Better than the free chocolate muffins
August 9, 2024 10:52 AM Subscribe
The Olympic Village has free healthcare. The United States, of course, does not:
In the days following her victory, US rugby player Ariana Ramsey made appointments with the Village gynecologist, dentist and ophthalmologist. “Like, what?” she said in a post on TikTok describing her new discovery. The Village also offers cardiology, orthopedics, physiotherapy, psychology, podiatry and, of course, sports medicine—all at no cost to the athletes. Ramsey came to Paris as a rugby player, she is leaving as a universal free healthcare advocate.
The French press has done several stories about "American tourist discovers universal free healthcare!", although they point out that the Olympics charter requires this no matter the location and that it reimburses the host country for the medical services, so Ramsey is not costing France anything.
posted by autopilot at 11:05 AM on August 9 [12 favorites]
posted by autopilot at 11:05 AM on August 9 [12 favorites]
I have long contended, to all the americans among whom I now live, that people here simply don't understand the enormous stress they are under at all times due to the system here. I never once, growing up, gave a moment's thought to whether or not I could go to the doctor. There was no point of sale at any of the walk-in clinics I used to use.
Universal health care is obviously an expense, health care is not in any way free, but knowing that your immediate needs are not tied to immediate payment/subsequent individual debt is a gift Canada gave me and everyone I knew. (It's a gift we gave each other! Collectively deciding that health care is a social priority is a great decision!)
Anyway this young woman has now experienced that gift in a small way and I am glad she's making the connection and deciding to advocate for it at home. Good luck to her and all of us!
posted by Lawn Beaver at 11:44 AM on August 9 [69 favorites]
Universal health care is obviously an expense, health care is not in any way free, but knowing that your immediate needs are not tied to immediate payment/subsequent individual debt is a gift Canada gave me and everyone I knew. (It's a gift we gave each other! Collectively deciding that health care is a social priority is a great decision!)
Anyway this young woman has now experienced that gift in a small way and I am glad she's making the connection and deciding to advocate for it at home. Good luck to her and all of us!
posted by Lawn Beaver at 11:44 AM on August 9 [69 favorites]
I remember the first time I went to a clinic when I moved to Canada. It was a strange sensation to not have to produce an insurance card or prepare to pay after my appointment was over.
Universal health care is obviously an expense, health care is not in any way free, but knowing that your immediate needs are not tied to immediate payment/subsequent individual debt is a gift Canada gave me and everyone I knew. (It's a gift we gave each other! Collectively deciding that health care is a social priority is a great decision!)
This is also why I fight tooth and nail against the encroaching privatization of Tommy Douglas' legacy. EVERYONE gets seen, even the homeless. I've been working in healthcare for the past decade--hospital staffing, family medicine, now psychiatry--and I believe in the system. I believe it needs a massive fucking overhaul but that doesn't have mean going private. I do not want a have and have not system like the US.
Also, I had medical debt at 15. So that was fun.
posted by Kitteh at 12:04 PM on August 9 [27 favorites]
Universal health care is obviously an expense, health care is not in any way free, but knowing that your immediate needs are not tied to immediate payment/subsequent individual debt is a gift Canada gave me and everyone I knew. (It's a gift we gave each other! Collectively deciding that health care is a social priority is a great decision!)
This is also why I fight tooth and nail against the encroaching privatization of Tommy Douglas' legacy. EVERYONE gets seen, even the homeless. I've been working in healthcare for the past decade--hospital staffing, family medicine, now psychiatry--and I believe in the system. I believe it needs a massive fucking overhaul but that doesn't have mean going private. I do not want a have and have not system like the US.
Also, I had medical debt at 15. So that was fun.
posted by Kitteh at 12:04 PM on August 9 [27 favorites]
Gasp. But if we provide free healthcare then someone might have to share a hospital room with a poor or…or…a black person. /faints
posted by Abehammerb Lincoln at 12:05 PM on August 9 [10 favorites]
posted by Abehammerb Lincoln at 12:05 PM on August 9 [10 favorites]
I never once, growing up, gave a moment's thought to whether or not I could go to the doctor.
Way back when, I used to read comments on Meta and Ask like, "Woke up today and one of my testicles is 3 times the size of other. Do I need to go to the doctor NOW or can I wait a few days?" and I would be... UM!? WTF, get to the doctor!
It happened over and over and I wondered what was was wrong with people being unwilling to go to the doctor? And then I learned about the American Health Care System and I was in disbelief that it could be true.
posted by dobbs at 12:05 PM on August 9 [32 favorites]
Way back when, I used to read comments on Meta and Ask like, "Woke up today and one of my testicles is 3 times the size of other. Do I need to go to the doctor NOW or can I wait a few days?" and I would be... UM!? WTF, get to the doctor!
It happened over and over and I wondered what was was wrong with people being unwilling to go to the doctor? And then I learned about the American Health Care System and I was in disbelief that it could be true.
posted by dobbs at 12:05 PM on August 9 [32 favorites]
My Canadian husband got a taste of the US healthcare system in 2012 when he broke his foot while we were on vacation. Never again, he said.
posted by Kitteh at 12:07 PM on August 9 [3 favorites]
posted by Kitteh at 12:07 PM on August 9 [3 favorites]
It happened over and over and I wondered what was was wrong with people being unwilling to go to the doctor? And then I learned about the American Health Care System and I was in disbelief that it could be true.
Serious question (as an American): are emergency rooms as chaotic in other countries as they are in the US? One of the big reasons why I'm reluctant to seek urgent medical care when something happens is I don't want to go to the ER and be exposed to god knows what new strain of Covid is floating around in the waiting room, and I don't want to witness people bleeding/barfing/crying while we're all waiting around for hours and hours.
Is this a feature of our system that other countries avoid, in addition to the financial strains? Or is this waiting room experience pretty universal and just a fact of life?
posted by knotty knots at 12:15 PM on August 9 [4 favorites]
Serious question (as an American): are emergency rooms as chaotic in other countries as they are in the US? One of the big reasons why I'm reluctant to seek urgent medical care when something happens is I don't want to go to the ER and be exposed to god knows what new strain of Covid is floating around in the waiting room, and I don't want to witness people bleeding/barfing/crying while we're all waiting around for hours and hours.
Is this a feature of our system that other countries avoid, in addition to the financial strains? Or is this waiting room experience pretty universal and just a fact of life?
posted by knotty knots at 12:15 PM on August 9 [4 favorites]
Years and years ago, TV Nation did a head-to-head comparison of the health care systems in the US, Canada, and Cuba.
Cuba technically won on ease-of-use and affordability, but they had to fudge it so that Canada won because that would have been unacceptable for the communists to win.
The US finished in last place, even then.
I've told this story before, probably, but you never forget seeing the first time you see the disappointment and sadness hit a European visitor when you explain how medical debt is a leading cause of bankruptcy in the US. Healthcare is tied to our jobs! This kinda explains why we're like this!
posted by fifteen schnitzengruben is my limit at 12:16 PM on August 9 [8 favorites]
Cuba technically won on ease-of-use and affordability, but they had to fudge it so that Canada won because that would have been unacceptable for the communists to win.
The US finished in last place, even then.
I've told this story before, probably, but you never forget seeing the first time you see the disappointment and sadness hit a European visitor when you explain how medical debt is a leading cause of bankruptcy in the US. Healthcare is tied to our jobs! This kinda explains why we're like this!
posted by fifteen schnitzengruben is my limit at 12:16 PM on August 9 [8 favorites]
Emergency Rooms in Canada are typically under a lot of stress due to staffing issues, and triage is definitely in play. And people in pain are pretty much the same everywhere. That said, Canadian ERs usually only have people who really should be at the ER, rather than people who just can't get help anywhere else because they have no insurance/money.
posted by seanmpuckett at 12:37 PM on August 9 [17 favorites]
posted by seanmpuckett at 12:37 PM on August 9 [17 favorites]
Or is this waiting room experience pretty universal and just a fact of life?
I'm in London UK and this sounds pretty normal for every visit I've had my local A&E (the ED). It usually clocks in on an average 6 hour wait for most things. Last time I was there, I made friends with a woman who was actively having a miscarriage in the waiting room, she was still there after 6 hours when I left. The longest I've been there has been about 10 hours. My A&E also functions as the only Urgent Care in the area as well. They've also recently opened an out of hours GP surgery in the same place to try to funnel people out of the hospital system and into the lower urgency medical care they actually need. Many people go to A&E because they can't see anyone else for the mild but urgent issues they have.
Access to medical care here isn't hampered by costs, but it is absolutely a matter of deciding whether you can cope with less than stellar care and waiting 6+ months for a single appointment with a specialist who might just look at your file and tell you they don't know what to do with you, by which time your original symptoms might have disappeared or gotten worse.
Turns out universal healthcare only functions when it is funded and organised properly. Who knew!
posted by fight or flight at 12:46 PM on August 9 [16 favorites]
I'm in London UK and this sounds pretty normal for every visit I've had my local A&E (the ED). It usually clocks in on an average 6 hour wait for most things. Last time I was there, I made friends with a woman who was actively having a miscarriage in the waiting room, she was still there after 6 hours when I left. The longest I've been there has been about 10 hours. My A&E also functions as the only Urgent Care in the area as well. They've also recently opened an out of hours GP surgery in the same place to try to funnel people out of the hospital system and into the lower urgency medical care they actually need. Many people go to A&E because they can't see anyone else for the mild but urgent issues they have.
Access to medical care here isn't hampered by costs, but it is absolutely a matter of deciding whether you can cope with less than stellar care and waiting 6+ months for a single appointment with a specialist who might just look at your file and tell you they don't know what to do with you, by which time your original symptoms might have disappeared or gotten worse.
Turns out universal healthcare only functions when it is funded and organised properly. Who knew!
posted by fight or flight at 12:46 PM on August 9 [16 favorites]
The biggest problem in a lot of Canadian ERs these days send to be that they are filled with people who can't find a family doctor or get into a walk in clinic. That's a function of how few people we train to be doctors and of how poorly we pay family doctors relative to other specialties.
posted by jacquilynne at 12:47 PM on August 9 [10 favorites]
posted by jacquilynne at 12:47 PM on August 9 [10 favorites]
I ran into a really interesting thing recently, having just gotten a new ophthalmologist after moving to the EU. My vision has apparently not declined in the last three years, so I asked about what the laser correction options were. I have a condition that, at the time I was diagnosed, meant I could have PRK but not LASIK, but that was more than a decade ago and medicine moves fast. I was still not prepared for his response.
They don’t do laser vision correction at all anymore. Once you’ve reached the appropriate age and your vision has stabilized, they set you up for a cataract lens replacement, just without the cataracts. It corrects your vision and prevents you from getting cataracts in the future. He explained that they just assume everybody gets cataracts eventually, and the procedure isn’t any more risky, so they might as well.
I thought I had a pretty good bead on all the ways the US system was screwed, but this one still managed to shock me, both for how sensible it was, and how the economic forces in the US would never allow for such a holistic solution.
posted by gelfin at 12:56 PM on August 9 [24 favorites]
They don’t do laser vision correction at all anymore. Once you’ve reached the appropriate age and your vision has stabilized, they set you up for a cataract lens replacement, just without the cataracts. It corrects your vision and prevents you from getting cataracts in the future. He explained that they just assume everybody gets cataracts eventually, and the procedure isn’t any more risky, so they might as well.
I thought I had a pretty good bead on all the ways the US system was screwed, but this one still managed to shock me, both for how sensible it was, and how the economic forces in the US would never allow for such a holistic solution.
posted by gelfin at 12:56 PM on August 9 [24 favorites]
Ramsey came to Paris as a rugby player, she is leaving as a universal free healthcare advocate.
It's worth a try!
posted by chavenet at 12:57 PM on August 9 [12 favorites]
It's worth a try!
posted by chavenet at 12:57 PM on August 9 [12 favorites]
I have long contended, to all the americans among whom I now live, that people here simply don't understand the enormous stress they are under at all times due to the system here.
