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Post-apocalyptic life in American health care

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Re: Post-apocalyptic life in American health care

#141

Post by qwytw »

specialist wrote: post #137
qwytw wrote: post #126

Earlier quoted context omitted.

> companies are immensely profitable That's not necessarily true. If all the for profit insurance companies reduced their profit margins prices wouldn't go down that significantly. I think it's mainly the extreme inefficiency and much higher labor costs.

> extreme inefficiency and much higher labor costs Which is mooted with single payer. Roughly 1/3rd of costs eliminated. Last time I checked (mid 2000s). Probably more now.

> Which is mooted with single payer.

As in doctors, nurses, and other personnel will accept lower salaries because they won't have any choice? I'm not sure that would work in the US.

Also, there are relatively efficient non-single-payer systems in Europe (e.g., IIRC, Switzerland and the Netherlands don't have the equivalents of Medicare/Medicaid). Proper regulation, including price transparency and regulation, would solve most of the main issues and would probably be much easier to achieve than a single-payer system.

A federally imposed universal single-payer system seems to be totally politically infeasible. The best you could hope for is a two-tier system with the government continuing to subsidize for-profit healthcare (including insurance) companies (all extremely expensive treatments covered by the government, but most people who can afford it will continue having private coverage as well).

Wouldn't it be much easier (and possibly more efficient and equitable) to just adopt the Dutch system?

Re: Post-apocalyptic life in American health care

#142

Post by decafninja »

When the subject of how bad the American healthcare system is, why is it that the European systems are always brought up as the ones to emulate and not those of some East Asian countries?

Stories I hear about Europe is that it’s affordable, but still slow and bureaucratic. You hear about some people even coming to the US (gasp!) to get expedited treatment.

Asia seems to be both affordable and also fast and efficient.

Re: Post-apocalyptic life in American health care

#143

Post by BeefDinnerPurge »

Wytwwww wrote: post #129
op00to wrote: post #104

Earlier quoted context omitted.

You provide no examples of your statement. I say Medicare for all is a panacea and will cause no breaks in care. That was easy.

So healthcare providers would be fine with significantly lower incomes just because the government tell them to suck it up? Also, it's not like the fact that the private insurance model failed in the US means that it can't work at all. For instance, not all countries in Europe have single payer. In some the health insurance system is privatized to a much higher degree than in the US, no equivalent of Medicaid/Medicar…

The chief problem is here is asserting healthcare must be either entirely Medicare For All or the current inadequate privately funded system when the two can coexist. Just like legalizing drugs won't cure crime and unhappiness on its own, I doubt a baseline (note I said baseline) Medicare For All fixes healthcare on its own, but to assert neither are a step in the right direction seems absolutely absurd.

There are clear problems with the current system, and we paid quite a bit out of pocket to evade substandard care this past year with our insurance company threatening to not cover it at all at every step. We called their bluff by enrolling in clinical trials and they folded. Most can't afford to do so, and some never will, but I wish I lived in a country where more could.

And sure, a more transparent private system could work, in fact, utter transparency should be a requirement from the get-go given what is happening with the public/private mix in Canada. But we have 50 individual states in which to experiment yet good luck with that in the current media/political environment. Not giving either party a break here.

Re: Post-apocalyptic life in American health care

#144

Post by Thadawan »

AnthonyMouse wrote: post #95
colechristensen wrote: post #65

Earlier quoted context omitted.

>when compared to commercial HMOs, Medicaid HMOs and Medicare HMOs. That's not all private insurance, just some of it. That's also talking about the average. >although there is high variation in quality across individual VA facilities ... >It's the usual "review effect", you only see negatives about the VA, not positives. You're saying in rebuttal to a negative review of private insurance, which isn't even what's at…

> That's also talking about the average. It's worse than that. The VA can't be compared to the average insurer because all of their patients are people who could at some point in their adult life satisfy the military's physical fitness requirements, which is not the case for the population at large.

It could be argued that the veteran population had a higher likelihood of exposure to dangerous chemicals (agent orange, burn pits), higher rates of mental illness-triggering situations (leading to their own homeless, PTSD, and drug addiction epidemic), and physical wounds from shrapnel IED’s and gunfire.

Re: Post-apocalyptic life in American health care

#145

Post by BeefDinnerPurge »

jmye wrote: post #122
op00to wrote: post #104

Earlier quoted context omitted.

You provide no examples of your statement. I say Medicare for all is a panacea and will cause no breaks in care. That was easy.

I didn’t realize you were looking for a sourced essay. Medicare-for-all extends a fee for service model that results in poor care, poorer outcomes, massively increases expense, and simultaneously lowers physician reimbursements. Given the increasing doctor shortage, that’s an issue that will be immediately exacerbated. Further, the FFS model incentivizes throughput, not quality of care. Your care won’t get better.

So how do places like Hong Kong make this work? Because they do. My out of pocket expenses there uninsured are less than my copayments fully insured here.

https://journals.lww.com/jcma/Fulltext/2015/10000/Overview_o...

I suspect every reason you will cite is something we could both address as a nation and we will refuse to do so because freedom or some other idiocy. I truly give up. I threw money at family's medical crisis and prevailed. Most can't. More should be able to do so.

