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US health system ranks last compared with peer nations – report

theguardian.com

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Re: US health system ranks last compared with peer nations – report

#221

Post by vidarh »

vkazanov wrote: post #165
vidarh wrote: post #33

Earlier quoted context omitted.

As someone in the UK with income in the top 1%, I have never bothered with private insurance because I genuinely don't feel I need it. I occasionally pay for private GP services, and I've paid for some private services for my son, but for the most part the NHS works. It has waiting times for non-essential things, and if you don't want that, you can pay for insurance that gets you seen faster and it costs a pittance.…

As someone in the same income range, and many friends in comparable spot, I have to say that NHS is sometimes ok . Here's an NHS case. Case 1. My friend's wife had her body going numb, like, completely senseless. They didn't have a private insurance back then. It was maddening hard to get past the GP. And then there were numerous tests, and queues, and... She had a viral brain infection that was, luckily, easy to fix…

"all the publicly available NHS numbers"? The number you should call if it looks serious is 999 (or 112; same thing). If they don't send an ambulance, then sure, that's a problem (and one worth filing a complaint about), but the times I've called 999 the reaction has been immediate.

As for tests, one of the reasons they "are afraid" has nothing to do with being afraid, but what is medically indicated. A lot of private services will do everything "just in case", the NHS won't. That means you often get people wondering why they've not been sent to an MRI for example (as one of the most common examples), because it's only actually affecting outcomes for a very small set of diagnoses. But some GPs certainly do get it wrong, and people need to be more aggressive about changing GPs if they feel they're not being heard.

Re: US health system ranks last compared with peer nations – report

#222

Post by gregjor »

trimethylpurine wrote: post #219
gregjor wrote: post #141

Earlier quoted context omitted.

Not true except for immediate emergency care. Many employers do not provide coverage. They skirt the law by employing people part-time (Walmart, Amazon) or as gig workers. Even if the law reads as you claim that doesn’t mean you can get care in the US.

And that's different from other countries how? I can walk into a hospital in any country in Europe as a non-citizen and request non emergency care and receive it? >Many employers do not provide coverage For under 50 employees, making less than 50k, Healthcare.gov covers those cases. You can visit there now to confirm my claim. And yes, it means you can get care in the US. I brought my Euro girlfriend here and she got…

Counter examples that don’t involve fraud, as you describe? Yes, many, but I don’t see any reason to try to refute the nonsense you posted.

Re: US health system ranks last compared with peer nations – report

#224

Post by trimethylpurine »

gregjor wrote: post #222
trimethylpurine wrote: post #219

Earlier quoted context omitted.

And that's different from other countries how? I can walk into a hospital in any country in Europe as a non-citizen and request non emergency care and receive it? >Many employers do not provide coverage For under 50 employees, making less than 50k, Healthcare.gov covers those cases. You can visit there now to confirm my claim. And yes, it means you can get care in the US. I brought my Euro girlfriend here and she got…

Counter examples that don’t involve fraud, as you describe? Yes, many, but I don’t see any reason to try to refute the nonsense you posted.

The point is that hospitals in the US indeed treat anyone with or without ID. Emergency or not.

I'm not sure what point you were making, or refuting, but I didn't catch it.

Re: US health system ranks last compared with peer nations – report

#225

Post by trimethylpurine »

shiroiushi wrote: post #28
trimethylpurine wrote: post #5

Earlier quoted context omitted.

The US health care system is partly socialized. Health care is provided for the unemployed or low income and the employed are covered as employers are required to provide health coverage. The odd ones out are typically small business owners who don't insure themselves and choose to take on the risk of potentially large medical bills. In all cases treatment is required by law, regardless of payment.

>In all cases treatment is required by law, regardless of payment. No, it's not. This is a myth. The only thing that's required is to stabilize the patient. If you need surgery to repair your shattered leg bone so you don't get an infection and need an amputation, you're not going to get that surgery without payment. But once you get a bad infection and need the leg amputated so you don't die, they'll do that for fre…

Just wanted to post back to share that I researched such incidences and except for a few cases where the hospital was sued and lost and doctors fired, I didn't find any examples of this as an accepted or legally viable practice. If you have some examples to share, I'll be interested.

Re: US health system ranks last compared with peer nations – report

#226

Post by vkazanov »

vidarh wrote: post #221
vkazanov wrote: post #165

Earlier quoted context omitted.

As someone in the same income range, and many friends in comparable spot, I have to say that NHS is sometimes ok . Here's an NHS case. Case 1. My friend's wife had her body going numb, like, completely senseless. They didn't have a private insurance back then. It was maddening hard to get past the GP. And then there were numerous tests, and queues, and... She had a viral brain infection that was, luckily, easy to fix…

"all the publicly available NHS numbers"? The number you should call if it looks serious is 999 (or 112; same thing). If they don't send an ambulance, then sure, that's a problem (and one worth filing a complaint about), but the times I've called 999 the reaction has been immediate. As for tests, one of the reasons they "are afraid" has nothing to do with being afraid, but what is medically indicated. A lot of privat…

Yes, I know, 999 was what we called.

So how it works, unfortunately, is that GPs get a lot of pressure to not do things "just in case". But "just in case" is the only way you can notice things that are wrong on a deeper level.