Admittedly I have spent years living in countries with actual functional healthcare to give me perspective, but many of my US friends and family who never travel still understand just how bad they have it, they're not dumb. But what exactly are they supposed to do? Our government is owned by the healthcare corporations and most of their fellow citizens are brainwashed into thinking they have the Greatest Healthcare On Earth.
posted by photo guy at 12:57 PM on August 9 [10 favorites]
Admittedly I have spent years living in countries with actual functional healthcare to give me perspective, but many of my US friends and family who never travel still understand just how bad they have it, they're not dumb. But what exactly are they supposed to do? Our government is owned by the healthcare corporations and most of their fellow citizens are brainwashed into thinking they have the Greatest Healthcare On Earth.
posted by photo guy at 12:57 PM on August 9 [10 favorites]
Not only is medical care in the U.S. expensive, the billing procedures are absolutely Byzantine. I went to the ER, had to be admitted overnight, paid the hospital bill when it came, then discovered that that was just one bill of four that needed to be paid. The ER doc, specialist, and lab all had to be paid separately. I was lucky in that I was able to catch all the specific bills, but for people who are sicker or busier than I, it can quickly spiral into financial catastrophe.
We can prevent this kind of life-changing disaster. Some people just really want others to suffer if they had to.
posted by corey flood at 12:58 PM on August 9 [8 favorites]
We can prevent this kind of life-changing disaster. Some people just really want others to suffer if they had to.
posted by corey flood at 12:58 PM on August 9 [8 favorites]
gelfin, my finnish healthcare system (also EU) is also proactively designed. After I hit 50, I just get automatic mammogram and pap smear appointments every two years in the mail (I can adjust the date and time if required). healthcare is increasingly being linked to wellbeing. otoh as a small country that is heavily urbanized, rural health systems are feeling the strain
posted by infini at 1:07 PM on August 9 [6 favorites]
posted by infini at 1:07 PM on August 9 [6 favorites]
Mrs. Example and I are Americans who moved to the UK some seventeen years ago, and the utter sense of relief at just being able to see a doctor and afford medication was life-changing. We never knew how much stress we were living under.
She's had a couple of medical emergencies over the last few years, and the knowledge that the only thing we'd have to pay was the taxes we were already paying plus the odd taxi ride back home from the hospital was a godsend.
Last year we went back to America to visit the family. I bought travel insurance, which I'd never bought before. (I'd had it through work, but never bought it personally.) Thank god I did, because halfway through a two-week trip, Mrs. Example wound up having to have emergency gall bladder surgery.
Even with the insurance, it took months of haggling and trying to get the hospital to understand that it needed to talk to the insurance company and not any of us, and the final bill (over $20K!) wasn't finally settled until almost a year after the actual surgery.
British people occasionally ask us if we'd ever consider moving back to America, and...no. Just no. We're not willing to give up the NHS.
posted by Mr. Bad Example at 1:08 PM on August 9 [21 favorites]
She's had a couple of medical emergencies over the last few years, and the knowledge that the only thing we'd have to pay was the taxes we were already paying plus the odd taxi ride back home from the hospital was a godsend.
Last year we went back to America to visit the family. I bought travel insurance, which I'd never bought before. (I'd had it through work, but never bought it personally.) Thank god I did, because halfway through a two-week trip, Mrs. Example wound up having to have emergency gall bladder surgery.
Even with the insurance, it took months of haggling and trying to get the hospital to understand that it needed to talk to the insurance company and not any of us, and the final bill (over $20K!) wasn't finally settled until almost a year after the actual surgery.
British people occasionally ask us if we'd ever consider moving back to America, and...no. Just no. We're not willing to give up the NHS.
posted by Mr. Bad Example at 1:08 PM on August 9 [21 favorites]
That said, Canadian ERs usually only have people who really should be at the ER, rather than people who just can't get help anywhere else because they have no insurance/money.
Unless it's after-hours or on the weekend. I'd bet a lot of the people in an Ontarian ER at those times are there because they either don't have a family doctor or can't get an appointment with one within a reasonable timeframe.
posted by any portmanteau in a storm at 1:08 PM on August 9 [3 favorites]
Unless it's after-hours or on the weekend. I'd bet a lot of the people in an Ontarian ER at those times are there because they either don't have a family doctor or can't get an appointment with one within a reasonable timeframe.
posted by any portmanteau in a storm at 1:08 PM on August 9 [3 favorites]
The biggest problem in a lot of Canadian ERs these days send to be that they are filled with people who can't find a family doctor or get into a walk in clinic. That's a function of how few people we train to be doctors and of how poorly we pay family doctors relative to other specialties.
So: former family medicine clerk here who used to work at a family health team that also trained med grads in family medicine. (At the risk of outing myself, it was a clinic attached to a major Canadian university.) I can say that out of the dozens who passed through those doors for a year of service and learning (sometimes two years), only three of them went on to chose family medicine. They saw the hours, the paperwork, and the constant hustle of having too many patients and not enough time with those patients and said Absolutely the fuck not. A lot of them went on specialist fields because that's where the money is at and you gotta pay off those student loans.
Family medicine is less than appealing than ever right now, especially post lockdown. Family docs don't make as much as their fellow doctors, the paperwork is Byzantine and ridiculous and is not the kind of paperwork you can hand off to admin, and they are overrostered. It's A LOT. And until we make family medicine appealing to medical students, the problem will only get worse. Here in Ontario, getting a family doctor is like winning the lottery. A lot of them have retired and there aren't as many young bodies to replace them.* Municipalities are offering increasing amounts of money to their cities and towns, resulting in a weird Hunger Games chase for family doctors. Hell, my family doctor is no spring chicken and I have no idea what I will do when she does retire.
*this is why I laugh at medical AskMes where the answers are "just change doctors" LOLOLOLOLOL
posted by Kitteh at 1:27 PM on August 9 [12 favorites]
So: former family medicine clerk here who used to work at a family health team that also trained med grads in family medicine. (At the risk of outing myself, it was a clinic attached to a major Canadian university.) I can say that out of the dozens who passed through those doors for a year of service and learning (sometimes two years), only three of them went on to chose family medicine. They saw the hours, the paperwork, and the constant hustle of having too many patients and not enough time with those patients and said Absolutely the fuck not. A lot of them went on specialist fields because that's where the money is at and you gotta pay off those student loans.
Family medicine is less than appealing than ever right now, especially post lockdown. Family docs don't make as much as their fellow doctors, the paperwork is Byzantine and ridiculous and is not the kind of paperwork you can hand off to admin, and they are overrostered. It's A LOT. And until we make family medicine appealing to medical students, the problem will only get worse. Here in Ontario, getting a family doctor is like winning the lottery. A lot of them have retired and there aren't as many young bodies to replace them.* Municipalities are offering increasing amounts of money to their cities and towns, resulting in a weird Hunger Games chase for family doctors. Hell, my family doctor is no spring chicken and I have no idea what I will do when she does retire.
*this is why I laugh at medical AskMes where the answers are "just change doctors" LOLOLOLOLOL
posted by Kitteh at 1:27 PM on August 9 [12 favorites]
Even more than the health care, I was started by the information that, since, unlike most countries, the USA provides no support to the athletes, at least some of them live in incredibly precarious positions. Maybe some of that broadcast money could go to support them….
posted by GenjiandProust at 1:31 PM on August 9 [9 favorites]
posted by GenjiandProust at 1:31 PM on August 9 [9 favorites]
The guys I work with who want to have relations with our PM bang the private healthcare slippery slope drum all the time saying "At least if we had an American system I could just pay out of pocket to get [whatever procedure they think they need]". And having seen the AskMe questions like dobbs I'm like "You you have absolutely no idea what you are talking about. America spends twice as much as Canada and doesn't cover all their people and a large percentage of Americans technically have insurance but they are plans with deductibles so high that they can't actually use it. People have to choose between rent and taking their kids to the doctor all the time. It costs 10s of thousands of dollars to have a baby with insurance and heaven forbid your kid have to spend a couple days in the hospital after birth." "But I have to wait 6 months for a MRI on my knee *whine*." A bunch of ignoramuses all of them. I have that conversation at least every month.
posted by Mitheral at 1:33 PM on August 9 [13 favorites]
posted by Mitheral at 1:33 PM on August 9 [13 favorites]
In Canada it varies.
I took a friend to ER a couple of weeks ago and went aw shit .. but what you gonna do?
I was very surprised at how not unpleasant it was. It really went well.
But , and it's a big but., the hospital had just built a large addition. Bigger than the older preexisting building.
So the two combined buildings had a lot of space.
The ambulances had their own wing. So you did not see the stretchers , guerneys.
The walkins like my friend, well the triage was much better, much quicker than before.
The triage , admin stuff was far better than I recalled.
I think our wait time was like 30 minutes. I was impressed.
But I' ve also seen where the chaos is just hidden behind several layers.
And in Ontario an ambulance ride is a flat $45.
Used to be $75. They bill you. You don't have to pay upfront.
posted by yyz at 1:38 PM on August 9 [3 favorites]
I took a friend to ER a couple of weeks ago and went aw shit .. but what you gonna do?
I was very surprised at how not unpleasant it was. It really went well.
But , and it's a big but., the hospital had just built a large addition. Bigger than the older preexisting building.
So the two combined buildings had a lot of space.
The ambulances had their own wing. So you did not see the stretchers , guerneys.
The walkins like my friend, well the triage was much better, much quicker than before.
The triage , admin stuff was far better than I recalled.
I think our wait time was like 30 minutes. I was impressed.
But I' ve also seen where the chaos is just hidden behind several layers.
And in Ontario an ambulance ride is a flat $45.
Used to be $75. They bill you. You don't have to pay upfront.
posted by yyz at 1:38 PM on August 9 [3 favorites]
And until we make family medicine appealing to medical students, the problem will only get worse.
I don't think we necessarily need to make family medicine more appealing to medical students, we just need more medical students and then more of them will end up as family doctors. There's no lack of students who want to go into med school, even if you aren't going to get rich being a family doctor. We could simply train more doctors. This is such a solvable problem.
posted by ssg at 1:41 PM on August 9 [9 favorites]
I don't think we necessarily need to make family medicine more appealing to medical students, we just need more medical students and then more of them will end up as family doctors. There's no lack of students who want to go into med school, even if you aren't going to get rich being a family doctor. We could simply train more doctors. This is such a solvable problem.
posted by ssg at 1:41 PM on August 9 [9 favorites]
Mitheral I know people like that as well.
Sing the praises of the American system. Thinking if I tip more I can jump the line up. Sorta like tipping the doorman for a table
They have no frigging idea what they are talking about. They are so full of misinformation, disinformation it's astounding.
They don't realize that any doctor or group doctors can open up a practice or surgery and charge whatever they want. A true private clinic or hospital. There is no law against it. Go ahead
They can charge what they want. But if they accept OHIP ( government fee ) that is it. They cannot charge extra. They cannot charge OHIP plus a bit extra privately.
They are either wholly in or they are out.
This is what some desire . To have OHIP pay , and then receive an additional payment from the patient.
So far that's been shot down.
But there is nothing stopping anyone from opening up a private hospital and charging what they want. Go ahead. But then you are out of the government system
posted by yyz at 2:00 PM on August 9 [4 favorites]
Sing the praises of the American system. Thinking if I tip more I can jump the line up. Sorta like tipping the doorman for a table
They have no frigging idea what they are talking about. They are so full of misinformation, disinformation it's astounding.
They don't realize that any doctor or group doctors can open up a practice or surgery and charge whatever they want. A true private clinic or hospital. There is no law against it. Go ahead
They can charge what they want. But if they accept OHIP ( government fee ) that is it. They cannot charge extra. They cannot charge OHIP plus a bit extra privately.
They are either wholly in or they are out.
This is what some desire . To have OHIP pay , and then receive an additional payment from the patient.
So far that's been shot down.
But there is nothing stopping anyone from opening up a private hospital and charging what they want. Go ahead. But then you are out of the government system
posted by yyz at 2:00 PM on August 9 [4 favorites]
A bunch of ignoramuses all of them. I have that conversation at least every month.
I want to go, "OH WOW, I didn't know you were rich!" Those folks have no idea how much healthcare can cost. Again, me, an American, had medical debt at fifteen.
posted by Kitteh at 2:04 PM on August 9 [7 favorites]
I want to go, "OH WOW, I didn't know you were rich!" Those folks have no idea how much healthcare can cost. Again, me, an American, had medical debt at fifteen.
posted by Kitteh at 2:04 PM on August 9 [7 favorites]
I have been in the ER several times in Canada in the past year for both myself and my son in the past year, so I think I can give a good overiew. FIrst, I have a family doctor. I had the same family doctor for 35 years and she retired and sold her practice to a newly graduated doc so now I have him, so we were there for non-family-doctor-treatable reasons.
