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This is how you healthcare: American Death in London

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Re: This is how you healthcare: American Death in London

#101

Post by bunderbunder »

cpleppert wrote: post #73
bunderbunder wrote: post #16

Earlier quoted context omitted.

Actually, it does refuse to treat people quite regularly. Aside from emergency department, health care providers are generally free to refuse care for patients they believe cannot pay except in the case of a life-threatening emergency. What this means is that in the USA it's common for people to have to allow earlier-stage, less expensive to treat problems develop into serious problems before finally going into the E…

>>Actually, it does refuse to treat people quite regularly. Aside from emergency department, health care providers are generally free to refuse care for patients they believe cannot pay except in the case of a life-threatening emergency. This isn't actually accurate at all. Hospitals with emergency departments must stabilize patients in an emergency. Thats it. The emergency room has no responsibility to treat the und…

You're right, that's exactly the case. Sorry if I explained it poorly. The spot where this gets really fantastically expensive is when you get to the "wash, rinse, repeat" part of the situation. After all, someone who is just being stabilized and discharged without significant treatment of the underlying cause is much more likely to just get sick again.

There's a hospital in the town where I grew up which managed to shave millions off of the cost of operating their emergency department in a rather instructive way: They identified their most expensive repeat patients, and started just paying to send them in for regular medical care for whatever health problems it was they had. Yeah it meant that they were giving out free health care to these folks, but that turned out to be nothing compared to the cost of having them show up in an ambulance every other week.

Re: This is how you healthcare: American Death in London

#102

Post by abstractbill »

marknutter wrote: post #92
abstractbill wrote: post #51

Earlier quoted context omitted.

For me there's a very specific, personal, reason. At the end of 2011 I got randomly unlucky and suffered from pneumonia, a stomach ulcer, and a norovirus all in the space of three months. I was hospitalized for the norovirus. After that I was told by more than one insurance agent that I wouldn't be able to purchase insurance at any price , for about 18 months. Obamacare does at least stop that from happening to peopl…

Well, buying insurance to treat a pre-existing condition would be a little like trying to get a car accident covered by insurance after the fact, wouldn't it?

What pre-existing condition? This was after I fully recovered from the pneumonia, the stomach ulcer, and the norovirus.

Re: This is how you healthcare: American Death in London

#103

Post by flexie »

carsongross wrote: post #95
flexie wrote: post #93

Earlier quoted context omitted.

http://epianalysis.wordpress.com/2012/07/18/usversuseurope/

No, I mean how could you possibly know if you paid for the service? I'm not going to defend the US healthcare system, which is a charming mixture of the worst aspects of monopoly markets and socialism.

OK. It is a quick guess based on the taxes we have paid.

Of course our taxes also went for other things like welfare, education, administration and defense, and as we all know many European governments have run deficits for years.

Re: This is how you healthcare: American Death in London

#104

Post by elemeno »

Aaronontheweb wrote: post #74
bengillies wrote: post #57

Earlier quoted context omitted.

Can you explain this please, as I'm pretty sure you can totally sue the NHS if you want to.

Sure In one instance in the 1970s I had a great uncle who came into a local clinic complaining about crushing chest-pain, and was told to come back the following day because the attending physician was out for the day. He died on the street of a heart attack while walking home. Why he wasn't immediately rushed to a hospital is beyond me. More recently, my grandmother, who died in 2004, was wait listed for over a year…

Both of your examples are tragic and clearly represent failings of the system - some of which have since been fixed, and at least one of which would likely have happened in the US as well.

I hope you'll forgive me if I sound callous in this post - I certainly don't mean to, but I also recognise that this is a touchy subject when talking about someone's own family.

In the case of your great-uncle the problem is likely that it was the 70s and fourty years ago there was nowhere near the same awareness of the symptoms of cardiac arrest amongst non-physicians. If the doctor wasn't there, chances are it wouldn't have been picked up on. Even had he been rushed to hospital, his chance of survival would have been pretty low - heart attacks are still a major killer in the 2010s where even in London, which has the highest survival rate in the UK for heart attacks that occur outside a hospital, the survival rate is only 30%. Keep in mind though that survival rates have increased significantly over the last fourty years with advances in diagnostics and treatment as well as improved defibrillators etc.

Your grandmother's case is a more clear cut case of failure. Waiting times have long been a problem in the NHS, but it's a matter of resource contention, and it's a problem which they're trying to improve with the guarantee that patients should start treatment within 18 weeks of their first appointment and that tests should be done within six weeks. The only, very rough, numbers I can find for the US suggests that scans and tests are normally done within seven to twenty weeks when cancer is suspected. Even in the US, the problem of resources exists - there's only so many hospitals that can perform certain types of scans, and only so many doctors who are capable of properly interpreting the results. The thing I can't comment on is whether or not the physician who saw your grandmother should have treated it as a higher priority or if, given the symptoms that were presented, it would be reasonable to assume that there was a benign cause and it being cancer was pretty remote possibility. If it's the case that his prognosis was obviously wrong given the symptoms, then there's a case to be made for malpractice, or at least a complaint to the GMC and/or NHS trust.

Re: This is how you healthcare: American Death in London

#105

Post by marknutter »

potatolicious wrote: post #99
marknutter wrote: post #92

Earlier quoted context omitted.

Well, buying insurance to treat a pre-existing condition would be a little like trying to get a car accident covered by insurance after the fact, wouldn't it?

Yes, but health insurance is not insurance at all. It's really a gross misnomer, and outside of a niche market, no one seriously sells health insurance . Insurance is designed to protect the policy holder from an unlikely, catastrophic event they cannot afford otherwise - coverage of everyday costs is not insurance. Notice your insurance company doesn't pay to rotate your tires or change your oil. Health care, no mat…

Well then what's wrong with people simply paying out of pocket for basic services? Insurance would be there to cover the truly catastrophic health issues, but otherwise we would all pay for the level of basic service (maintenance) we prefer to pay for.

