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

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

#31

Post by refurb » Sun, Jan 30, 2022, 2:18 PM UTC

cmmeur01 wrote: post #18

Used to do these “pre-authorizations” for Humana and wanted to kill myself after a week. Seniors write in about how they’re eating dog food to pay for their medicine, I forward the letter to insurance doctors, who deny it because they “have to try these 3 drugs before you can get what works”. Made me realize this whole country is broken and those at the top are morally bankrupt.

Why is that broken? Even systems with universal healthcare have rules like this.

Why use a $1000 per month branded drug unless you know the $5 per month generic drug doesn’t work?

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

#32

Post by chousuke » Sun, Jan 30, 2022, 2:19 PM UTC

nceqs3 wrote: post #24

throw8932894 wrote: post #3

> The price of my prescription without insurance was $339 per vial of insulin In most countries insulin price is around $30. I remember it was cheap in US too. Seems like another problem created by US kleptocracy. Make something prohibitively expensive, and "solve" problem by providing handouts to cover costs.

You are comparing an insured price to a cash list price (most of which does not go to the pharma co and a price which effectively nobody pays). As an insured American, I would pay 0$ for insulin.

That's not really a good counterpoint if the non-insured prices are patently insane. How on Earth is it justifiable for insulin to cost 300 dollars? Here it seems to be around 20-40 euros before the deduction you will get from our national health bureau (which can vary from 0% to 100% depending on your diagnosis and the medication you need.)

On top of the national mandatory health insurance, there's also optional private health insurance and private hospitals and such, but even for those the prices are nowhere near the insane numbers I see whenever US healthcare is discussed, and I frankly can't understand how people aren't revolting over there.

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

#33

Post by civilized » Sun, Jan 30, 2022, 2:21 PM UTC

lotsofpulp wrote: post #28

civilized wrote: post #21

Earlier quoted context omitted.

Well, we were told this is impossible, so either everyone involved lied to us or your experience isn't universal. While insurance tied to your employer sucks, I think the best thing to do here is for the law to iron out the data interchange between MCOs. In a "marketplace" like the US, insurers must be under a dire legal obligation to transfer your data in a comprehensive and timely fashion to whoever is currently ad…

> , there is the question of why someone with Type 1 Diabetes is being denied their medicine. I feel like the only potentially valid excuse would be if the insurer literally didn't know the person had Type 1 Diabetes. I forgot to respond to this in your prior reply. The answer here is because insulin is not just insulin. There are many different formulations and brands with many different prices. Even the federal gov…

If the problem is around different insurers paying for different brands, then yes, I think the solution is for the consumer to have the choice of MCO rather than it being tied to the employer. But I'm sure this would create other problems and snarl the system with even more complexity.

That's ignoring the fundamental cosmic absurdity of this entire system, with its pretense to be some kind of competitive private market with the usual benefits of such. When in reality, insurers are just a bunch of hogs at the trough that you're shuffled between as you change employers. The private market does not seem to create any sort of incentive for efficiency or a better consumer experience.

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

#34

Post by lotsofpulp » Sun, Jan 30, 2022, 2:23 PM UTC

erenyeager wrote: post #23

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…

Honestly doctors don’t have enough time to juggle all this along with treating the patient. Many times it is the case that the patient cannot afford the medication and/or their insurance will not cover it. Shifting this burden on the physician and patients to figure out these economic problems interferes with healthcare.

Definitely, but it is a result of the mismatch in costs relative to expectations of quality and quantity of healthcare with current supply of doctors and medicines (out of patent).

I am in favor of the US federal government to spend money on R&D for medicines resulting in fewer patented medications resulting in lower cost medications. And also reforming the process to becoming a doctor because obviously people want more doctors. Not necessarily making doctors less qualified, but the whole spend your 20s torturing yourself is unnecessary, along with wasting 4 years on a bachelors.

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

#35

Post by peteradio » Sun, Jan 30, 2022, 2:24 PM UTC

refurb wrote: post #31

cmmeur01 wrote: post #18

Used to do these “pre-authorizations” for Humana and wanted to kill myself after a week. Seniors write in about how they’re eating dog food to pay for their medicine, I forward the letter to insurance doctors, who deny it because they “have to try these 3 drugs before you can get what works”. Made me realize this whole country is broken and those at the top are morally bankrupt.

Why is that broken? Even systems with universal healthcare have rules like this. Why use a $1000 per month branded drug unless you know the $5 per month generic drug doesn’t work?

If you have a past knowledge that the generic doesn't work and you also save money by withholding the real treatment, then that seems perverse.

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

#36

Post by throwaway6734 » Sun, Jan 30, 2022, 2:24 PM UTC

cmmeur01 wrote: post #18

Used to do these “pre-authorizations” for Humana and wanted to kill myself after a week. Seniors write in about how they’re eating dog food to pay for their medicine, I forward the letter to insurance doctors, who deny it because they “have to try these 3 drugs before you can get what works”. Made me realize this whole country is broken and those at the top are morally bankrupt.

>those at the top are morally bankrupt.

These seniors should vote for and advocate for a more expansive social safety net then.

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

#37

Post by nine_zeros » Sun, Jan 30, 2022, 2:27 PM UTC

Price aside, the biggest problem with American health care system is the administrative black hole at every stage.