Longest visit: ~40 hours. I had covid. Saw a doc after about 5 hours. Got a CT scan. CT scan showed something and most of the rest of the time was spent waiting for follow-up MRI and then specialist consults and more specialist consults.
Shortest visit: ~4 hours? Mid-day weekday visit at the pediatric hospital to have something removed from son's ear that he had stuck in there. I actually called the family doctor and they said take him to the ER we don't do removing stuff from kids.
Most intervention-y: Tie: Minor procedure for me to treat an infection under local anesthetic, iv meds and lots of tests and cultures, visit about 6 hours. Again, I had called family doc and they said we don't do that, you need to go to ER. Removing item my son had stuck his finger into and could not remove, required twilight anesthesia, maybe 3 hours total visit. OK, this may actually have been the shortest.
Chaos?: The hospital closest to our home gets a fair number of people there who have mental health concerns or who are possibly drug-seeking. When I was there removing the item stuck on my son's finger one person was aggressively folllowing him and kind of speaking to him loudly but security made him back off and a triage nurse immediately brought my son to wait in the back where he would not be bothered. Also, since my son's finger was noticeably black they did deal with him right away.
I mean mostly the ER waiting room is full of of people who look exhausted. Some of them seem like they're in pain. Some people are coughing. One or two people may be kind of angry or annoyed and there may be some entitled people who want to complain that they've been waiting or whatever whatever, but most people are aware that no one is there because they're having a great day and everyone would rather be somewhere else and most people try to be kind to each other and just chill and wait their turn. Yeah it sucks to wait to but it sucks more to be the person who doesn't have to wait because that means you're really sick.
posted by If only I had a penguin... at 2:09 PM on August 9 [4 favorites]
Longest visit: ~40 hours. I had covid. Saw a doc after about 5 hours. Got a CT scan. CT scan showed something and most of the rest of the time was spent waiting for follow-up MRI and then specialist consults and more specialist consults.
Shortest visit: ~4 hours? Mid-day weekday visit at the pediatric hospital to have something removed from son's ear that he had stuck in there. I actually called the family doctor and they said take him to the ER we don't do removing stuff from kids.
Most intervention-y: Tie: Minor procedure for me to treat an infection under local anesthetic, iv meds and lots of tests and cultures, visit about 6 hours. Again, I had called family doc and they said we don't do that, you need to go to ER. Removing item my son had stuck his finger into and could not remove, required twilight anesthesia, maybe 3 hours total visit. OK, this may actually have been the shortest.
Chaos?: The hospital closest to our home gets a fair number of people there who have mental health concerns or who are possibly drug-seeking. When I was there removing the item stuck on my son's finger one person was aggressively folllowing him and kind of speaking to him loudly but security made him back off and a triage nurse immediately brought my son to wait in the back where he would not be bothered. Also, since my son's finger was noticeably black they did deal with him right away.
I mean mostly the ER waiting room is full of of people who look exhausted. Some of them seem like they're in pain. Some people are coughing. One or two people may be kind of angry or annoyed and there may be some entitled people who want to complain that they've been waiting or whatever whatever, but most people are aware that no one is there because they're having a great day and everyone would rather be somewhere else and most people try to be kind to each other and just chill and wait their turn. Yeah it sucks to wait to but it sucks more to be the person who doesn't have to wait because that means you're really sick.
posted by If only I had a penguin... at 2:09 PM on August 9 [4 favorites]
A someone in the US who directly buys my health insurance through the state health insurance marketplace (Covered California) rather than through my employer, can someone help clarify the meaning of "US. Healthcare is tied to our jobs"? I am guessing this may mean either:
A: The cost of acquiring health insurance is lower through my employer than through my state-provided marketplace.
B: I will lose access to my preferred doctors and hospitals without employer-provided health insurance.
C: Both A & B.
Is there another meaning? I don't have direct experience with health insurance in other US states.
posted by Goblin Barbarian at 2:28 PM on August 9
A: The cost of acquiring health insurance is lower through my employer than through my state-provided marketplace.
B: I will lose access to my preferred doctors and hospitals without employer-provided health insurance.
C: Both A & B.
Is there another meaning? I don't have direct experience with health insurance in other US states.
posted by Goblin Barbarian at 2:28 PM on August 9
(d) My employer pays for all or most of my health insurance.
Most people don't use Covered California due to the individual expense. Employers have enough people to balance out the costs, something like that.
posted by jenfullmoon at 2:44 PM on August 9 [3 favorites]
Most people don't use Covered California due to the individual expense. Employers have enough people to balance out the costs, something like that.
posted by jenfullmoon at 2:44 PM on August 9 [3 favorites]
A story from the US, even when you're fully insured in an above-average medical system: A relative recently went to the ER with complications from a surgery they just had in the same hospital. Despite the severe pain and swelling, and notes of a non-standard surgical procedure in their record, they still had to wait six hours to get triaged and were almost sent home. The lone doctor who could authorize admission wasn't answering their phone. A quote from a nurse explaining why they weren't high priority: "You have two kidneys."
posted by credulous at 2:58 PM on August 9 [4 favorites]
posted by credulous at 2:58 PM on August 9 [4 favorites]
E) if I leave my employer in the middle of my coverage year, I have to restart meeting a deductible for the year. I will also lose any unused FSA funds
F) my employer pays the entirety of my premium (and I’m lucky that they cover my spouse as well). If I leave my job, and take a new one offering the “same” salary, I can still easily be making 300-600 less a month due to insurance premiums that they may not covered
G) if I and my spouse are unemployed, we will not have insurance coverage- or enough money to purchase coverage through a state marketplace.
posted by raccoon409 at 3:04 PM on August 9 [9 favorites]
F) my employer pays the entirety of my premium (and I’m lucky that they cover my spouse as well). If I leave my job, and take a new one offering the “same” salary, I can still easily be making 300-600 less a month due to insurance premiums that they may not covered
G) if I and my spouse are unemployed, we will not have insurance coverage- or enough money to purchase coverage through a state marketplace.
posted by raccoon409 at 3:04 PM on August 9 [9 favorites]
I just got a bill for $163 dollars for an $80 arm brace that I needed from urgent care when I broke my arm over Memorial Day weekend. I got a “member discount” of $11 but BCBS didn’t actually cover any of the cost.
posted by raccoon409 at 3:05 PM on August 9 [1 favorite]
posted by raccoon409 at 3:05 PM on August 9 [1 favorite]
A someone in the US who directly buys my health insurance through the state health insurance marketplace (Covered California) rather than through my employer, can someone help clarify the meaning of "US. Healthcare is tied to our jobs"? I am guessing this may mean either:
X: I live in Georgia. We do not have Medicaid expansion, so at least 400,000 people are too poor to qualify for an ACA subsidy to buy insurance on the marketplace but do not qualify for Medicaid. (They recently passed an alleged Medicaid expansion with work requirements. Kemp claimed 100,000 people would sign up this year. 4,000 people did. The requirements to prove you worked or went to school the right number of hours each month are too onerous for most humans.)
Y: I live in Georgia. I have a serious, chronic medical condition requiring expensive prescriptions as does my spouse. If I lost my employer (state) health insurance, the only marketplace plans we could afford would have an enormous deductible and would require us paying outrageous amounts for our medications each month.
posted by hydropsyche at 3:29 PM on August 9 [7 favorites]
X: I live in Georgia. We do not have Medicaid expansion, so at least 400,000 people are too poor to qualify for an ACA subsidy to buy insurance on the marketplace but do not qualify for Medicaid. (They recently passed an alleged Medicaid expansion with work requirements. Kemp claimed 100,000 people would sign up this year. 4,000 people did. The requirements to prove you worked or went to school the right number of hours each month are too onerous for most humans.)
Y: I live in Georgia. I have a serious, chronic medical condition requiring expensive prescriptions as does my spouse. If I lost my employer (state) health insurance, the only marketplace plans we could afford would have an enormous deductible and would require us paying outrageous amounts for our medications each month.
posted by hydropsyche at 3:29 PM on August 9 [7 favorites]
My Canadian husband got a taste of the US healthcare system in 2012 when he broke his foot while we were on vacation. Never again, he said.
I tripped on a sidewalk in Hollywood, fell into a construction pit. I've had a lot of spills in my life and felt like I'd broken my nose and cracked my knee and wrist. I had travel insurance.
I ended up at an urgent care place. There was a $99 deductible. In the examining room, I explained what happened and told the doctor my diagnoses. He looked at me for 5 minutes and told me I had a broken nose and "probably" a fractured knee and a fractured wrist.
"So, exactly what I said?"
He nodded.
He then offered to "clean me up" (my face looked pretty bad) and added that it was not covered by insurance. I asked what he meant and he said it was $60 per "incident". I said it was one incident. He said, "No, each time I have to remove my hand and go to another area of your face, it's another incident." I asked how many he could see. He counted.
"Nine or ten."
I asked if he could not just drag his hand around and not lift it off and consider it one incident. He neither smiled or answered.
I said, "Define 'clean up'." He showed me some antiseptic wipes and some Polysporin. "So, $600 to wipe my face and put some goop on it?"
He nodded.
I left and spent $14 on Polysporin and some wipes at CVS and did it myself using the front window of the pharmacy as a mirror.
Nine months later I got the deductible back from my insurance.
To put this in perspective for Americans, all of this would have been free in Canada and they would have x-rayed my knee and wrist and provided me with pain medication while in the emergency room and given me a prescription for pain meds that I could choose to fill or not (at my expense). If followup stuff was needed for the knee and wrist, it would have been free. (No one does anything any longer for broken noses.) Admittedly, I would have had to wait a few hours for this care.
posted by dobbs at 3:32 PM on August 9 [18 favorites]
I tripped on a sidewalk in Hollywood, fell into a construction pit. I've had a lot of spills in my life and felt like I'd broken my nose and cracked my knee and wrist. I had travel insurance.
I ended up at an urgent care place. There was a $99 deductible. In the examining room, I explained what happened and told the doctor my diagnoses. He looked at me for 5 minutes and told me I had a broken nose and "probably" a fractured knee and a fractured wrist.
"So, exactly what I said?"
He nodded.
He then offered to "clean me up" (my face looked pretty bad) and added that it was not covered by insurance. I asked what he meant and he said it was $60 per "incident". I said it was one incident. He said, "No, each time I have to remove my hand and go to another area of your face, it's another incident." I asked how many he could see. He counted.
"Nine or ten."
I asked if he could not just drag his hand around and not lift it off and consider it one incident. He neither smiled or answered.
I said, "Define 'clean up'." He showed me some antiseptic wipes and some Polysporin. "So, $600 to wipe my face and put some goop on it?"
He nodded.
I left and spent $14 on Polysporin and some wipes at CVS and did it myself using the front window of the pharmacy as a mirror.
Nine months later I got the deductible back from my insurance.
To put this in perspective for Americans, all of this would have been free in Canada and they would have x-rayed my knee and wrist and provided me with pain medication while in the emergency room and given me a prescription for pain meds that I could choose to fill or not (at my expense). If followup stuff was needed for the knee and wrist, it would have been free. (No one does anything any longer for broken noses.) Admittedly, I would have had to wait a few hours for this care.
posted by dobbs at 3:32 PM on August 9 [18 favorites]
I haven't been to a doctor in over 15 years. I assume the next time I see one will be shortly before my death so I won't really have to foot the bill, which is a nice bonus.
posted by GoblinHoney at 3:41 PM on August 9 [1 favorite]
posted by GoblinHoney at 3:41 PM on August 9 [1 favorite]
>I remember the first time I went to a clinic when I moved to Canada. It was a strange sensation to not have to produce an insurance card or prepare to pay after my appointment was over.
I didn’t go to the doctor for my first year to year-and-a-half in Canada because I couldn’t find any information on how much the co-pay for a visit would be. I figured out at one point that I wouldn’t have to pay any money at the time of my visit to a doctor or clinic, but couldn’t figure out how much I’d be on the hook for when they sent me a bill afterwards. The idea of co-pays or follow-up bills of unspecified amounts was so alien and bizarre to Canadians at the time that no one thought to explain to a new US resident that (for most stuff at least) it’s just free.
