are the true laboratories of democracy, to use innovation waivers under the ACA to develop unique locally tailored approaches to health coverage. This will include removing barriers to states which seek to experiment with plans to ensure universal health care to every person in their state."
A public option for health insurance which they will still have to pay for, people over 55 can get Medicare and if any state wants to try to implement actual universal health care we won't stop them. Not quite what I was talking about.

I don't get why you and the Democrats are thinking so small. Every other developed nation on the planet has some form of universal health care which provides better outcomes for less cost. Just pick one of their systems, copy it and make that the platform and forget this incrementalist bullshit that is letting people needlessly die every day.
posted by any portmanteau in a storm at 5:37 PM on February 1, 2018 [3 favorites]


If a doctor charges $120 he cannot bill the government $100 and an additional $20 to the patient.

Here in the US, that’s called “balance billing.” It’s definitely a thing that happens here.
posted by Thorzdad at 5:45 PM on February 1, 2018 [1 favorite]


I'm glad we have banned that "balance billing" or extra billing.

It comes up on a regular basis here. Fortunately it gets shot down, so far.

It may be an approach in the USA.

You can charge what you want i.e. no socialism
But if you take the Government payment ,that's it.
No extra billing allowed.

For doctors it simplifies their billing , no bad debts, no collections, no chickens or IOU's, no pro bono etc.
The payment is guaranteed, so their administrative costs are much lower
posted by yyz at 6:08 PM on February 1, 2018 [3 favorites]


Every other developed nation on the planet has some form of universal health care which provides better outcomes for less cost.

Not in the way you describe. Single payer is NOT the only model. Japan has some of the best outcomes/$ in the world (not to mention just good outcomes generally) and is basically ACA on steroids.

I don't like single payer, although I'd take it over what we have now. But the best health outcomes, according to the data I've seen, are from places like Germany and Japan which do not have single payer.
posted by thefoxgod at 6:26 PM on February 1, 2018


To me, the important point of universal healthcare is that everyone has access to care, and no one is dissuaded from seeking care because of money. In a system like Japan's, it may not be literally free, but those points are covered (in a single-payer system it's obviously not literally free either since its coming from taxes).

Thats why I think the important point is government control of pricing and insurance, not whether you pay through taxes or insurance or whatever. Subsidies + controls make it so anyone can afford healthcare in countries without single payer (except America, of course, because we have weak subsidies and extremely limited controls).
posted by thefoxgod at 6:38 PM on February 1, 2018


I recently read Elizabeth Rosenthal's An_American_Sickness and found it very interesting. Dr. Rosenthal looks at the progression of increasing medical costs over roughly the last 50 years and how our current system came about.

One of the most important parts of the book is its emphasis on the COST of care, not on access to insurance/care, although that is part of how dysfunctional healthcare is here compared to countries with similar economies. We are all paying for a very skewed system where health care has become big business that uses every possible means to put profit ahead of caring. And to subvert any regulation or oversight that actually has teeth.

In the last part of the book, she offers suggestions including questions to start asking our health car providers about the costs and benefits of tests, procedures and medications. I recommend reading it. I have read many articles and books about the state of US health care over the last 15-20 years and this is a well considered analysis from a pragmatic perspective.
posted by Altomentis at 8:42 PM on February 1, 2018 [1 favorite]


If a doctor charges $120 he cannot bill the government $100 and an additional $20 to the patient.

Here in the US, that’s called “balance billing.” It’s definitely a thing that happens here.


A few years ago, I needed hand surgery and consulted with the only hand surgeon in town even though he was out of network on my insurance. He said, “Oh your insurance is great; I've worked with them before and they'll cover 90%.” I called my insurance company to verify, describing the whole situation to two different representatives. They both assured me that yes, they would reimburse me 90% of the bill. The doctor agreed to waitfor payment until the reimbursement came through, and I had the procedure.

About six weeks later, I got a check from the insurance company for roughly 25% of the bill. Call the insurance company again, and they said that their policy was to reimburse 90% of what they thought it should cost, not 90% of what the doctor was asking. Nobody mentioned any of this when I was looking for information beforehand. It took me years to pay that bill off.
posted by The Underpants Monster at 9:17 PM on February 1, 2018 [8 favorites]


I know I've said it before, but yeah, the fun of explaining to people from other countries our health care. I'm pretty sure almost every time they simply didn't believe me.