Re: This is how you healthcare: American Death in London

#106

Post by elemeno »

redblacktree wrote: post #97
marknutter wrote: post #91

Earlier quoted context omitted.

Of course it's cheaper - the NHS is actively controlling prices. That of course means that doctors get paid less, patients wait longer for certain types of treatments or are denied other types outright, and people do are not granted unlimited resources to fight death at their end of life as they are in our system. You can't just say it's cheaper as a blanket endorsement without analyzing exactly why it's cheaper.

Is private insurance still available if I want more exotic options? Sounds like the best of both worlds to me.

Yup. You can happily pay for private insurance, or pay out of pocket for private care, and you'll be able to get all the drugs that the NHS thinks are too expensive for the benefits they bring, or surgical procedures that are considered experimental.

Re: This is how you healthcare: American Death in London

#107

Post by marknutter »

abstractbill wrote: post #102
marknutter wrote: post #92

Earlier quoted context omitted.

Well, buying insurance to treat a pre-existing condition would be a little like trying to get a car accident covered by insurance after the fact, wouldn't it?

What pre-existing condition? This was after I fully recovered from the pneumonia, the stomach ulcer, and the norovirus.

Sorry, I read your post wrong. At any rate, the analogy still applies - it becomes much more expensive to buy auto insurance after you've gotten into an accident. If you are prone to sickness, I can see why health insurance would also be harder to obtain.

Re: This is how you healthcare: American Death in London

#108

Post by carbocation »

revelation wrote: post #42
carbocation wrote: post #24

Earlier quoted context omitted.

> Actually, it does refuse to treat people quite regularly. Let's not play with words like that. People in the US get treatment—you even say so later, despite your ominous lead sentence. They just get it later, via the ED, after prevention goes un-performed. That's abominable enough, and that's what we should talk about, not the (false) specter of non-treatment.

Now thats playing with words. Do you really think the people on the ground in a US hospital are completely distanced and isolated from the costs that accrue once they admit someone without insurance?

At my hospital it generally only affects placement after discharge, but I'm sure it's variable.

My primary point was that while most things can be debated, it's absurd to claim that people don't get treated in the US.

Re: This is how you healthcare: American Death in London

#109

Post by potatolicious »

marknutter wrote: post #105
potatolicious wrote: post #99

Earlier quoted context omitted.

Yes, but health insurance is not insurance at all. It's really a gross misnomer, and outside of a niche market, no one seriously sells health insurance . Insurance is designed to protect the policy holder from an unlikely, catastrophic event they cannot afford otherwise - coverage of everyday costs is not insurance. Notice your insurance company doesn't pay to rotate your tires or change your oil. Health care, no mat…

Well then what's wrong with people simply paying out of pocket for basic services? Insurance would be there to cover the truly catastrophic health issues, but otherwise we would all pay for the level of basic service (maintenance) we prefer to pay for.

We have this - this is what one normally finds in the form of health indemnity. They cover (up to some maximum) only emergency/catastrophic costs, and have no everyday coverage.

They are extremely unpopular for many reasons, which center primarily around paying out of pocket for normal services:

For the purposes of this argument I'm going to use "health plan" to refer to what most people call "insurance" - to avoid confusing the two concepts.

- The out of pocket costs for a no-plan person is extremely inflated. Where your insurance company might pay $60 for a doctor's visit, the cost for someone not on a health plan may be $200-300. This makes the notion of paying out of pocket for routine services unrealistic for the majority of the population.

- These out of pocket costs are expensive because the status quo is for everyone to be on an employer-sponsored health plan. Those who can afford to pay, are on a health plan - the bulk of those who aren't on a plan are financially compromised and likely to default on their debts. This encourages a wild inflation of quoted cost to compensate.

- This further drives people to health plans. Barring the ultra-rich, no one is able to afford health care at "free market" prices, making health plans the only reasonable route forward.

In short, what's wrong with people paying out of pocket for basic services is that "basic services" at market rates will set you back $300 for sore throat.

Re: This is how you healthcare: American Death in London

#110

Post by lotharbot »

potatolicious wrote: post #109
marknutter wrote: post #105

Earlier quoted context omitted.

Well then what's wrong with people simply paying out of pocket for basic services? Insurance would be there to cover the truly catastrophic health issues, but otherwise we would all pay for the level of basic service (maintenance) we prefer to pay for.

We have this - this is what one normally finds in the form of health indemnity. They cover (up to some maximum) only emergency/catastrophic costs, and have no everyday coverage. They are extremely unpopular for many reasons, which center primarily around paying out of pocket for normal services: For the purposes of this argument I'm going to use "health plan" to refer to what most people call "insurance" - to avoid c…

I've been without a traditional health plan for quite a while. There's actually been a lot of innovation in this space recently.

For example, in some locales you can subscribe to a "direct primary care" practice for a family of four (2 adults, 2 kids) for around $150 per month, and visit your primary care provider as much as you need, paying only for supplies or possibly a token per-visit amount. This, combined with a legitimate "insurance" plan with a high deductible, might set a family back less than half as much as a traditional all-inclusive health plan. (This is what I had in Seattle, with Qliance as my direct primary care provider.)

My son recently needed a physical to start school. As a self-pay patient now located in Denver, I called around to independent clinics in my area and was able to get a fairly good price ($110 total out of pocket, paid up front.) My wife was recently able to be treated for an ear infection for around $80.

If you're actually paying out of pocket it can be a little bit of work, but there are ways to get your costs down to close to "free market" levels.

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