Earlier in my time here, I had two US visitors who needed health care while visiting me in Canada. They did eventually get bills, and the doctors office staff weren’t sure ahead of time how much it would cost because they hadn’t had to deal with billing people before. But in both cases it was half or less than half what the same visit would have cost in the US, even for the one who had what was at the time middle-tier US health insurance.
posted by eviemath at 3:49 PM on August 9 [2 favorites]
I didn’t go to the doctor for my first year to year-and-a-half in Canada because I couldn’t find any information on how much the co-pay for a visit would be. I figured out at one point that I wouldn’t have to pay any money at the time of my visit to a doctor or clinic, but couldn’t figure out how much I’d be on the hook for when they sent me a bill afterwards. The idea of co-pays or follow-up bills of unspecified amounts was so alien and bizarre to Canadians at the time that no one thought to explain to a new US resident that (for most stuff at least) it’s just free.
Earlier in my time here, I had two US visitors who needed health care while visiting me in Canada. They did eventually get bills, and the doctors office staff weren’t sure ahead of time how much it would cost because they hadn’t had to deal with billing people before. But in both cases it was half or less than half what the same visit would have cost in the US, even for the one who had what was at the time middle-tier US health insurance.
posted by eviemath at 3:49 PM on August 9 [2 favorites]
I’ve also accessed health care while travelling in both France and Austria. Very minor consultations in both cases, so they might have bothered figuring out how to bill me if it was something more involved, I suppose. But in both of those cases my health care was just free, despite being a visitor not enrolled in either country’s national health care system. The US system is so insane from the perspective of any other country with comparable or even a bit less overall wealth.
posted by eviemath at 3:54 PM on August 9 [4 favorites]
posted by eviemath at 3:54 PM on August 9 [4 favorites]
In the past two years I've had 3 surgeries and with included pre and post ops and related visits, I've spent about $16,000 dollars (not counting the $200 a month I pay towards my employer's insurance plan). As much as I didn't love eating through most of my savings that took a hell of a lot longer than two years to save, that wasn't the hardest part for me. By US standards I'm extraordinarily lucky. At virtually every appointment, procedure and surgery I would think, "there are so many people who need this at least as much as I do, but can't get it". I'm getting very emotional, mad and tearing up just typing that.
I have said, "the system is broken" to a good number of front line health care workers over the years and their responses always fell on a scale somewhere between, "absolutely" and "don't get me started". To the Canadian privatizers, be careful what you wish for... you just might get it.
posted by BigHeartedGuy at 4:46 PM on August 9 [7 favorites]
I have said, "the system is broken" to a good number of front line health care workers over the years and their responses always fell on a scale somewhere between, "absolutely" and "don't get me started". To the Canadian privatizers, be careful what you wish for... you just might get it.
posted by BigHeartedGuy at 4:46 PM on August 9 [7 favorites]
I have luckily lived long enough to finally make it onto Medicare and, man, what a different world it is. I still have monthly premiums, but they’re tiny compared to what I was paying for my previous marketplace plan. And the yearly deductible is miniscule. And damned near every provider in the US accepts Medicare, so there’s no in/out network bullshit to navigate.
It’s also the most efficiently-run health insurance program in the US.
posted by Thorzdad at 5:24 PM on August 9 [10 favorites]
It’s also the most efficiently-run health insurance program in the US.
posted by Thorzdad at 5:24 PM on August 9 [10 favorites]
Ceterum censeo United Health Care esse delendam.
posted by Sphinx at 5:25 PM on August 9 [1 favorite]
posted by Sphinx at 5:25 PM on August 9 [1 favorite]
I'm a Canadian-American dual citizen, who lived in Canada for 30 years, moved to the States for 20 years, and returned to Canada just a few months ago. To help do my little bit to combat Canadian politicians advocating for privatization, I annually posted my health insurance costs on Facebook, and I bitch when something comes up, so I have some figures ready to hand.
Healthcare costs:
Healthcare costs:
It's that time of the year when I share my healthcare costs! I've just done my elections for 2021 health insurance coverage. I'm an admin at a hospital with unusually-good health insurance (it can't really be overstated how good my health insurance is for the US, especially for the US South).How you can end up spending that deductible so quickly (this is from 2018) and an example of "US. Healthcare is tied to our jobs":
Next year, every 2 weeks, I'll pay $83.50 in premiums (same as this year) to cover my spouse and me. Annually, that's $2,171 and doesn't include dental or vision. (I pay out of pocket for dental and vision. Those expenses aren't accounted for below.)
I lowered my Health Care Flexible Spending Account deduction to $1,750 annually - because of the pandemic we've been limiting ourselves to medical visits that can't be delayed, so we have a bunch of money left. The FSA pays for medications, co-pays, and deductibles, from pre-tax money, but if you put too much in, they just keep the leftover balance, so it's this tricky bet you make on exactly how sick you think you might get.
So that's *at least* $3,921 (2171 + 1750) on health care in 2021. My expenses may go up to a maximum of my max out-of-pocket of $7,500 + my premiums, or $9,671 total.
Keep in mind, I am "lucky" and this is pretty much a best-case scenario. Many Americans have no effective max out of pocket since when they hit their deductible they then "only" have to pay 20% (or whatever) of any further bills they incur. I hit my max out-of-pocket in 2016, 2017, and 2018, but not 2019 or 2020 (unless something bad happens in the next two months). I am generally healthy.
I had my gallbladder out in mid-January in the US. I work for a hospital, and have excellent healthcare. My employer is regularly ranked as having the best or close to the best health insurance benefits of all Tennessee employers (not only in our industry, but all employers). Keep in mind that what I'm about to tell you is a best-case scenario.And more on my Flexible Spending Account (this happened in 2022):
I've received a notification from my insurance that a bill for my surgery has been processed. I just confirmed with a hospital patient billing rep that it's a partial bill--I'll receive this bill at the end of the month, and a second bill 30 days later. Looking only at the charges I know about from this partial bill, my surgery and two of the five days I was in hospital (the other three days aren't on this bill, though the two days that are, are from the middle of my stay, weirdly) totaled charges of $69,458.59. Of that, I owe $4,020.
No idea how much the remaining charges will be yet. I'm guessing my portion will be another $1k to $3k. It won't be more than $3,480, because my insurance has an annual out-of-pocket maximum of $7,500 (and 7500 - 4020 = 3480). (That out-of-pocket max is why I will never, ever, ever quit my job.)
I have this fund called an FSA which I am allowed to put pre-tax money in, as part of my healthcare insurance electives, during the period that in the US is called open enrollment. I elect to put in what I think I will reasonably spend in a year. The money does not roll over year-to-year (there's a thing that does that, called an HSA, but my employer does not offer it). I have until March 15 to spend the 2021 money I put in.posted by joannemerriam at 5:35 PM on August 9 [4 favorites]
I called at the end of December to find out how much money I have left. It was about $700. I received a new card in the mail from them, but with different logos and my old card hadn't expired, so I called to ask what was up and they told me: that's the new card, go ahead and cut up your old card because we won't accept it anymore. I, like a fool, believed them.
In the past few months, I had my annual wellness visits, mammogram, etc, and, to spend the money, Alan ordered new glasses he didn't strictly need. I called this morning to find out what our remaining balance was, thinking it would be like $100 or so. It's $710.24 they tell me.
I don't understand, I say. I ask what is my 2022 balance and they tell me $1,183.49, which means they have been pulling from my 2022 balance all this time. Can you apply all of my expenses to my 2021 balance, I ask, since it should be spent first, and why isn't it being spent first?
You have to use the old card to spend that money, they tell me.
The card they had told me I couldn't use anymore and to go ahead and cut up, six weeks ago.
Can you transfer those funds for me? No, they tell me. They can't transfer money between years. They sound faintly scandalized that I would even suggest it. I asked them to escalate to somebody who could help me, and am awaiting a call back.
Probably they will fix it, because everything in this country is designed to be broken for the benefit of a company (which in this case just gets to keep any unspent funds) unless you carefully track everything and have the time and energy to complain your way up the chain until you get to a person empowered to fix things, which is part of the reason why we have so many people whose first impulse whenever they encounter anything they don't like is to ask for the manager. And if they won't fix it, luckily Alan saved the information about the old card so we can buy me some new glasses and things like that which can be ordered online rather than with the physical card. So it's going to be fine (for values of "fine" that include "I spent my own money instead of forfeiting it to a middleman who does nothing whatsoever for me and probably shouldn't exist" but not "I spent the money on healthcare I actually require" because unnecessary healthcare spending is a feature not a bug in a for-profit system).
[a few days later:] Further to the thing with my FSA spending being put on the wrong year: They told me just now that I would need to gather all my receipts, request a reimbursement, deposit the check they send, write a new check, and send it to them for the same amount, just to get the money transferred. LOL forever. Obviously I'm not going to do all that. I am escalating this to a higher level of management and fully expect them to do absolutely nothing about it. ¯\_(ツ)_/¯ I'll just order some new glasses but I'm going to wait til I talk to them again tomorrow on the off-chance they are less useless than I anticipate.
[They were not less useless. I ended up buying some glasses.]
I made the muffins.
Unfortunately I cannot make the health care. (In slightly positive news though, the Inflation Reduction Act did allow Medicare to negotiate for drug prices. The first ten drugs are being negotiated for now..)
posted by nat at 6:08 PM on August 9 [1 favorite]
Unfortunately I cannot make the health care. (In slightly positive news though, the Inflation Reduction Act did allow Medicare to negotiate for drug prices. The first ten drugs are being negotiated for now..)
posted by nat at 6:08 PM on August 9 [1 favorite]
Heh, I remember receiving an "Explanation of Benefits" in the mail for the very first time after moving to the US. I read it over and thought to myself, this explains nothing.
I had some questions about all the new insurance jargon (copays, FSA, HSA, PPO, COBRA?) I was encountering so I asked my coworkers about it over lunch. After a few lunches we had to collectively decide that "explain US healthcare to btfreek" was off-limits as a topic as it was getting everyone very worked up. I still don't know what co-insurance is.
(I ended up going with Kaiser for the entirety of my US residency, which was perfectly fine and almost downright pleasant for all of my, admittedly very pedestrian, medical care needs. Which means that every time I talk about my US healthcare experience, I have to try and heavily asterisk it before my dad starts crowing that see, the US system really does work better!!)
posted by btfreek at 6:18 PM on August 9 [7 favorites]
I had some questions about all the new insurance jargon (copays, FSA, HSA, PPO, COBRA?) I was encountering so I asked my coworkers about it over lunch. After a few lunches we had to collectively decide that "explain US healthcare to btfreek" was off-limits as a topic as it was getting everyone very worked up. I still don't know what co-insurance is.
(I ended up going with Kaiser for the entirety of my US residency, which was perfectly fine and almost downright pleasant for all of my, admittedly very pedestrian, medical care needs. Which means that every time I talk about my US healthcare experience, I have to try and heavily asterisk it before my dad starts crowing that see, the US system really does work better!!)
posted by btfreek at 6:18 PM on August 9 [7 favorites]
My youngest daughter was one of those kids who was accident prone, so when she was young, we spent a lot of time in the ER. Enough that the doctors and nurses recognized her and knew her by name. They prioritize children, so we never spent more than an hour waiting. But while we waited, we often saw American tourists who were completely confused by the fact that healthcare was free. Technically, Americans have to pay, but usually the staff doesn't want to deal with it, so they just treat people and pretend they couldn't figure out how to bill them.
I also went a lot to the ER with my gran, and the wait time was even shorter. Once she had a tick in a place where I didn't feel comfortable removing it, and I decided to drive to a rural hospital to get it removed (and get the antibiotics), and there was no waiting time. But here (in Denmark) you have to call the central ER administration before going and they will send you to the hospital with the least patients.
For about a decade, I worked with design for healthcare, I'm still today on a board for a health research foundation and you will not believe how much big US healthcare businesses lobby in Europe for privatization. And some European health industries too, because they earn more money in the US (NOVO, I'm looking at you). It should be a huge scandal, because some politicians are caught up in the grift. They ignore the obvious truths, that European healthcare is cheaper and better, and lie to the public about "choice" and "waiting lists", and their decisions create severe problems in the hospitals. I think the reason it isn't a bigger scandal is that it is really complicated and journalists can't see through the issues.