What, for example, is "back pain"? In 90% of the cases this can be fixed by, say, 10 sessions with a physio. But sometimes it can mean something serious, like a spinal disk injury.

Or sleepiness. 98% of that can be fixed with lifestyle and diet changes. But sometimes this can a sympthom of something scary.

Or my wife's example: didn't feel quite right for 3-4 weeks then fainted. Turned out to be serious. The full GP discussion would have taken weeks.

Or my friend's example: increasing numbness, nothing serious at first. Major brain infection. The GP actively tried to downplay things.

I don't know if there is a solution to this. Right now it feels that without chatgpt-assisted self-diagnoses and being aggressive with getting over the GP wall the system tries to avoid helping out.

Re: US health system ranks last compared with peer nations – report

#227

Post by gregjor »

trimethylpurine wrote: post #224
gregjor wrote: post #222

Earlier quoted context omitted.

Counter examples that don’t involve fraud, as you describe? Yes, many, but I don’t see any reason to try to refute the nonsense you posted.

The point is that hospitals in the US indeed treat anyone with or without ID. Emergency or not. I'm not sure what point you were making, or refuting, but I didn't catch it.

You got lucky. US hospitals routinely turn people away for non-emergency conditions. That probably happens everywhere but I was only responding about US medical care.

https://journalofethics.ama-assn.org/article/obligation-prov...

Re: US health system ranks last compared with peer nations – report

#228

Post by trimethylpurine »

gregjor wrote: post #227
trimethylpurine wrote: post #224

Earlier quoted context omitted.

The point is that hospitals in the US indeed treat anyone with or without ID. Emergency or not. I'm not sure what point you were making, or refuting, but I didn't catch it.

You got lucky. US hospitals routinely turn people away for non-emergency conditions. That probably happens everywhere but I was only responding about US medical care. https://journalofethics.ama-assn.org/article/obligation-prov...

What you linked to is a legal description and critique. While it represents the legal imperative, it's not representative, I don't think, of actual medical care.

It wouldn't make sense to risk your license or insurability. It's a bad business decision both for the doctor and for the hospital to send you home without care and discover later that a more serious condition was underlying the symptoms presented as non-emergent. It makes sense to at least check, and in so doing, treat. And if treating to provide the best care possible to avoid liability.

If you have examples of hospitals doing otherwise as a matter of practice I'll be interested to understand how that business model is possible.

As far as I've researched, I've only found cases where the hospital was sued and lost. Doctors fired or jailed. Etc.

The situation is that by requiring emergency care (which is subjective) the law creates enough risk that the de facto mode of operation is to treat all cases where risk is a factor, which is very nearly all cases.

Re: US health system ranks last compared with peer nations – report

#229

Post by gregjor »

trimethylpurine wrote: post #228
gregjor wrote: post #227

Earlier quoted context omitted.

You got lucky. US hospitals routinely turn people away for non-emergency conditions. That probably happens everywhere but I was only responding about US medical care. https://journalofethics.ama-assn.org/article/obligation-prov...

What you linked to is a legal description and critique. While it represents the legal imperative, it's not representative, I don't think, of actual medical care. It wouldn't make sense to risk your license or insurability. It's a bad business decision both for the doctor and for the hospital to send you home without care and discover later that a more serious condition was underlying the symptoms presented as non-eme…

Millions of Americans without medical insurance cannot get routine care. That can happen for a variety of reasons, but one of those reasons comes down to hospitals and clinics refusing to give non-emergency care for free. I don’t need to provide anecdotes for an endemic problem that gets studied at the federal policy level.

Personally I have experienced wait times approaching infinity, the hospital not denying care, but not providing it either, because people with insurance or cash get to the front of the queue unless an indigent person bleeds out in the ER.

If you go to an ER and need diagnostic tests for a real but non-emergency condition you will likely get referred to a diagnostic clinic, a place that only does tests and does not provide medical care, and that’s where your journey will end if you don’t have insurance or cash up front.

Try to get prenatal care in the US without insurance or cash. Possible to find programs for low-income uninsured people in some cities, but not everywhere by any stretch, and getting worse every year.

Talk to homeless people and advocates about people who cannot get treatment or medications because they have no insurance or money. Hospitals won’t dispense things like insulin until you go into shock in the ER, assuming you can get to one.

Re: US health system ranks last compared with peer nations – report

#230

Post by shiroiushi »

trimethylpurine wrote: post #217
shiroiushi wrote: post #28

Earlier quoted context omitted.

>In all cases treatment is required by law, regardless of payment. No, it's not. This is a myth. The only thing that's required is to stabilize the patient. If you need surgery to repair your shattered leg bone so you don't get an infection and need an amputation, you're not going to get that surgery without payment. But once you get a bad infection and need the leg amputated so you don't die, they'll do that for fre…

I'm not sure where this is happening, and I'm not saying you're wrong, but where I live, doctors are paid salary and they care for patients, so from my perspective what you're referring to sounds like a myth. My friends, who are doctors, operate all the time on people who have no identification and they do their absolute best. And there is no monetary incentive to do otherwise and they would quit and find a different…

Doctors have absolutely nothing to do with who gets care and who doesn't: that's controlled by hospital administration and other hospital staff. The doctors are just employees. When was the last time you saw a doctor in the ER reception room talking to new arrivals and deciding if they need to see a doctor or not?
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