Post-apocalyptic life in American health care
21–30 of 170 posts
Re: Post-apocalyptic life in American health care
#22It's amazing that someone can go through this and come to the conclusion, at the end, that the solution is that this is a business opportunity that would make a lot of money if someone could just make it more efficient. Trying to make money off of healthcare is exactly how we have gotten the absolute mess that is the American medical system. All the incredibly complex rules exist so that health insurance companies ca…
We can complain about capitalism all we want, but at the end of the day, in America, we still live in a capitalistic society. Good deeds that cannot happen profitably will not happen here en masse without subsidies, period. Given that our government has proven incapable of subsidizing healthcare in a way that promotes a combination of efficiency and effectiveness, it makes total sense that people would try to make a…
> Edit: To those downvoting me, can you please explain? What flaw do I have in my logic?
The idea that we're in a "capitalistic society". Every country in the world lives somewhere on the spectrum between capitalism and socialism. The US is further towards the capitalistic side than Europe, but we've plenty of non-capitalist aspects of our society.
We already accept a wide array of socialist policies in the form of Medicare, Social Security, etc. We've also plenty of evidence from the rest of the developed world that the socialist approach to healthcare provides similar outcomes at greatly reduced cost. "We're capitalists, deal with it" is a fundamentally silly reason to avoid healthcare reforms.
Re: Post-apocalyptic life in American health care
#23The important thing is to refrain from assigning blame for any of the problems in our healthcare system. Politics are bad, and we shouldn't try to figure out how things got this way because we don't want to get into any politics.
Re: Post-apocalyptic life in American health care
#24> For complex health care problems, I recommend hiring a consultant to provide administrative (not medical!) guidance. This is called a patient advocate. Think of them as your healthcare guardian. Sometimes you hire one, sometimes one will be assigned to you in more progressive healthcare systems. If you are fighting a chronic or potentially lethal disease, I highly recommend one. Edit: Your patient advocate is usual…
Does American insurance cover this? I have inquired about something like this before when I was getting conflicting diagnoses and treatment plans. Everyone I asked (at my insurance company) acted like they didn’t know what I was talking about. I did not size the phrase “patient advocate” but if one were available, I think my need for them would have been clear.
The patient advocates employed by insurers are primarily there to try and reduce your medical needs, so they can save money.
They're not going to reconcile differing diagnoses, they're going to ask if you've gotten your flu shot yet.
Re: Post-apocalyptic life in American health care
#25About 8 years ago I broke my leg and eventually developed a methicillin-resistant infection where screws had been inserted. Fighting this type of infection in the bone is difficult. I spent 11 months in a hospital bed plus some time in a SNF. A total of 7 surgeries in the first 18 months and another 2 after that, the most recent 3 years ago.
I can second the experience of the author. All in I had contact with over 40 different providers. I was lucky in that I had to leave my job and could concentrate on the administrative work required full time. I eventually learned I needed to keep a detailed written narrative up to date with a tl;dr at the top. Eventually I added appendixes that summarized lab tests and surgery reports. This was the only way I could make sure each provider had the details they needed. I would always send it advance, most of the time the doctor hadn't read it so I brought paper copies and sat there while they did.
The billing and who covered what was hopeless. I had to fight with medical insurance, the medical disability company and Medicare when I maxed both of those out. I went through every bill line by line to identify mistakes, there were many. Then I would make sure each had received a copy of each bill and start figuring out who would cover what, sometimes line-by-line. This all had to be done over phone and fax.
It's broken and I am sure it's killing people. I also don't see a technology fix. Anything that requires more than two or three providers is an edge case, this space is 90% edge cases.
Re: Post-apocalyptic life in American health care
#26I've been through similar experiences with my mother.
The best thing you can do, before your parent gets too old, is to consult with an elderlaw firm to get health care directives, wills and power of attorney written up. Most importantly, be sure to fully talk through the possible scenarios for what happens financially in the event of putting your parent in an SNF (skilled nursing facility).
Private pay for SNF in the USA is about $10000/month. That's a steep rate for middle class and even upper middle class folks. That's what your family will pay until medicaid "kicks in" when the savings of the parent are depleted. If your parent made the mistake of giving away part of their wealth to family within 5 years of entering SNF, that money still counts and they have to pay it to the SNF. The medicaid provider for your state will demand 5 years of bank statements for all accounts as well as query ALL financial transactions. You might have to hire a lawyer just to untangle the mess. Dealing with this stuff is a nightmare in paperwork at the worst possible time you can imagine.
