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I write about America’s health care system, and I got caught up in it

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Re: I write about America’s health care system, and I got caught up in it

#111

Post by stefan_ »

lotsofpulp wrote: post #13
civilized wrote: post #4

Aside from someone being denied life-saving medication, the most awful thing for me in these stories is the relentless Kafkaesque quality. We never get any answers to our basic sense-making questions about the bureaucratic process: - What did the insurer expect to happen, in order for this person to keep getting their medicine? - Why did those things not happen? - Whose job was it to make sure those things happened?…

I find the article written in a circuitous way, that does not clearly lay out the timeline. This statement about what a prior authorization is is also incorrect: > They’re essentially requirements that a physician get approval from an insurance company before prescribing a treatment. Doctors need no approval from anyone to prescribe. A prior authorization is approval from the insurance company that they agree with th…

None of this is making any sense. There is no cure for T1 Diabetes and it is lifelong. There is no reason to have any of these requirements, middlemen, authorizations or whatever.

Re: I write about America’s health care system, and I got caught up in it

#112

Post by syki »

BobbyJo wrote: post #61
syki wrote: post #56

Earlier quoted context omitted.

In all healthcare systems some form of rationing occurs since there aren’t enough resources to provide the best care to everyone. A system that rations care based on ability to pay or on wether or not your employer is generous is immoral. It is also immoral to profit off of denying someone care. Tough decisions have to be made and financially rewarding a company by denying care is despicable.

> A system that rations care based on ability to pay... is immoral. You lost me there. What makes it immoral? Money is an asset allocation tool, so why is it morally wrong to use it for medicine the same way we do for food and housing? Genuine question. I have a hard time understanding what sets medicine apart from everything else when people think healthcare should be universally free, but not food, water, clothing,…

Of course healthcare isn’t and can’t be free. Unless by free you mean free at the point of usage. I support government provided healthcare and government runs off of tax revenue. Denying a person cancer treatment for no other reason than because they can’t pay $x at the point of usage is an immoral system. An analogous situation occurs with federal courts. Those who can’t afford filing fees have those fees waived and those that can pay them do so. This is done because the court system recognizes that access to the court system based on the ability to pay at the point of usage is a bad system.

Re: I write about America’s health care system, and I got caught up in it

#113

Post by tragictrash »

throwaway6734 wrote: post #99
tragictrash wrote: post #74

Earlier quoted context omitted.

Sounds like the morally bankrupt trying to defend themselves.

What's your ideal healthcare situation and how do we get there from the current one? Broad platitudes like "everyone should have access to healthcare" doesn't count

Above my pay grade. Would be good to look at the countries that have a lower death rate per 100k and see what they are doing.

Most likely we need to reform the insurance industry, but systemic changes are definitely needed.

Re: I write about America’s health care system, and I got caught up in it

#114

Post by beerandt »

civilized wrote: post #44
lotsofpulp wrote: post #40

Earlier quoted context omitted.

The hogs at the trough have net profit margins of 5% or less, and pay out 85%+ of premiums they collect to healthcare providers. You can remove MCOs from the equation, and their function will still have to be done by whoever is paying. For example, the approving/denying is still done in the UK even though they have taxpayer funded healthcare. Or even within the Kaiser health system in the US. It does make life easier…

> More importantly, it gives employees an additional hurdle and fear of changing employers, because what if they have to go through what the person who wrote this article did? Maybe they should not shop around to see if they can sell their labor at a higher price, and just stick to their current employer. Another unnecessary chip for employers to have over employees in the US. This is horrifying to contemplate... do…

The people that are most concerned about insurance before quitting are generally the ones that have expensive, known health issues.

Which self insured employers pay for directly.

So the barriers to switching aren't necessarily good for the employer either, because the more reliant someone is on their health insurance, the more they cost the company, and the less likely they are to ever leave.

Re: I write about America’s health care system, and I got caught up in it

#115

Post by lotsofpulp »

stefan_ wrote: post #111
lotsofpulp wrote: post #13

Earlier quoted context omitted.

I find the article written in a circuitous way, that does not clearly lay out the timeline. This statement about what a prior authorization is is also incorrect: > They’re essentially requirements that a physician get approval from an insurance company before prescribing a treatment. Doctors need no approval from anyone to prescribe. A prior authorization is approval from the insurance company that they agree with th…

None of this is making any sense. There is no cure for T1 Diabetes and it is lifelong. There is no reason to have any of these requirements, middlemen, authorizations or whatever.

There are many different kinds of insulins at different prices, and apparently, in the US there is not though political will to pay for any choice of them as even the federal government restricts which one it pays for.

https://www.healthline.com/diabetesmine/new-medicare-program...

Re: I write about America’s health care system, and I got caught up in it

#116

Post by syki »

mantas wrote: post #86
syki wrote: post #56

Earlier quoted context omitted.