All of that said, I think there is a consensus that France, who are the hosts of the Olympics, have one of the very best healthcare systems in the world, both in terms of price, care and outcomes.
posted by mumimor at 8:06 PM on August 9 [7 favorites]
I also went a lot to the ER with my gran, and the wait time was even shorter. Once she had a tick in a place where I didn't feel comfortable removing it, and I decided to drive to a rural hospital to get it removed (and get the antibiotics), and there was no waiting time. But here (in Denmark) you have to call the central ER administration before going and they will send you to the hospital with the least patients.
For about a decade, I worked with design for healthcare, I'm still today on a board for a health research foundation and you will not believe how much big US healthcare businesses lobby in Europe for privatization. And some European health industries too, because they earn more money in the US (NOVO, I'm looking at you). It should be a huge scandal, because some politicians are caught up in the grift. They ignore the obvious truths, that European healthcare is cheaper and better, and lie to the public about "choice" and "waiting lists", and their decisions create severe problems in the hospitals. I think the reason it isn't a bigger scandal is that it is really complicated and journalists can't see through the issues.
All of that said, I think there is a consensus that France, who are the hosts of the Olympics, have one of the very best healthcare systems in the world, both in terms of price, care and outcomes.
posted by mumimor at 8:06 PM on August 9 [7 favorites]
My wife is on my insurance plan, since although we sort of work for the same employer, we sort of don't, and my plan is better than hers would be. Last year she went to get a prescription filled and discovered that her coverage had been suspended. On calling them, it turns out that the insurance company had, for no apparent reason, decided that maybe she had some other insurance coverage already, which would render her ineligible. They sent us a letter asking us to confirm that she had no other coverage, but we didn't see it because they sent it in an envelope that made it look like junk mail and we didn't open it -- we found it in our discarded junk mail pile much later. We were told that in order to reinstate her plan we would have to confirm that she had no other insurance coverage. So I sent them a message saying that of course she had no other coverage, because why would we pay for insurance twice? They reinstated her coverage.
This is a pretty minor frustration in the grand scheme, and in fact we've had much worse frustrations with them. (Including like two months where she couldn't get a common and inexpensive medicine refilled that she'd been taking for years, due to insurance demanding a "prior authorization" -- in the end it turned out they were throwing a fit because her doc had prescribed 200mg instead of two 100mg tablets, and they were perfectly happy once the prescription was changed. Oh, and another time they refused to fill a prescription unless her doctor tried treating her with five other medications first to be sure those wouldn't work. One of those medications was ibuprofen, which she had already tried over-the-counter. Her doc refused to do this because in his medical judgment the meds the insurance wanted her to try were not medically appropriate for her condition. Rather than use the appeals process and draw things out, we discovered that the out-of-pocket cost for the pills was actually not very high and just paid for them without insurance. Which is probably what the insurer was hoping for.) But it is an example of the completely bizarre things that the insurance companies keep inventing as new ways to torment their customers. As far as I can tell, there was absolutely no reason for them to question whether my wife had other coverage, they just... decided to.
This insurer is generally considered to be the best one available in my state.
posted by biogeo at 9:23 PM on August 9 [4 favorites]
This is a pretty minor frustration in the grand scheme, and in fact we've had much worse frustrations with them. (Including like two months where she couldn't get a common and inexpensive medicine refilled that she'd been taking for years, due to insurance demanding a "prior authorization" -- in the end it turned out they were throwing a fit because her doc had prescribed 200mg instead of two 100mg tablets, and they were perfectly happy once the prescription was changed. Oh, and another time they refused to fill a prescription unless her doctor tried treating her with five other medications first to be sure those wouldn't work. One of those medications was ibuprofen, which she had already tried over-the-counter. Her doc refused to do this because in his medical judgment the meds the insurance wanted her to try were not medically appropriate for her condition. Rather than use the appeals process and draw things out, we discovered that the out-of-pocket cost for the pills was actually not very high and just paid for them without insurance. Which is probably what the insurer was hoping for.) But it is an example of the completely bizarre things that the insurance companies keep inventing as new ways to torment their customers. As far as I can tell, there was absolutely no reason for them to question whether my wife had other coverage, they just... decided to.
This insurer is generally considered to be the best one available in my state.
posted by biogeo at 9:23 PM on August 9 [4 favorites]
Australian here - ER can be stressful - Friday nights onwards especially.
A nurse told me how in her lower socio-economic district, single mothers would bring their children in on a Friday night saying that the child(ren) was/were sick, make sure that they would be checked in overnight and then disappear to have a bender. She was furious that the hospital was being treated as a child minding service. In principle, I agreed. On the other hand, I was more upset that these women had so few options, and relieved that at least they recognised that the hospital was a good option.
My then 5 year old jumped off a table and hit her elbow, and woke up in the night in pain and with a swollen elbow. It was 2 am and my solution was that the entire family (H, W, 3 year old, new born) went to ER as it was a Wednesday and the fastest way to get an Xray was if we all went as I had to take the new born as I was still breast feeding and a father arriving on his own with an injured 5 year old is likely to cause more questions. We were home by 4 am.
Part the millionth why I am unlikely to ever visit the US.
posted by Barbara Spitzer at 10:00 PM on August 9 [2 favorites]
A nurse told me how in her lower socio-economic district, single mothers would bring their children in on a Friday night saying that the child(ren) was/were sick, make sure that they would be checked in overnight and then disappear to have a bender. She was furious that the hospital was being treated as a child minding service. In principle, I agreed. On the other hand, I was more upset that these women had so few options, and relieved that at least they recognised that the hospital was a good option.
My then 5 year old jumped off a table and hit her elbow, and woke up in the night in pain and with a swollen elbow. It was 2 am and my solution was that the entire family (H, W, 3 year old, new born) went to ER as it was a Wednesday and the fastest way to get an Xray was if we all went as I had to take the new born as I was still breast feeding and a father arriving on his own with an injured 5 year old is likely to cause more questions. We were home by 4 am.
Part the millionth why I am unlikely to ever visit the US.
posted by Barbara Spitzer at 10:00 PM on August 9 [2 favorites]
This is why I like paying taxes. It tends to work out cheaper for me, benefits others in my community and means I don't have to spend mental effort finding the best option, dealing with bills, etc. It's what I imagine having a butler feels like!
posted by demi-octopus at 2:01 AM on August 10 [7 favorites]
posted by demi-octopus at 2:01 AM on August 10 [7 favorites]
I'm Australian and our healthcare is ok but definitely has been weathering some storms. There's more and more fees for things that used to be bulk billed (free). Definitely needs some vision and investment.
This is an interesting take on the NHS from Matt Bevan's "If you're listening" podcast series "who broke Britain" .
posted by freethefeet at 3:16 AM on August 10
This is an interesting take on the NHS from Matt Bevan's "If you're listening" podcast series "who broke Britain" .
posted by freethefeet at 3:16 AM on August 10
A nurse told me how in her lower socio-economic district, single mothers would bring their children in on a Friday night saying that the child(ren) was/were sick, make sure that they would be checked in overnight and then disappear to have a bender. She was furious that the hospital was being treated as a child minding service.
This is the sort of story that healthcare workers who are completely burnt out to the point that they hate their "lower socio-economic district" patients make up and then spread around as gospel truth. Most likely, there were lots of exhausted parents who assumed that once their sick children were checked into the hospital then they were safe and being cared for and went home to get some sleep, care for other children, go to their jobs, etc. Which is actually a normal thing to do as someone who has also had to get on with my life while a loved one was in the hospital.
posted by hydropsyche at 3:22 AM on August 10 [9 favorites]
This is the sort of story that healthcare workers who are completely burnt out to the point that they hate their "lower socio-economic district" patients make up and then spread around as gospel truth. Most likely, there were lots of exhausted parents who assumed that once their sick children were checked into the hospital then they were safe and being cared for and went home to get some sleep, care for other children, go to their jobs, etc. Which is actually a normal thing to do as someone who has also had to get on with my life while a loved one was in the hospital.
posted by hydropsyche at 3:22 AM on August 10 [9 favorites]
Can those with universal healthcare systems confirm what happens in the case of a car accident or other situation where liability is involved? Does the government try to get reimbursed in those circumstances? I wonder how different our car, property, and other liability insurance policies would be if we had universal healthcare.
I ask because one of the fun things about the US system is, say you get hit by a car and go to the hospital and the driver’s car insurance carrier accepts fault. But in the meantime, your personal health insurance covers whatever it covers of your hospital bills. A year or more later when you finally settle with the driver’s insurance, they will tell you how much they’ll pay you to reimburse you for out of pocket costs, pain and suffering, lost wages, lifetime disability, etc. But then, fun times, your health insurance provider will first get reimbursed for what they paid for your hospital bills in a process called subrogation and that comes out of the total settlement amount.
Because liability minimums can be really low (this varies by state), and the health insurer is higher on the list for reimbursement than the actual victim, this can often mean people will receive zero dollars from the driver’s insurance in these circumstances.
Luckily when this happened to my partner, the driver had really good liability coverage with a relatively high limit, and we hired an attorney, and after everything he did receive a decent settlement - still probably not sufficient for a lifetime of soreness and arthritis from a metal plate and half-dozen screws in his knee, but decent. But part of the benefit of hiring an attorney is they negotiate down how much the insurance company and hospital receive during subrogation, and not everyone can hire an attorney or have an incident that is bad enough to be worth hiring one.
posted by misskaz at 5:48 AM on August 10
I ask because one of the fun things about the US system is, say you get hit by a car and go to the hospital and the driver’s car insurance carrier accepts fault. But in the meantime, your personal health insurance covers whatever it covers of your hospital bills. A year or more later when you finally settle with the driver’s insurance, they will tell you how much they’ll pay you to reimburse you for out of pocket costs, pain and suffering, lost wages, lifetime disability, etc. But then, fun times, your health insurance provider will first get reimbursed for what they paid for your hospital bills in a process called subrogation and that comes out of the total settlement amount.
Because liability minimums can be really low (this varies by state), and the health insurer is higher on the list for reimbursement than the actual victim, this can often mean people will receive zero dollars from the driver’s insurance in these circumstances.
Luckily when this happened to my partner, the driver had really good liability coverage with a relatively high limit, and we hired an attorney, and after everything he did receive a decent settlement - still probably not sufficient for a lifetime of soreness and arthritis from a metal plate and half-dozen screws in his knee, but decent. But part of the benefit of hiring an attorney is they negotiate down how much the insurance company and hospital receive during subrogation, and not everyone can hire an attorney or have an incident that is bad enough to be worth hiring one.
posted by misskaz at 5:48 AM on August 10
Can those with universal healthcare systems confirm what happens in the case of a car accident or other situation where liability is involved? Does the government try to get reimbursed in those circumstances?
No in the UK and I don't believe they do in Australia either. You just go and get treated the same as any other injury. If there were ongoing costs for longer-term issues or disabilities arising from the accident, those would be paid to the injured by the insurance company for the at-fault party but not for initial medical needs.
posted by goo at 6:17 AM on August 10 [1 favorite]
No in the UK and I don't believe they do in Australia either. You just go and get treated the same as any other injury. If there were ongoing costs for longer-term issues or disabilities arising from the accident, those would be paid to the injured by the insurance company for the at-fault party but not for initial medical needs.
posted by goo at 6:17 AM on August 10 [1 favorite]
Can those with universal healthcare systems confirm what happens in the case of a car accident or other situation where liability is involved?
I don't think the system attempts to recover costs, certainly not from the injured or with their cooperation. People can still sue in the case of automobile accidents but only for pain and suffering and loss of function not for covered medical costs. We may be an outlier though in BC because we also have mandatory no fault government auto insurance.
People can sue if you say slip on a puddle in a store and break something but again it is only for things besides medical costs. But people are much less likely to do so at least partially because they aren't on the hook for medical costs. If you go to your friends place and slip and fall and need to go to the ER for some stitches practically no one is going to sue. It isn't worth it for the small payout and lawyers aren't motivated by a large contingency. 30% of a few thousand dollars isn't worth it.