I have found that face-to-face communication with the bureaucrats helps a lot. The HHS staff people who process medicaid long term care enrollments in SNF's have massive, soul-crushing workloads. Of course they're going to just skim the hundreds (not exaggerating) of pages of documents you send them. The article is right. You have to watch out for your family. No one else will do it.
Eldercare consultants cost several thousand dollars. We decided not to engage one because the SNF provided a lot of support and we had previously worked with an elderlaw firm, but it probably would have saved us some stress when dealing with medicaid/HHS as I was on the hook for $100K+ until a property sale from 4 years ago was sorted out. There are families that end up going bankrupt needlessly just because a parent wanted to "leave something" to their children and didn't know about the 5-year-lookback trap (Thank George W Bush for that fuck-up, see Deficit Reduction Act of 2005). We were fully aware of the basics and still narrowly averted a financial disaster.
Re: Post-apocalyptic life in American health care
#27Earlier quoted context omitted.
It isn't profit-seeking what makes healthcare what it is. Its the incredibly burdensome regulation and restrictions. If profit-seeking destroyed markets for profit, we would all be starving.
You know those regulations are there for a reason right? Would you like to go back to the days where people are kicked off insurance for extremely dubious pre-existing conditions? >If profit-seeking destroyed markets for profit, we would all be starving. It depends on what you mean by 'destroy markets.' The market is functioning well in the sense that healthcare stocks keep going up. It's functioning poorly in the se…
>You know those regulations are there for a reason right?
The road to hell is paved with good intentions.
> It depends on what you mean by 'destroy markets.' The market is functioning well in the sense that healthcare stocks keep going up. It's functioning poorly in the sense that it's the ill who have to die or go bankrupt to support it.
The measure of the health of a market is not the profits of the industry in it. A better rule of thumb would be how many people get serviced and at what relative cost. In that sense, the american healthcare market is very unhealthy.
Re: Post-apocalyptic life in American health care
#28Earlier quoted context omitted.
We can complain about capitalism all we want, but at the end of the day, in America, we still live in a capitalistic society. Good deeds that cannot happen profitably will not happen here en masse without subsidies, period. Given that our government has proven incapable of subsidizing healthcare in a way that promotes a combination of efficiency and effectiveness, it makes total sense that people would try to make a…
> Edit: To those downvoting me, can you please explain? What flaw do I have in my logic? The idea that we're in a "capitalistic society". Every country in the world lives somewhere on the spectrum between capitalism and socialism. The US is further towards the capitalistic side than Europe, but we've plenty of non-capitalist aspects of our society. We already accept a wide array of socialist policies in the form of M…
I'm not saying that we shouldn't continue pushing for reform. I'm just saying that our government has proven incapable of reformation, and we should be pushing towards non-governmental approaches until they can get their act together. If we can improve the way things are through capitalism, that's still better than just yelling at politicians that don't do anything.
Re: Post-apocalyptic life in American health care
#29I know this is going to be controversial, but at this point: > My mother’s mild dementia began accelerating rapidly a year ago. I’ve been picking up pieces of her life as she drops them. That has grown from a part-time job to a full-time job. In the past month, as she’s developed unrelated serious medical issues, it’s become a way-more-than-full-time job. I would have kept my mother out of the healthcare system and l…
I don't think that's a particularly controversial view. Your last few sentences touch more on the issue - when you're faced with losing someone, it's very easy to say "Pull out all the stops, having [ mom | dad | grandma | grandpa ] here for one more year is worth it." Honestly, the only group of people I've ever been around who have less trouble with that mindset are medical professionals. Most doctors, especially if they're 65+, are DNR/DNI because they've seen what spending significant time in the healthcare system is really like. But I've seen some of those same people fall into the trap of demanding care for their aging parents that they've explicitly rejected for themselves.
Re: Post-apocalyptic life in American health care
#30In the software world, we would fork or rewrite, and deprecate the old version. I think we should do the same for healthcare. The existing system is unmaintainable spaghetti code that needs to be deleted.
Create a new single payer healthcare system that is completely separate from anything existing now. Don't attempt to incorporate any existing insurance, regulations, medical records, etc. Allow the new system to ignore any existing drug patents. Get a few brand-new hospitals, a few hundred doctors fresh out of med school/residency, and tens of thousands of people using it - probably do this in a single city, a la Google Fiber. Spend a couple years working out the kinks.
Once that is done, migrate everyone to the new system over the course of a decade or so. Any existing hospitals, doctors, and patients are free to stick with the existing system, but I suspect they'll learn to regret that decision.
There are no technical or medical roadblocks to this that I can see. The only obstacles are political and legal, which can be overcome in one or two election cycles.