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Poverty Is the 4th Leading Cause of Death in the US, Research Shows

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Re: Poverty Is the 4th Leading Cause of Death in the US, Research Shows

#51

Post by atdrummond »

Madmallard wrote: post #39
atdrummond wrote: post #10

Earlier quoted context omitted.

Just don’t pay it. I wish I had been told this instead of flushing thousands upon thousands down the toilet in a futile attempt to keep the balance at $0. The system is designed to be adversarial and your best tactic as a patient is to delay, delay, delay and fight every single bill. I have had seven operations for Crohns, a back surgery, and treatment for ongoing Leukaemia. I have lived in a half dozen different jur…

I imagine at some point UCLA or Cedar Sinai will just stop offering me services? I need to see nutrition but it isn’t covered by medicare so it is $600 for an appointment but it is integral to my actual condition so it seems like I am being screwed over. I cannot pay that and also eat, which sorta defeats the purpose of staying alive. I cannot do food banks because I have a mast cell disorder and what I can actually…

I have an ER bill of $100k+ owed to Stanford for the better part of a decade (amongst an huge number of other more recent bills) and they still see me for regular booked appointments and ERs.

It works less well for specialist offices owned by doctors themselves but I’ve found the large hospitals are disinclined to outright deny service, for a multitude of reasons.

Re: nutrition, is there a clinic outside your normal network that might offer that? You may have to wait longer but I’ve been able to see no-cost specialists in St Louis, Chicago and the Bay Area through various neighborhood clinics. I’m always happy to help too - feel free to drop me an email and I can connect you to some resources in your area.

Most importantly, best of luck with all of this.

Re: Poverty Is the 4th Leading Cause of Death in the US, Research Shows

#52

Post by atdrummond »

wskinner wrote: post #12
atdrummond wrote: post #10

Earlier quoted context omitted.

Just don’t pay it. I wish I had been told this instead of flushing thousands upon thousands down the toilet in a futile attempt to keep the balance at $0. The system is designed to be adversarial and your best tactic as a patient is to delay, delay, delay and fight every single bill. I have had seven operations for Crohns, a back surgery, and treatment for ongoing Leukaemia. I have lived in a half dozen different jur…

What happens to the typical person’s healthcare costs when some people who consume extremely expensive treatments” just don’t pay”? What is the equilibrium here?

Not sure but none of the medical care I’ve received should actually be expensive. Every medicine I’ve ever been prescribed is generic, every emergency procedure would have been covered by state funds had I not paid.

The fact that very few institutions pursue me at all for these supposedly owed funds tells me none of them are close to teetering on the brink of insolvency.

As someone who as also had healthcare in single payer (the NHS) and presently pays both the government (Estonia) and private insurance (Estonia and US), I have zero problem paying for the general upkeep of the country’s medical system.

I simply refuse to believe that because some life saving care was “out of network” the cost to treat me actually ballooned from thousands to millions. It’s an artifact of a system that’s not designed for uninsured/underinsured participants.

Re: Poverty Is the 4th Leading Cause of Death in the US, Research Shows

#53

Post by friendzis »

mindslight wrote: post #33
TMWNN wrote: post #11

Earlier quoted context omitted.

>I wonder how much of this can be attributed to medical bankruptcy. Only 4% of US bankruptcies are because of medical bills https://www.washingtonpost.com/blogs/post-partisan/wp/2018/0... >. A tipoff that [insert large percentage here] of bankruptcies aren't actually because of medical costs is that only 6% of bankruptcies by those without health insurance are because of that cause. The biggest cause of bankruptcies…

> the way people online ~~lie~~ exaggerate it's not surprising that so many non-Americans believe that every American is one hangnail away from bankruptcy. People exaggerating online certainly don't cause more confusion than the routine lies of medical providers, sending bills with completely-fictitious humongous numbers claiming to be the price. And then even if you do have "insurance" (which isn't actually insuranc…

> the provider and the "insurance" company both continue to keep the actual prices obfuscated with those fictitious numbers and a whole bunch of "adjustments", rather than ever just plainly stating prices.

That's the name of the game, not unique to USofA. Once you have majority/monopoly payer (be that private insurance or tax-supported state health fund) it becomes a game of cat and mouse. Health providers try to extract as much per case as possible, insurance providers try to cut per-case payment to the minimum. Inflating list prices on provider's end, establishing various per-item limits and per-case adjustments on payer's end are the low hanging fruit towards the goal. State insurance systems just have this less visible as the patient is usually not involved in the invoicing process, but nevertheless it is there.

The sad reality is that there is very little to none incentive for list prices to remain low or reflective of actual cost.

Re: Poverty Is the 4th Leading Cause of Death in the US, Research Shows

#54

Post by atdrummond »

I’m very skeptical of this. I have been homeless in metro America and a huge number of the people I was homeless with (as well as their families) would be no healthier with an additional $10k, $20k, $30k etc., a year.

Activists like to claim that “food deserts” are a supply side phenomena but I promise they exist due to a lack of demand for the food those in suburbs or luxury high-rises prefer. A larger budget just means the vast majority of these people will purchase Pizza Hut instead of Caseys/7-Eleven.