Even California is looking to places like Houston to mine ideas for improving their raging homeless problem. If you're not going to steal from the best, why bother doing anything?

Re: Post-apocalyptic life in American health care

#146

Post by spondylosaurus »

ufocia wrote: post #128
andutu wrote: post #19

My boyfriend woke up one day to find out they couldn't pee. After a few ER visits and an MRI, they determined he had Stage 2 bladder cancer. However, because they had the audacity to seek immediate medical treatment for a life threatening health issue, they have now been saddled with thousands of dollars in medical debt. I had to personally dip into my earnings from my Big Tech internship to help pay some of it off.…

Not an ad hominem attack or a microaggression, but hopefully constructive criticism. Your use of the "them" pronoun makes the post confusing. Does it refer to "they," presumably the doctors, the employer (job), the insurance, UT Southwestern, or to the gendered "boyfriend." Since you already decided to use a gendered noun, perhaps use it instead of the "they/them" or use a matching gendered pronoun "he/him" to distin…

It's not the most common, but some people do go by they/them and still use certain gendered terms like boyfriend/girlfriend where appropriate. (Full disclosure that I'm one of them, lol.)

I think part of it is that there isn't a great neutral word to take its place. "Partner" is probably the best option overall, but it can mean anything from "person I've been married to for 15 years" to "person with whom I opened an LLC," whereas boy/girlfriend is pretty specific. And the only neutral term of that specificity I've seen proposed is "joyfriend," which I find unbearably silly because I'm not 15 years old :P

Re: Post-apocalyptic life in American health care

#147

Post by spondylosaurus »

andutu wrote: post #19

My boyfriend woke up one day to find out they couldn't pee. After a few ER visits and an MRI, they determined he had Stage 2 bladder cancer. However, because they had the audacity to seek immediate medical treatment for a life threatening health issue, they have now been saddled with thousands of dollars in medical debt. I had to personally dip into my earnings from my Big Tech internship to help pay some of it off.…

> The vast majority of doctors genuinely want to help people and are more I interested in practicing the skills they've honed for decades rather than deal with faceless automata at health insurance companies who deny claims upon a mere glance.

Not only that, but doctors also have to fight tooth and nail to get reimbursed by insurance companies (some worse than others... I have doctors who won't even take UHC anymore because the reimbursement rates are too low to break even on practice costs). So we end up with this bizarre arrangement where patients get their wallets drained and doctors have to hunt down their paychecks for services provided... all while the middleman gets richer.

I hope your boyfriend's doing okay. Dealing with a major medical issue like cancer is already hard enough on its own without the added financial nightmare in this country, but at least it sounds like they're in good hands between you and the doctors they're seeing.

Re: Post-apocalyptic life in American health care

#148

Post by nothercastle »

x86x87 wrote: post #139
nothercastle wrote: post #133

Soviet health care is like that. A friend is taking care of an elderly mother and to get anything done you have to network through associates, acquire medicines for medical procedures though 3rd party networks. Assemble your own surgical team etc. It’s a completely tribal and manual process. When done with western money you can get world class care though. I would assume similar things are possible in the USA if you…

I don't think anyone is saying that you cannot get the best healthcare on the planet if you have the required money. Lots of money. The problem is that most people don't have that kind of money and the system as a whole is designed to take advantage of regular folks by not providing the care they need (regular care, not the best care).

I think this is a common theme in all 3rd world medicine. That’s the point we’re moving towards that model

Re: Post-apocalyptic life in American health care

#149

Post by op00to »

jmye wrote: post #123
op00to wrote: post #105

Earlier quoted context omitted.

Why is it Medicare’s problem to fix that educated people choose not to live in certain places?

So your solution to healthcare in this country is to light rural America on fire so that you, personally, can have cheaper care? That sounds workable.

That’s not what I said at all.

Re: Post-apocalyptic life in American health care

#150

Post by jmye »

BeefDinnerPurge wrote: post #145
jmye wrote: post #122

Earlier quoted context omitted.

I didn’t realize you were looking for a sourced essay. Medicare-for-all extends a fee for service model that results in poor care, poorer outcomes, massively increases expense, and simultaneously lowers physician reimbursements. Given the increasing doctor shortage, that’s an issue that will be immediately exacerbated. Further, the FFS model incentivizes throughput, not quality of care. Your care won’t get better.

So how do places like Hong Kong make this work? Because they do. My out of pocket expenses there uninsured are less than my copayments fully insured here. https://journals.lww.com/jcma/Fulltext/2015/10000/Overview_o... I suspect every reason you will cite is something we could both address as a nation and we will refuse to do so because freedom or some other idiocy. I truly give up. I threw money at family's medical…

Do you think there might be other differences between Hong Kong and the United States that could account for differing challenges in providing healthcare?

I’m not clear why you’re giving up - it’s not an intractable problem. Some folks need to give up on “healthcare only for the rich/cities” and some folks need to stop having strong opinions about a very, very complicated industry they don’t understand at even a surface level (not directed at anyone specifically - it’s a common US problem with healthcare discussions/solutions).

Cost/utilization/availability challenges are fully solvable, if one is committed to a solution and not a message.

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