Wife was on some serious (and expensive) medical treatment. After many months, the medical provider was at the final stages of the treatment. As usual, the provider needs insurance approval for arcane codes that constitute that segment of the treatment.

Get this, the medical provider applies for approval using a FAX. There is no acknowledgement or online tracking. And the authorization is received back using FAX. What a joke!

My wife didn't hear about the treatment for 3 weeks. Under pressure, she called her insurance. Insurance says, they didn't receive any request for authorization.

Why the fuck didn't the medical provider follow up? Exact question asked by my wife. Medical provider's explanation was that they faxed and were just waiting on insurance. They just sat on their fat bums while the time was running out.

So, wife patiently asked medical provider to apply for authorization again. The provider said they sent another request right away.

Another week later, wife had to call insurance again to find out that they STILL DID NOT receive any request.

Distraught wife asked insurance rep to call the medical provider immediately. Of course the call went to voice mail.

Wife then called the medical provider and left a scathing voicemail, threatening to sue. Only then this system worked miraculously. It still took a day for the medical provider to figure out what was wrong with their fax system. It still required my wife to follow up with insurance asking if they received the authorization request. Then 3 days later, the insurance provider approved the authorization and my wife had to call the medical provider again to confirm that the authorization was received.

All good now? Ohhh Noooo. Now the medical provider placed an order for medication that needs to be shipped from a pharmacy in another state. And they do place it. Now my wife gets a call from the shipping pharmacy to schedule a delivery. The delivery happens after 3 days.

Wife checks the delivery. Oops, it is missing a few items required for treatment. Guess what she needs to do to get the missing items delivered? You guessed it. Have the medical provider do the authorization process ALL OVER AGAIN.

Oh, and every call to the medical provider goes to a voicemail to which they take a minimum of 8 hours to reply and every call to insurance has a 30 min elevator music. Imagine all this 10 times in 3 weeks and that was just one round of shipping and nervousness.

Fuck American Healthcare.

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

#38

Post by kemiller2002 » Sun, Jan 30, 2022, 2:28 PM UTC

refurb wrote: post #31

cmmeur01 wrote: post #18

Used to do these “pre-authorizations” for Humana and wanted to kill myself after a week. Seniors write in about how they’re eating dog food to pay for their medicine, I forward the letter to insurance doctors, who deny it because they “have to try these 3 drugs before you can get what works”. Made me realize this whole country is broken and those at the top are morally bankrupt.

Why is that broken? Even systems with universal healthcare have rules like this. Why use a $1000 per month branded drug unless you know the $5 per month generic drug doesn’t work?

It's because a lot of times the doctors know it isn't going to work on the outset. A number of generics don't work exactly the same. You're punishing the patient and questioning the expert simply for the fact that the insurance company (or the government in the case of geriatrics) might save a few dollars.

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

#39

Post by tragictrash » Sun, Jan 30, 2022, 2:29 PM UTC

throwaway6734 wrote: post #36

cmmeur01 wrote: post #18

Used to do these “pre-authorizations” for Humana and wanted to kill myself after a week. Seniors write in about how they’re eating dog food to pay for their medicine, I forward the letter to insurance doctors, who deny it because they “have to try these 3 drugs before you can get what works”. Made me realize this whole country is broken and those at the top are morally bankrupt.

>those at the top are morally bankrupt. These seniors should vote for and advocate for a more expansive social safety net then.

What twisted fucked up naive world view does this come from. These people are poor, vulnerable and sick. You should be ashamed of yourself.

Why don't I throw you in a cage, and then you can try voting for someone to advocate for your release.

The point is the seniors need help now, not being told to go organize. The healthcare system is broken, and until you get sucked into it, you don't understand the extent of it.

It's different for people less fortunate than ourselves. We all mostly work tech jobs with great pay and decent insurance. These people don't have that. A lot of them can't pay for food.

So yeah, I'm doubling down. Downvote away.

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

#40

Post by lotsofpulp » Sun, Jan 30, 2022, 2:30 PM UTC

civilized wrote: post #33

lotsofpulp wrote: post #28

Earlier quoted context omitted.

> , there is the question of why someone with Type 1 Diabetes is being denied their medicine. I feel like the only potentially valid excuse would be if the insurer literally didn't know the person had Type 1 Diabetes. I forgot to respond to this in your prior reply. The answer here is because insulin is not just insulin. There are many different formulations and brands with many different prices. Even the federal gov…

If the problem is around different insurers paying for different brands, then yes, I think the solution is for the consumer to have the choice of MCO rather than it being tied to the employer. But I'm sure this would create other problems and snarl the system with even more complexity. That's ignoring the fundamental cosmic absurdity of this entire system, with its pretense to be some kind of competitive private mark…

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 for providers and patients when there is one system that provides quick definitive answers rather than back and forth. On that front, there is much improvement to be made in electronic communications between healthcare providers and MCOs.

On a positive note, this is happening via electronic prescriptions and integrated EMRs. I have seen my kids’ doctor pull up covered medications in their system and then quickly sending the electronic prescription to the pharmacy.

> But I'm sure this would create other problems and snarl the system with even more complexity.

There is absolutely no reason for employers to be involved in your healthcare. They currently are able to use it as a leash around your neck because paying for MCOs via your employer means you get to purchase with pre tax dollars. Paying yourself means you have to pay with post tax dollars. I am looking at my box 12 code DD total, and for me that is $32k of insurance premiums I was able to pay with pre tax dollars.

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.