A Brit telling me how terrible their health care was because they had to wait 4-6 weeks for an appointment. Ha! I was trying to explain that I usually have to wait that long too, only it's going to cost hundreds or thousands of dollars, even though I spent over a grand a month on insurance.

I finally had to cancel my insurance. I just can't do it any more. $1300 a month for 2 people, $6500 deductible each. Which is better than it used to be. 2 healthy adults who rarely go to the doctor. I've spent $150k to $200k on insurance the last 10-15 years, and they barely paid for anything.

If I get seriously ill I'm just checking out.
posted by bongo_x at 11:45 PM on February 1, 2018 [2 favorites]


Reading this after I just got back home after being in the hospital for almost a week after waking up and being unable to stand is...more than a bit alarming.
posted by sperose at 1:55 AM on February 2, 2018


I don't like single payer, although I'd take it over what we have now. But the best health outcomes, according to the data I've seen, are from places like Germany and Japan which do not have single payer.

Medicare (the single-payer model most people point to in the US) achieves some pretty good outcomes. It's also the most cost-effective and efficient "insurer" in the US, with administrative costs averaging only around 2% of its operating expenditures.
posted by Thorzdad at 8:03 AM on February 2, 2018 [3 favorites]


Medicare (the single-payer model most people point to in the US) achieves some pretty good outcomes. It's also the most cost-effective and efficient "insurer" in the US, with administrative costs averaging only around 2% of its operating expenditures.

I discuss this with every doctor I see. Without exception, every one of them loves Medicare, and wouldn't mind if it was the single payer, period. And what nitwit doesn't want that additional the additional savings in operating expenses used for patient care???
posted by mikelieman at 8:29 AM on February 2, 2018 [1 favorite]


Before the 2008 election, health insurance and access to health care was a huge issue. President Obama put together a pretty good plan that he was able to get passed. It was discussed and debated and a fairly open process. My state is one of 17 that didn't participate in Medicaid expansion, so that sucks. And the vile republican Congress just broke the ACA while giving away massive tax breaks. Yeah, you know all this. But here we are again, talking about what a mess access to health care is in the US. I am so thankful that preexisting conditions are still legislated out of health insurance because I just went 6 months with no insurance. I'm paying 700/month for insurance that isn't great. We need to make this a major part of the next election cycle. Its a terrific article by someone who lives in a state that implemented ACA and then some. Be well, all of you, especially the Americans who have to navigate this mess.
posted by theora55 at 8:55 AM on February 2, 2018


Or even more insidious: God is giving you some kind of fucked-up booby prize from which you are supposed to learn valuable life lessons. Your suffering makes me question my belief in an all-powerful loving God so shhhhhh just suffer and don't talk about it.

This deserves more emphasis since it is rarely brought up. Way back when, not too far off from ET, my mom was diagnosed with MS and ended up gravitating closer to her church, where half the people insisted illness was a punishment from God. Sadly, she seemed to eventually internalize that feeling. Not a good thought to have in your head when you are facing (at the time, there are treatments now) a slow decline into complete disability. I was too young to understand the full implications at the time, but thinking back I'm disgusted that people who consider themselves kind and moral could say that.
posted by wierdo at 12:44 PM on February 2, 2018 [12 favorites]


For those with no insurance and have large bills to pay off - NEGOTIATE if you haven't already. I know from experience the insurance companies aren't paying the rates they are charging you (and I recall reading a story about the Amish needing hospital services and they negotiated what they'd pay). If that doesn't work, tell them what you're willing to pay and anything more and they won't get any money -- they should want to get something rather than nothing.
posted by evening at 4:36 PM on February 2, 2018


Negotiating is a great tactic, if your hospital actually allows it. The hospital in the last county I lived in simply sent you to a local finance company to take out a loan to pay your bill. Interest-free if paid-off in 12 months, of course.
posted by Thorzdad at 9:55 AM on February 3, 2018 [1 favorite]


A lot of this probably doesn't matter moving forward, but I'm going to mention it anyway.

If any of you are registered members of federally recognized American Indian tribes, you (and possibly your spouse or children) are exempt from the individual mandate. You're also eligible for CHIP and/or Medicaid if your IHS doesn't offer the services you need. And if you can get much better rates on the marketplace than you would otherwise.
posted by elsietheeel at 11:07 PM on February 3, 2018


« Older Big hair, big heart.   |   A Press Conference With George Harrison. Newer »


This thread has been archived and is closed to new comments