And it's reflected in our rates. I haven't had auto insurance in a few years now but when I did going from the legal 3rd party liability minimum of $200,000 to 3 million cost less than $50 a year for example.
In my immediate family over the last 40 years we've received medical treatment where another party might have been at fault if one was litigious for two dog bites, three broken noses, a broken arm, one workplace (where we also have a no fault system) injury and an automobile accident and only the auto accident involved lawyers and only for loss of work.
Supplemental medical insurance for stuff like drugs, dental, vision, physiotherapy, massage, and orthotics that isn't covered is paid by my union but the self pay option if I haven't been working enough is about $150 a month for a family of any size and $89 for a single person.
All this funded by taxes. In BC we used to have a nominal health insurance monthly fee of ~$100 but they eliminated that a few years ago mostly I think because it cost more to collect than it was taking in and it was pretty regressive.
posted by Mitheral at 6:39 AM on August 10 [1 favorite]
I don't think the system attempts to recover costs, certainly not from the injured or with their cooperation. People can still sue in the case of automobile accidents but only for pain and suffering and loss of function not for covered medical costs. We may be an outlier though in BC because we also have mandatory no fault government auto insurance.
People can sue if you say slip on a puddle in a store and break something but again it is only for things besides medical costs. But people are much less likely to do so at least partially because they aren't on the hook for medical costs. If you go to your friends place and slip and fall and need to go to the ER for some stitches practically no one is going to sue. It isn't worth it for the small payout and lawyers aren't motivated by a large contingency. 30% of a few thousand dollars isn't worth it.
And it's reflected in our rates. I haven't had auto insurance in a few years now but when I did going from the legal 3rd party liability minimum of $200,000 to 3 million cost less than $50 a year for example.
In my immediate family over the last 40 years we've received medical treatment where another party might have been at fault if one was litigious for two dog bites, three broken noses, a broken arm, one workplace (where we also have a no fault system) injury and an automobile accident and only the auto accident involved lawyers and only for loss of work.
Supplemental medical insurance for stuff like drugs, dental, vision, physiotherapy, massage, and orthotics that isn't covered is paid by my union but the self pay option if I haven't been working enough is about $150 a month for a family of any size and $89 for a single person.
All this funded by taxes. In BC we used to have a nominal health insurance monthly fee of ~$100 but they eliminated that a few years ago mostly I think because it cost more to collect than it was taking in and it was pretty regressive.
posted by Mitheral at 6:39 AM on August 10 [1 favorite]
Can those with universal healthcare systems confirm what happens in the case of a car accident or other situation where liability is involved? Does the government try to get reimbursed in those circumstances?
In Australia the public health system will definitely seek out reimbursement from the relevant insurer, but they do not charge the patient before seeking this out.
posted by chiquitita at 6:58 AM on August 10 [1 favorite]
lie to the public about "choice" and "waiting lists"
You forgot about the "death panels" mumimor lol
Every country with universal health care must have death panels.
Or so Americans are told.
choice
We in Canada have choice, Americans do not.
In network ,out of network has no meaning in Canada
You choose where you want to go. Not the insurance company. We have real choice
Your doctor can choose which medicines , which procedures are best for his patient.
Not some bean counter at the insurance company.
Waiting lists .. I've heard rumours the US has waiting lists as well.
Americans are being sold a bill of goods
posted by yyz at 7:27 AM on August 10 [8 favorites]
You forgot about the "death panels" mumimor lol
Every country with universal health care must have death panels.
Or so Americans are told.
choice
We in Canada have choice, Americans do not.
In network ,out of network has no meaning in Canada
You choose where you want to go. Not the insurance company. We have real choice
Your doctor can choose which medicines , which procedures are best for his patient.
Not some bean counter at the insurance company.
Waiting lists .. I've heard rumours the US has waiting lists as well.
Americans are being sold a bill of goods
posted by yyz at 7:27 AM on August 10 [8 favorites]
Does the government try to get reimbursed in those circumstances?
Here in British Columbia, the health system will seek reimbursement for certain things from vehicle insurance and from worker's insurance — both of which are just other parts of the government, but funded directly by insurance premiums from drivers and employers.
posted by ssg at 7:36 AM on August 10
Here in British Columbia, the health system will seek reimbursement for certain things from vehicle insurance and from worker's insurance — both of which are just other parts of the government, but funded directly by insurance premiums from drivers and employers.
posted by ssg at 7:36 AM on August 10
Waiting lists .. I've heard rumours the US has waiting lists as well.
Yup. I am a US physician and my waitlist for a new patient appointment is about 8 months. For return patients, it's > 13 months (as far out as our system will let you schedule). If you think this is ridiculous, you are right!
This is not just me or my health system, either. I have colleagues all over the country reporting the same thing. Combination of decreased supply (burnout, retirement) and increased need (aging population, complexity of care) means that everyone has gotten squeezed.
Even before the current crisis, the type of insurance you had absolutely dictated the kind of care you received. When I was a medical student, the resident "continuity" clinic was basically the Wild West. A bunch of people and a pile of paper charts. Grab the top chart on the pile, that's your patient for the next 30 min, here's a renovated closet you can see them in. It was an awful way to care for people, more akin to a walk-in/urgent care clinic than a longitudinal neurology ambulatory practice. Then I did a rotation in the attendings' clinic, nice waiting room with comfy chairs and soft music, private examination rooms large enough to accommodate a walker or wheelchair, actual scheduled visit with a specific physician. Guess which one was on the Upper East Side and which was in Washington Heights?
posted by basalganglia at 8:18 AM on August 10 [8 favorites]
Yup. I am a US physician and my waitlist for a new patient appointment is about 8 months. For return patients, it's > 13 months (as far out as our system will let you schedule). If you think this is ridiculous, you are right!
This is not just me or my health system, either. I have colleagues all over the country reporting the same thing. Combination of decreased supply (burnout, retirement) and increased need (aging population, complexity of care) means that everyone has gotten squeezed.
Even before the current crisis, the type of insurance you had absolutely dictated the kind of care you received. When I was a medical student, the resident "continuity" clinic was basically the Wild West. A bunch of people and a pile of paper charts. Grab the top chart on the pile, that's your patient for the next 30 min, here's a renovated closet you can see them in. It was an awful way to care for people, more akin to a walk-in/urgent care clinic than a longitudinal neurology ambulatory practice. Then I did a rotation in the attendings' clinic, nice waiting room with comfy chairs and soft music, private examination rooms large enough to accommodate a walker or wheelchair, actual scheduled visit with a specific physician. Guess which one was on the Upper East Side and which was in Washington Heights?
posted by basalganglia at 8:18 AM on August 10 [8 favorites]
Can those with universal healthcare systems confirm what happens in the case of a car accident or other situation where liability is involved? Does the government try to get reimbursed in those circumstances?
I don't know if this varies by province but in Ontario, they would not seek any sort of reimbursement for a car accident or like if you fell in a supermarket or whatever, but one thing they do always ask about is if an injury is workplace related. They DO make employers pay for workplace compensation-based injuries, but it would be the employer who somehow pays, not the patient and if they employer doesn't pay it somehow that doesn't mean the patient pays. The patient never pays. It's against the law to bill an OHIP (ontario-health insurance plan) covered patient for services that are covered by OHIP.
One nice side effect of nobody having to pay their healthcare costs is that it makes people a lot less litigious since you don't have to sue to recover your medical expenses.
posted by If only I had a penguin... at 9:08 AM on August 10 [3 favorites]
I don't know if this varies by province but in Ontario, they would not seek any sort of reimbursement for a car accident or like if you fell in a supermarket or whatever, but one thing they do always ask about is if an injury is workplace related. They DO make employers pay for workplace compensation-based injuries, but it would be the employer who somehow pays, not the patient and if they employer doesn't pay it somehow that doesn't mean the patient pays. The patient never pays. It's against the law to bill an OHIP (ontario-health insurance plan) covered patient for services that are covered by OHIP.
One nice side effect of nobody having to pay their healthcare costs is that it makes people a lot less litigious since you don't have to sue to recover your medical expenses.
posted by If only I had a penguin... at 9:08 AM on August 10 [3 favorites]
You forgot about the "death panels" mumimor lol
Every country with universal health care must have death panels.
Let me tell you about the death panels. By a complete coincidence (nothing to do with my above mentioned job), I was chose through a lottery to participate in a huge citizen engagement proces. One part was a meeting with 1000 participants, mostly voters from all parts of society, but also at each table of 12 a politician and someone from the healthcare system. It could be a doctor, a nurse or someone from admin. In the middle of the day, we all changed tables.
At the time, there was a huge scandal about "secret codes" at a specific hopsital, telling staff not to resuscitate patients with KOL who had a heart attack or stopped breathing during operations. I always suspected it was planted by some of the for-profit health businesses. But there is no doubt that the hospital was bad at communicating with patients, compared to other hospitals.
Anyway, there was a guy with KOL at my table, and he was worried, because this hospital was where he'd probably go if anything happened. But the nurse and politician at the table explained to him that the issue was that if his heart stopped, they could not save his brain (this was 20 years ago, I think they can today), so he would live on in a coma, on a ventilator. And then he just plainly said: well, why didn't they tell us that from the beginning? I don't want to be kept alive as a vegetable.
Because it was also my job, I asked the politician about it later, and he said he had been astounded by the lay-people's responses throughout the proces, not just the KOL guy. People had really sensible thoughts about what healthcare should do or shouldn't. He felt they were being pulled around in the media-lobbyist-patient organization spin circus and had far too little contact with the actual people out here.
posted by mumimor at 9:42 AM on August 10 [3 favorites]
Every country with universal health care must have death panels.
Let me tell you about the death panels. By a complete coincidence (nothing to do with my above mentioned job), I was chose through a lottery to participate in a huge citizen engagement proces. One part was a meeting with 1000 participants, mostly voters from all parts of society, but also at each table of 12 a politician and someone from the healthcare system. It could be a doctor, a nurse or someone from admin. In the middle of the day, we all changed tables.
At the time, there was a huge scandal about "secret codes" at a specific hopsital, telling staff not to resuscitate patients with KOL who had a heart attack or stopped breathing during operations. I always suspected it was planted by some of the for-profit health businesses. But there is no doubt that the hospital was bad at communicating with patients, compared to other hospitals.
Anyway, there was a guy with KOL at my table, and he was worried, because this hospital was where he'd probably go if anything happened. But the nurse and politician at the table explained to him that the issue was that if his heart stopped, they could not save his brain (this was 20 years ago, I think they can today), so he would live on in a coma, on a ventilator. And then he just plainly said: well, why didn't they tell us that from the beginning? I don't want to be kept alive as a vegetable.
Because it was also my job, I asked the politician about it later, and he said he had been astounded by the lay-people's responses throughout the proces, not just the KOL guy. People had really sensible thoughts about what healthcare should do or shouldn't. He felt they were being pulled around in the media-lobbyist-patient organization spin circus and had far too little contact with the actual people out here.
posted by mumimor at 9:42 AM on August 10 [3 favorites]
What is KOL? google is not helping.
posted by If only I had a penguin... at 9:52 AM on August 10
posted by If only I had a penguin... at 9:52 AM on August 10
Oh sorry, mostly we use the international acronyms, so I thought this was one. It's COPD
posted by mumimor at 10:24 AM on August 10
posted by mumimor at 10:24 AM on August 10
i like the fire dept analogy (cw: nathan robinson)
A Way To Think Clearly About 'Medicare For All' Debates - "What if we talked about the fire department the way we talk about healthcare."
or if you prefer the AMA...
A Single-Payer System Would Reduce U.S. Health Care Costs
posted by kliuless at 2:16 PM on August 10 [7 favorites]
A Way To Think Clearly About 'Medicare For All' Debates - "What if we talked about the fire department the way we talk about healthcare."
or if you prefer the AMA...