In all healthcare systems some form of rationing occurs since there aren’t enough resources to provide the best care to everyone. A system that rations care based on ability to pay or on wether or not your employer is generous is immoral. It is also immoral to profit off of denying someone care. Tough decisions have to be made and financially rewarding a company by denying care is despicable.

In countries with public healthcare it’s still based on ability to pay. You pay out of pocket and cut the queue, have decent time allotment with the doctor, get best medication available without money-saving algorithms etc.

In Canada private health clinics can not legally provide care that is covered by the Canada Health Act.

EDIT: After further reading it appears that private health care is a murky area in some provinces. My above stated belief appears to be wrong at least in terms of how things actually work there. Here is my view. Private medical care should be banned.

Re: I write about America’s health care system, and I got caught up in it

#117

Post by lotsofpulp »

hallway_monitor wrote: post #109
cascom wrote: post #87

Earlier quoted context omitted.

To your last point I wonder what the effect of not allowing a provider to charge a different price for the same service/product would be.

This is a really interesting idea. Seems like it would kind of level the playing field and might help guide us toward what I think is the ideal situation - no one needs health insurance other than for a catastrophic event because prices are known and reasonable and you just pay them, like literally every other service we need and consume.

That is supposedly the goal of high deductible health plans and HSAs.

Re: I write about America’s health care system, and I got caught up in it

#118

Post by mnhn1 »

BobbyJo wrote: post #101
mnhn1 wrote: post #76

Earlier quoted context omitted.

I don't think it's inconsistent. The people who advocate for free healthcare would probably also advocate for other parts of a social safety net, like food banks, food stamp programs, free access to water, temporary housing for the homeless and programs to get them to permanent homes, etc. And indeed the US has many such services, though they are often overwhelmed, or performed through a complex set of nonprofits com…

> don't think it's inconsistent. The people who advocate for free healthcare would probably also advocate for other parts of a social safety net, like food banks, food stamp programs, free access to water, temporary housing for the homeless and programs to get them to permanent homes, etc. Isn't it though? "This thing should be free for everyone all the time" is a lot different than "we should help people out a littl…

People don't consume healthcare "all the time" the same way they do food, housing, water. Preventive healthcare is cheaper/less work than treating illnesses that have gotten more serious, leading to less total consumption of healthcare (and those other downstream resources impacted by people avoiding preventive care). Also "Free healthcare available to all" doesn't preclude a private market. The Govt Healthcare is not always timely, may not cover treatments people want, or cover certain elective surgeries. Some people will always choose to participate in a private insurance market that provides value above a baseline govt health plan.

Re: I write about America’s health care system, and I got caught up in it

#119

Post by BobbyJo »

syki wrote: post #112
BobbyJo wrote: post #61

Earlier quoted context omitted.

> A system that rations care based on ability to pay... is immoral. You lost me there. What makes it immoral? Money is an asset allocation tool, so why is it morally wrong to use it for medicine the same way we do for food and housing? Genuine question. I have a hard time understanding what sets medicine apart from everything else when people think healthcare should be universally free, but not food, water, clothing,…

Of course healthcare isn’t and can’t be free. Unless by free you mean free at the point of usage. I support government provided healthcare and government runs off of tax revenue. Denying a person cancer treatment for no other reason than because they can’t pay $x at the point of usage is an immoral system. An analogous situation occurs with federal courts. Those who can’t afford filing fees have those fees waived and…

That's a bad comparison. The filing fee is small compared medical treatment, and it's in support of the government itself. The cost of doing that for people is tiny and doesn't really take away from anyone else.

Medicine is a scarce resource at this point, and, generally speaking, giving care to X often means Y won't get it. The fundamental problem with medical care is supply, lowering barriers for demand isn't a solution to that.

Re: I write about America’s health care system, and I got caught up in it

#120

Post by BobbyJo »

mnhn1 wrote: post #118
BobbyJo wrote: post #101

Earlier quoted context omitted.

> don't think it's inconsistent. The people who advocate for free healthcare would probably also advocate for other parts of a social safety net, like food banks, food stamp programs, free access to water, temporary housing for the homeless and programs to get them to permanent homes, etc. Isn't it though? "This thing should be free for everyone all the time" is a lot different than "we should help people out a littl…

People don't consume healthcare "all the time" the same way they do food, housing, water. Preventive healthcare is cheaper/less work than treating illnesses that have gotten more serious, leading to less total consumption of healthcare (and those other downstream resources impacted by people avoiding preventive care). Also "Free healthcare available to all" doesn't preclude a private market. The Govt Healthcare is no…

You can't pitch ways of increasing demand as a fix for a supply shortage. You're just shuffling around how who gets what is decided. Why is a government agent deciding any more ethical than your bank account?

And creating a public market necessarily diminishes the private, driving up costs, as purchasers are now competing with government for the same supply.

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