Re: Poverty Is the 4th Leading Cause of Death in the US, Research Shows

#55

Post by twelve40 »

TMWNN wrote: post #11
hunglee2 wrote: post #2

"Poverty, which the study defined as less than half the median U.S. income" I wonder how much of this can be attributed to medical bankruptcy. If you cannot afford insurance, get injured, can't afford treatment...pretty straightforward doom loop to an early grave

>I wonder how much of this can be attributed to medical bankruptcy. Only 4% of US bankruptcies are because of medical bills https://www.washingtonpost.com/blogs/post-partisan/wp/2018/0... >. A tipoff that [insert large percentage here] of bankruptcies aren't actually because of medical costs is that only 6% of bankruptcies by those without health insurance are because of that cause. The biggest cause of bankruptcies…

yeah although medical does contribute, I bet the bulk of it is consumer debt. There are trillions and trillions made by industries pushing on people shit they can't afford. After you max out on iphones and other stupid shit, you either have to put up with snowballing interest (forget the principal) or declare bankruptcy. The latest innovation is bnpl where people buy food, groceries on credit :facepalm:

Re: Poverty Is the 4th Leading Cause of Death in the US, Research Shows

#56

Post by salmonellaeater »

The study is paywalled but it looks like poverty is just correlated with death. The most likely explanation is that they have a common cause.

In studies that can differentiate between environmental and genetic causes, longevity has some genetic influence but no or very little influence from poverty. For example, from [1]:

> The heritability of longevity was estimated to be 0.26 for males and 0.23 for females. [...] There is no evidence for an impact of shared (family) environment.

In this context, "shared family environment" encompasses everything in the environment that is shared between children in the same family, including income.

Another study [2] shows that longevity has substantial genetic cause:

> Half of the variation in susceptibility to mortality is genetic: findings from Swedish twin survival data

Note that these two studies only include childhood poverty. What about adult poverty? From [3]:

> While we find some evidence that permanent income shocks lead to poorer health behaviour, we find no evidence that it affects directly any health measures. Despite sizable shocks to income at the cohort level during our period of analysis, which can be empirically linked to changes in consumption expenditures, we fail to find any changes in (cohort) health, even if we allow those shocks to affect health with a lag.

Note that this is health, not mortality, but they're related. It suggests that the stronger underlying cause is, in the paper's terms, "underlying factors" such as genetics, innate ability, or childhood poverty. Childhood poverty we already know from behavior genetics is not causal.

There's other evidence out there along similar lines. If the new paper used a research design that could actually determine causality, or could at least rule out some ways in which a common cause would explain the data, it would be more interesting.

[1] Herskind AM, McGue M, Holm NV, Sørensen TI, Harvald B, Vaupel JW. The heritability of human longevity: a population-based study of 2872 Danish twin pairs born 1870-1900. Hum Genet. 1996 Mar;97(3):319-23. doi: 10.1007/BF02185763. PMID: 8786073.

[2] Yashin AI, Iachine IA, Harris JR. Half of the variation in susceptibility to mortality is genetic: findings from Swedish twin survival data. Behav Genet. 1999 Jan;29(1):11-9. doi: 10.1023/a:1021481620934. PMID: 10371754.

[3] Adda, Jérôme, et al. “THE IMPACT OF INCOME SHOCKS ON HEALTH: EVIDENCE FROM COHORT DATA.” Journal of the European Economic Association, vol. 7, no. 6, 2009, pp. 1361–99. JSTOR, http://www.jstor.org/stable/40601206. Accessed 22 May 2023.

Re: Poverty Is the 4th Leading Cause of Death in the US, Research Shows

#58

Post by Madmallard »

atdrummond wrote: post #51
Madmallard wrote: post #39

Earlier quoted context omitted.

I imagine at some point UCLA or Cedar Sinai will just stop offering me services? I need to see nutrition but it isn’t covered by medicare so it is $600 for an appointment but it is integral to my actual condition so it seems like I am being screwed over. I cannot pay that and also eat, which sorta defeats the purpose of staying alive. I cannot do food banks because I have a mast cell disorder and what I can actually…

I have an ER bill of $100k+ owed to Stanford for the better part of a decade (amongst an huge number of other more recent bills) and they still see me for regular booked appointments and ERs. It works less well for specialist offices owned by doctors themselves but I’ve found the large hospitals are disinclined to outright deny service, for a multitude of reasons. Re: nutrition, is there a clinic outside your normal…

I appreciate that.

The nutritionist I saw is highly recommended because she has dealt with patients like me before. Is there some kind of bill deferring thing I could do in this situation?

Re: Poverty Is the 4th Leading Cause of Death in the US, Research Shows

#59

Post by jrflowers »

AbrahamParangi wrote: post #38
jrflowers wrote: post #29

Earlier quoted context omitted.

> I'd much rather see a calculation of how many years of life are lost, an actually meaningful metric. How do you calculate the number of years lost? Do you subtract their age from the national age expectancy or do you run a prediction model to extrapolate the age each individual would have lived to given what data is available for them?

Those are both better ideas than the cited study!

[dead]

Re: Poverty Is the 4th Leading Cause of Death in the US, Research Shows

#60

Post by atdrummond »

Madmallard wrote: post #58
atdrummond wrote: post #51

Earlier quoted context omitted.

I have an ER bill of $100k+ owed to Stanford for the better part of a decade (amongst an huge number of other more recent bills) and they still see me for regular booked appointments and ERs. It works less well for specialist offices owned by doctors themselves but I’ve found the large hospitals are disinclined to outright deny service, for a multitude of reasons. Re: nutrition, is there a clinic outside your normal…

I appreciate that. The nutritionist I saw is highly recommended because she has dealt with patients like me before. Is there some kind of bill deferring thing I could do in this situation?

Have you talked to her finance team? Is she part of the major hospital networks you already visit?

If that $600 isn’t your copay but instead the whole cost out-of-network, there is almost certainly a way to get that put on a 12 month payment plan or something similar.

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