A Single-Payer System Would Reduce U.S. Health Care Costs
Today’s fragmented system is akin to requiring each household in a community to anticipate their needs for the coming year and negotiate their own fees and scope of services with the local police and fire departments. Imagine instead how much of their budgets these life-saving community services would be obliged to devote to marketing to and negotiating with each household and the rampant disparities in service that would result. That is precisely what is happening today in health care, and it is absurdly wasteful. For police and fire departments, we have recognized that it is significantly less wasteful to give all citizens the same “coverage” for set prices and to administer it with regional coordination. Global budgeting is the only sensible strategy for such unpredictable yet universally needed services.and fwiw no less than hayek would agree :P
posted by kliuless at 2:16 PM on August 10 [7 favorites]
I think it's fantastic that this is maybe shining a light on the stupidity and greed that is the broken US healthcare system, but I feel like everyone has missed this other important bit in the SI article:
Because the U.S. is one of three countries whose elite athletes receive no government funding, athletes know that they need to find opportunities to build their brands to try to earn enough money to continue competing.
Which really says everything you need to know about America.
posted by photo guy at 1:32 AM on August 11 [4 favorites]
Because the U.S. is one of three countries whose elite athletes receive no government funding, athletes know that they need to find opportunities to build their brands to try to earn enough money to continue competing.
Which really says everything you need to know about America.
posted by photo guy at 1:32 AM on August 11 [4 favorites]
I have luckily lived long enough to finally make it onto Medicare and, man, what a different world it is. I still have monthly premiums, but they’re tiny compared to what I was paying for my previous marketplace plan. And the yearly deductible is miniscule.
I'm glad to hear it, but doesn't traditional Medicare have significant OOP costs? My understanding was that Part B still requires a 20% copay and there is no catastrophic cap whatsoever, while Part A has a sizeable deductible. I have gotten a crash course in all of this over the past year, and the lack of a cap in particular was kind of shocking. I know most people get Medigap insurance, but I would think that both Medigap + Part B premiums would be a significant expense.
I think Medicare for All is far better than what we have now but this is something that's crossed my mind. Of course maybe I have no idea what I'm talking about, this shit is way too complicated.
posted by photo guy at 1:32 AM on August 11
I'm glad to hear it, but doesn't traditional Medicare have significant OOP costs? My understanding was that Part B still requires a 20% copay and there is no catastrophic cap whatsoever, while Part A has a sizeable deductible. I have gotten a crash course in all of this over the past year, and the lack of a cap in particular was kind of shocking. I know most people get Medigap insurance, but I would think that both Medigap + Part B premiums would be a significant expense.
I think Medicare for All is far better than what we have now but this is something that's crossed my mind. Of course maybe I have no idea what I'm talking about, this shit is way too complicated.
posted by photo guy at 1:32 AM on August 11
Can those with universal healthcare systems confirm what happens in the case of a car accident or other situation where liability is involved?
Ooh, I have relevant experience! (Never thought the experience of getting hit by a car would come in handy one day.)
Years (decades?) ago, I got hit by a car while on my bike and was taken to hospital by an ambulance. I think I remember seeing an ambulance bill, but I don't recall any hassle about that part - it was probably just for information? (I believe it was 800 euros, which I thought was quite a lot.)
Anyway, the driver's insurance company took responsibility for 'making me whole' in terms of stuff that got damaged. I recall that for both my glasses and boots (the latter of which only got scuffed), I was reimbursed for the full cost. (I happened to have the receipts/bank statements still; otherwise I think they would have accepted any reasonable estimate.)
I recall that about three years later, I got a letter (or possibly a call) to check whether I had incurred any further medical costs related to the accident. Only after confirming this were they allowed to close the incident.
I realize this doesn't literally answer your question about whether the government recovers money from the car insurance, but I think it does show that the whole way of working is just different: the responsibility is on the insurance company (of the one at fault) to make things right for the 'victim'. (And they treat this as their job, rather than some pesky legal obligation.)
posted by demi-octopus at 1:51 AM on August 11 [1 favorite]
Ooh, I have relevant experience! (Never thought the experience of getting hit by a car would come in handy one day.)
Years (decades?) ago, I got hit by a car while on my bike and was taken to hospital by an ambulance. I think I remember seeing an ambulance bill, but I don't recall any hassle about that part - it was probably just for information? (I believe it was 800 euros, which I thought was quite a lot.)
Anyway, the driver's insurance company took responsibility for 'making me whole' in terms of stuff that got damaged. I recall that for both my glasses and boots (the latter of which only got scuffed), I was reimbursed for the full cost. (I happened to have the receipts/bank statements still; otherwise I think they would have accepted any reasonable estimate.)
I recall that about three years later, I got a letter (or possibly a call) to check whether I had incurred any further medical costs related to the accident. Only after confirming this were they allowed to close the incident.
I realize this doesn't literally answer your question about whether the government recovers money from the car insurance, but I think it does show that the whole way of working is just different: the responsibility is on the insurance company (of the one at fault) to make things right for the 'victim'. (And they treat this as their job, rather than some pesky legal obligation.)
posted by demi-octopus at 1:51 AM on August 11 [1 favorite]
"Can those with universal healthcare systems confirm what happens in the case of a car accident or other situation where liability is involved? Does the government try to get reimbursed in those circumstances? I wonder how different our car, property, and other liability insurance policies would be if we had universal healthcare. "
My country is one of very few (maybe the only one?) in the world with a universal, no-fault insurance scheme. We abolished the right to sue for damages (except for exemplary and punitive damages) and we take a small premium from people's wages and other sources... and if you suffer injury by accident or medical misadventure, the full cost of the treatment is covered, the rehab until you are ready to work again is covered, and you get paid a proportion of your lost income until you are ready to return to work, if ever.
The origins of the scheme were the observation that often when a serious accident happens, the obvious people to sue don't have any money, or it's not clear how to assign blame.
This often surprises visitors from litigious places, particularly the US, who think they can sue for anything that causes injury. You cannot. But you will be treated for free.
It's not without problems as a system, it can be administered unfairly and as an insurer rather than a welfare programme they will try and manage you off the scheme, and periodically there are worries it is unaffordable... but we've had it since 1974 and there has never been any serious proposal to return to the arrangements the rest of the world has.
An emerging debate is whether and how to extend the scheme to disabling events that are NOT the result of accident but a disease process. We do have a social welfare benefit for invalids but it is not nearly as generous, being a fixed universal payment rather than something tied to your previous income.
posted by i_am_joe's_spleen at 2:05 AM on August 11 [3 favorites]
My country is one of very few (maybe the only one?) in the world with a universal, no-fault insurance scheme. We abolished the right to sue for damages (except for exemplary and punitive damages) and we take a small premium from people's wages and other sources... and if you suffer injury by accident or medical misadventure, the full cost of the treatment is covered, the rehab until you are ready to work again is covered, and you get paid a proportion of your lost income until you are ready to return to work, if ever.
The origins of the scheme were the observation that often when a serious accident happens, the obvious people to sue don't have any money, or it's not clear how to assign blame.
This often surprises visitors from litigious places, particularly the US, who think they can sue for anything that causes injury. You cannot. But you will be treated for free.
It's not without problems as a system, it can be administered unfairly and as an insurer rather than a welfare programme they will try and manage you off the scheme, and periodically there are worries it is unaffordable... but we've had it since 1974 and there has never been any serious proposal to return to the arrangements the rest of the world has.
An emerging debate is whether and how to extend the scheme to disabling events that are NOT the result of accident but a disease process. We do have a social welfare benefit for invalids but it is not nearly as generous, being a fixed universal payment rather than something tied to your previous income.
posted by i_am_joe's_spleen at 2:05 AM on August 11 [3 favorites]
(one of my cousins was convicted for threatening to blow up the ACC offices after he considered they had unfairly terminated payments to him on the basis he was able to work, when he felt he was not).
posted by i_am_joe's_spleen at 2:09 AM on August 11
posted by i_am_joe's_spleen at 2:09 AM on August 11
I'm a Canadian who lives below the poverty level. I had a stroke in 2010, when I was in my early 40s. Emergency interventions, MRI CT scan, installation of a stent, two days in ICU, two days on a ward. It cost me nothing. Three years later I presented at Emergency experiencing stroke-like symptoms. I was seen immediately and found to have venous clots in my neck and on my brain. Six days in hospital, MRI, CT scan, IV drugs, round-the-clock monitoring. It cost me nothing. I was referred to a hematologist, one of the best in Canada and had many tests, appointments with neurologists, and more tests, where it was determined that my clotting issues were due to myelofibrosis, a rare form of bone cancer. Still there was no cost to me.
For nine years, I was under the care of a hematologist, with many appointments and much blood testing. I was referred to a specialist in stem cell transplants (the only known cure for myelofibrosis)and he monitored my condition (in addition to the monitoring by the hematologist) for five years. No cost.
In October of 2023, I received a stem cell transplant. It required three months in hospital and two months of thrice weekly care on the BMT unit. The transplant seems to have been successful and I continue under the care of the transplant team at quarterly appointments. These are some of the best doctors in North America, and I have literally received over a million dollars worth of treatment, even though I am a poor person. I have had to pay virtually nothing for my treatment or most of my prescriptions of Very Expensive Drugs*
I had a fatal disease, and I don't seem to have that disease any more. I am thankful every day that I live in a country where a person like me can receive the very best and most advanced care regardless of my financial situation. I'm alive solely because of that access and it looks like I may live a normal life span, with no noticeable deficits of mobility or cognition. To think that if I were geographically located only a hundred miles south of here, that I would have just died, probably back in 2010, is absolutely chilling.
* as well as physiotherapy (I broke two ribs in hospital), dieticians, temporary accommodations near the hospital for two months, mobility aids, personal care items, dietary supplements to rebuild muscle, dental checkups, and probably other things I'm forgetting to mention
posted by alltomorrowsparties at 2:17 AM on August 11 [24 favorites]
For nine years, I was under the care of a hematologist, with many appointments and much blood testing. I was referred to a specialist in stem cell transplants (the only known cure for myelofibrosis)and he monitored my condition (in addition to the monitoring by the hematologist) for five years. No cost.
In October of 2023, I received a stem cell transplant. It required three months in hospital and two months of thrice weekly care on the BMT unit. The transplant seems to have been successful and I continue under the care of the transplant team at quarterly appointments. These are some of the best doctors in North America, and I have literally received over a million dollars worth of treatment, even though I am a poor person. I have had to pay virtually nothing for my treatment or most of my prescriptions of Very Expensive Drugs*
I had a fatal disease, and I don't seem to have that disease any more. I am thankful every day that I live in a country where a person like me can receive the very best and most advanced care regardless of my financial situation. I'm alive solely because of that access and it looks like I may live a normal life span, with no noticeable deficits of mobility or cognition. To think that if I were geographically located only a hundred miles south of here, that I would have just died, probably back in 2010, is absolutely chilling.
* as well as physiotherapy (I broke two ribs in hospital), dieticians, temporary accommodations near the hospital for two months, mobility aids, personal care items, dietary supplements to rebuild muscle, dental checkups, and probably other things I'm forgetting to mention
posted by alltomorrowsparties at 2:17 AM on August 11 [24 favorites]
The Australian state of Victoria has the TAC which works similarly to NZ's ACC. Anything it pays out is on top of the Medicare system administered by the Commonwealth government. It's funded via Victorian car registration fees.
posted by flabdablet at 1:03 PM on August 11
posted by flabdablet at 1:03 PM on August 11
Can those with universal healthcare systems confirm what happens in the case of a car accident or other situation where liability is involved? Does the government try to get reimbursed in those circumstances?
Poland: nope. You get treated for free. The injured party can sue the party at fault/their insurance to cover extra expenses.
posted by M. at 1:44 PM on August 11
Poland: nope. You get treated for free. The injured party can sue the party at fault/their insurance to cover extra expenses.
posted by M. at 1:44 PM on August 11
I'm also a Canadian who's had a stroke and kidney stones and numerous broken bones (twice hit by car). X-rays, MRIs, CT scans, blood work, and on and on. Hasn't cost me a cent.
posted by dobbs at 2:05 PM on August 11 [1 favorite]
posted by dobbs at 2:05 PM on August 11 [1 favorite]
It was a huge relief to get Australian permanent residency and our Medicare (for all) cards. The system isn’t perfect, but if you believe healthcare is a human right, like I do, this is heck of a lot closer than the US system.
Some of the insurers (NIB, hiss) seem to be trying it on with an HMO model, but hopefully that nonsense won’t catch on.
Although some innovations are good: VIC has taken on the idea of urgent care clinics as a way to reduce pressure on the ER, but done it as a sensible, publicly funded effort (PPCCs). Which is great, because good luck finding a GP open on a Saturday night or a Sunday afternoon. We have a baby, so we’ve already been a bunch of times already. Every time, the quality of care has been excellent, generally with some waiting as they triage cases, but in a much nicer and smaller area than the ER.
NO FEE EITHER, because this is part of the public health system. Here’s hoping they have proved an economically viable model and stick around through the state’s cost cutting moves.
I might still visit the US, but this kind of thing is a key reason why I won’t be moving back. As a bonus, very low gun crime, although vape shop fire bombings are way up lately.
posted by ec2y at 3:53 AM on August 12 [1 favorite]
Some of the insurers (NIB, hiss) seem to be trying it on with an HMO model, but hopefully that nonsense won’t catch on.
Although some innovations are good: VIC has taken on the idea of urgent care clinics as a way to reduce pressure on the ER, but done it as a sensible, publicly funded effort (PPCCs). Which is great, because good luck finding a GP open on a Saturday night or a Sunday afternoon. We have a baby, so we’ve already been a bunch of times already. Every time, the quality of care has been excellent, generally with some waiting as they triage cases, but in a much nicer and smaller area than the ER.
NO FEE EITHER, because this is part of the public health system. Here’s hoping they have proved an economically viable model and stick around through the state’s cost cutting moves.
I might still visit the US, but this kind of thing is a key reason why I won’t be moving back. As a bonus, very low gun crime, although vape shop fire bombings are way up lately.
posted by ec2y at 3:53 AM on August 12 [1 favorite]
I'm glad to hear it, but doesn't traditional Medicare have significant OOP costs? My understanding was that Part B still requires a 20% copay and there is no catastrophic cap whatsoever, while Part A has a sizeable deductible.
Costs and coverages for Medicare A and B. A lot of it is income-dependent. As you can see, the deductible is crazy low for most folks.
There is also a thing called Medicare Supplement Plan G (aka medigap) that covers/pays for everything A & B don’t. Everything. If it’s something Medicare touches, Plan-G covers all the costs A & B don’t. My current Plan-G premium is about $140/mo.
The biggest snafu in Medicare remains Part-D prescription coverage. Coverage there is still largely dependent on private insurers’ formularies. It’s not bad for most prescriptions, but if you’re on something rare or expensive, it’s still gonna suck. I have a couple meds that I can get cheaper via GoodRX. FWIW, though, my Medicare Part-D coverage this year is costing me $0.
posted by Thorzdad at 10:22 AM on August 12 [1 favorite]
Costs and coverages for Medicare A and B. A lot of it is income-dependent. As you can see, the deductible is crazy low for most folks.
There is also a thing called Medicare Supplement Plan G (aka medigap) that covers/pays for everything A & B don’t. Everything. If it’s something Medicare touches, Plan-G covers all the costs A & B don’t. My current Plan-G premium is about $140/mo.
The biggest snafu in Medicare remains Part-D prescription coverage. Coverage there is still largely dependent on private insurers’ formularies. It’s not bad for most prescriptions, but if you’re on something rare or expensive, it’s still gonna suck. I have a couple meds that I can get cheaper via GoodRX. FWIW, though, my Medicare Part-D coverage this year is costing me $0.
posted by Thorzdad at 10:22 AM on August 12 [1 favorite]
FWIW, people experiencing “significant OOP costs” are quite likely those who opted for a Medicare Advantage plan as their supplement, instead of something like the aforementioned Part-G. Those tend to have most of the downsides of private insurance, like networks, OOP costs, etc.
posted by Thorzdad at 2:08 PM on August 12 [1 favorite]
posted by Thorzdad at 2:08 PM on August 12 [1 favorite]
How expensive is US healthcare? I changed jobs twice in 1 year. So I also changed health insurance. The exact same inhaler that year cost me:
- $7 (first insurance after meeting $500 deductible)
- $410 (second insurance, no deductible, name brand not covered under current plan, charged full cost with no generic option available)
- $30 (copay model, covered by plan, no deductible)
Now imagine being a poor single parent and trying to work out if you can afford your kid's life-saving asthma medicine -- regardless of whether it's with or without health insurance.
I have also stood in front of a pharmacist at CVS and had a full blown asthma attack because they could not refill my inhaler on a Sunday. I was out of authorized refills. The doctor's office was closed. That asthma attack is what triggered a $500 charge for an EMT to respond to the 911 call and give me a few puffs of MY ASTHMA MEDICATION so I wouldn't die until the doctor could refill it the following day.
I broke my leg in 2019. I have full health insurance through work. Vacation was in Michigan, health insurance policy is sourced through home office back in Florida. Needed tib-fib nail placement surgery to fix it.
Got billed $96,000 for out-of-network surgery at a hospital my plan didn't cover. Eventually got it down to a sane amount - $9,000 - mind you, with employer-provided health insurance I paid $218 a month for, with a $500 deductible.
You can literally die in America, even with health insurance, if you get hurt or sick at the wrong place or time. There is essentially zero safety net here for the sick or injured.
posted by Unicorn on the cob at 4:07 PM on August 12 [5 favorites]
- $7 (first insurance after meeting $500 deductible)
- $410 (second insurance, no deductible, name brand not covered under current plan, charged full cost with no generic option available)
- $30 (copay model, covered by plan, no deductible)
Now imagine being a poor single parent and trying to work out if you can afford your kid's life-saving asthma medicine -- regardless of whether it's with or without health insurance.
I have also stood in front of a pharmacist at CVS and had a full blown asthma attack because they could not refill my inhaler on a Sunday. I was out of authorized refills. The doctor's office was closed. That asthma attack is what triggered a $500 charge for an EMT to respond to the 911 call and give me a few puffs of MY ASTHMA MEDICATION so I wouldn't die until the doctor could refill it the following day.
I broke my leg in 2019. I have full health insurance through work. Vacation was in Michigan, health insurance policy is sourced through home office back in Florida. Needed tib-fib nail placement surgery to fix it.
Got billed $96,000 for out-of-network surgery at a hospital my plan didn't cover. Eventually got it down to a sane amount - $9,000 - mind you, with employer-provided health insurance I paid $218 a month for, with a $500 deductible.
You can literally die in America, even with health insurance, if you get hurt or sick at the wrong place or time. There is essentially zero safety net here for the sick or injured.
posted by Unicorn on the cob at 4:07 PM on August 12 [5 favorites]
So I had to switch health care for my job. Just today I found out (a) I am not permitted to switch or use my new PCP until September 1, (b) I have to make an appointment to try to continue getting birth control after that, which requires referral, (c) I really should just go to Planned Parenthood. Also, I was supposed to get blood work done today and found out, "oh, you are NOT ALLOWED to go to X Lab or Y Lab," you have to go to our SPECIAL LAB. This from the health insurance where you're supposed to have all these choices and options.
posted by jenfullmoon at 5:12 PM on August 12 [1 favorite]
posted by jenfullmoon at 5:12 PM on August 12 [1 favorite]
I have also stood in front of a pharmacist at CVS and had a full blown asthma attack because they could not refill my inhaler on a Sunday. I was out of authorized refills. The doctor's office was closed. That asthma attack is what triggered a $500 charge for an EMT to respond to the 911 call and give me a few puffs of MY ASTHMA MEDICATION so I wouldn't die until the doctor could refill it the following day.
It's relatively new however pharmacists can not only proscribe a range of common drugs here now including a lot of vaccines they can also just fill an emergency short term script for stuff you get regularly. So if you accidentally drop your open bottle of meds into the toilet on a holiday weekend they'll give you a weeks worth just on your history. (It's limited in that I think if you are on opiods or something you won't get it but an inhaler or blood pressure meds are no problem)
posted by Mitheral at 6:01 PM on August 12 [5 favorites]
It's relatively new however pharmacists can not only proscribe a range of common drugs here now including a lot of vaccines they can also just fill an emergency short term script for stuff you get regularly. So if you accidentally drop your open bottle of meds into the toilet on a holiday weekend they'll give you a weeks worth just on your history. (It's limited in that I think if you are on opiods or something you won't get it but an inhaler or blood pressure meds are no problem)
posted by Mitheral at 6:01 PM on August 12 [5 favorites]
Thank you for that info, Mitheral! This happened back in 2018 so I'm grateful to hear that. It's one of 2 times my only option for short-term asthma treatment involved calling 911. One of those times I was already unconscious by the time they got to me, which really sucked/I definitely don't enjoy risking brain damage just to get access to life-saving medication I've been prescribed since I was 7 years old.
posted by Unicorn on the cob at 6:20 AM on August 13
posted by Unicorn on the cob at 6:20 AM on August 13
My Canadian husband got a taste of the US healthcare system in 2012 when he broke his foot while we were on vacation. Never again, he said.
My partner, a Canadian, broke his shoulder in 2017 while visiting Burlington, Vermont from our home in Ottawa, Ontario. While the care he received was excellent and efficient, they sent him home with a bill for $22K USD (about $27K CAD at the time) for one night's hospital stay and X-raying and bracing of his broken shoulder, plus a couple of really horrifically overpriced bottles of painkillers. What are they even DOING for that price? Like, what? We extremely luckily have seamless international medical insurance through work because that would have put us into debt for a long time.
In Canada it would have just been ... done. No bill. He might have had to pay for a brace or something.
posted by urbanlenny at 11:52 AM on August 13 [2 favorites]
My partner, a Canadian, broke his shoulder in 2017 while visiting Burlington, Vermont from our home in Ottawa, Ontario. While the care he received was excellent and efficient, they sent him home with a bill for $22K USD (about $27K CAD at the time) for one night's hospital stay and X-raying and bracing of his broken shoulder, plus a couple of really horrifically overpriced bottles of painkillers. What are they even DOING for that price? Like, what? We extremely luckily have seamless international medical insurance through work because that would have put us into debt for a long time.
In Canada it would have just been ... done. No bill. He might have had to pay for a brace or something.
posted by urbanlenny at 11:52 AM on August 13 [2 favorites]
A friend of mine from the US was visiting Quebec City for Carnival like 20 years ago and slipped on the ice and broke his arm quite messily. They fixed him up and weren't sure what to bill him. I think they charged him $50 or something. He said he was really glad it happened in Canada otherwise he'd have had to go into some kind of life-altering debt. And this was 20 years ago!
posted by seanmpuckett at 12:34 PM on August 13 [1 favorite]
posted by seanmpuckett at 12:34 PM on August 13 [1 favorite]
My first first-hand exposure to how mercenary the US system is was 30 years ago when one of the guys I was traveling with in the US passed out when he stepped out to buy a drink from a convenience store (ironically he probably passed out because he was dehydrated). He came to as they were loading him into an ambulance and the first thing they asked him ahead of any query about his condition was "Which hospital do you want to go to?" "Uh, the closest one?"
Of course they were asking because even 30 years ago it was important to go to the hospital that was in network for your insurance. Something that just never comes up here.
posted by Mitheral at 6:13 PM on August 13 [1 favorite]
Of course they were asking because even 30 years ago it was important to go to the hospital that was in network for your insurance. Something that just never comes up here.
posted by Mitheral at 6:13 PM on August 13 [1 favorite]
Hell, you may even have to worry if the ambulance is in-network, something I found out after I dislocated my kneecap and needed paramedics to get me out of my basement and to an ER. And you don't have a choice over which ambulance the dispatcher sends. My insurance initially denied the claim because the specific emergency service that responded wasn't in-network, and I had to call them and point out that my plan very specifically said it covers any ambulance trips up to X miles, and this qualified, to get them to back down. It's nuts.
posted by biogeo at 8:45 PM on August 14 [3 favorites]
posted by biogeo at 8:45 PM on August 14 [3 favorites]
Once, ages ago (i.e. pre-ACA) I had to have, if I recall correctly, a CT done. I carefully made sure the imaging center I went to was in-network for my insurance. A few months later, I got a bill for just over $1,000. I immediately called the imaging center and discovered that, yes, the center was in-network, but the staff radiologist who looked at the scans was not. WTF???
posted by Thorzdad at 7:51 AM on August 20 [1 favorite]
posted by Thorzdad at 7:51 AM on August 20 [1 favorite]
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posted by supermedusa at 10:56 AM on August 9 [24 favorites]