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Sick and struggling to pay, 100M people in the U.S. live with medical debt

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Re: Sick and struggling to pay, 100M people in the U.S. live with medical debt

#361

Earlier quoted context omitted.

This is an important distinction. Nobody is getting free chemo or radiation therapy, treatment for chronic illness or anything like. For example, diabetics are not going to get a supply of insulin from the ER, especially if they can't pay, and someone with cancer isn't going to get treatment, either. Plenty of people die in the US from the inability to afford the medical care they need to live. If you're brought into…

"Nobody is getting free chemo or radiation therapy, treatment for chronic illness or anything like" Sure you can. In the US, you cannot be denied chemo or other treatments. You will be billed after the fact, and it's going to be a ton of money, but it's not as if they have security escort you out just because you don't have an insurance card. That simply doesn't happen. You'll get care, and if you don't qualify for a…

I've known many people denied care, myself included, I've been asked to pay up up front or we don't admit you. This includes treatment for brain tumors and infection.

ERs can't deny life saving care, but that's the exception.

Is this the conception people have of the US healthcare system? That everyone's taken care of so why are they complaining?

Let me disabuse you of that notion.

Re: Sick and struggling to pay, 100M people in the U.S. live with medical debt

#362

It's ridiculous in the year 2022 we still have people making a decision to not seek medical treatment of any kind because they are afraid it will bankrupt their family, they won't be able to pay their rent or mortgage on time, they might have to go without food, take out loans or borrow money that puts them in even more debt causing more health issues. I'm not sure what the solution is but I feel like there's got to…

> I'm not sure what the solution is but I feel like there's got to be a better way.

Universal healthcare? Like any other Western country?

Re: Sick and struggling to pay, 100M people in the U.S. live with medical debt

#363
post #316

Earlier quoted context omitted.

> Gerrymandering so that urban centers lose their voting power and other election rigging techniques is what is holding back Democratic policies. I mean gerrymandering doesn't help but the Democrats aren't one cohesive unit otherwise they'd have no issue doing stuff right now. Sure people claim they only have 50+1 in the senate so they can be filibustered but they can just remove the filibuster with 50+1 and then do…

Republicans were never going to get rid of ACA; it’s their plan after all. Republicans were never going to build a wall. These were just talking points. What Republican lawmakers are great at is being united in thwarting Democratic policies and doing what it takes to enhance their own power. Republican lawmakers are much more united when it comes to core principles: 1. Thwart Democrats 2. Oppose abortion 3. Tax cuts…

1. This is kind of vague but Republicans do vote on Democrat-lead bills [1] which is a pretty poor way of thwarting them.

2. I did forget about mentioning that one. Republicans could have easily restricted it in 2016 if they as a cohesive unit wanted to. They do not. It's much more useful to leave it in the current state where it can constantly be brought up every election cycle as a way to drum up supporters who have no object permanence.

3. You got me here but that's also the thing I listed as their only accomplishment.

4. This one is very bi-partisan. The military has no issue with losing funding and especially wants to optimize funding by doing things such as closing low-utilized bases and moving those staff to other under-utilized bases. However doing so affects congressional districts and their congress representative have no interest in losing jobs (money) for their region. The lack of awareness of defense spending as a jobs program is a big pet peeve of mine :/

> What Republican lawmakers are great at is being united in thwarting Democratic policies and doing what it takes to enhance their own power.

5. Sure but Democrats have this issue as well. There have long been calls for things such as Ranked Choice Voting, Approval Voting, etc and Democrats and Republicans have long tried to even overturn those efforts even when decided by voters as a ballot measure. Both of them know that allowing this will degrade the "both sides" situation going on as other parties will gain a foothold. However it also leads to situations where voting for your first choice (a 3rd party) in close elections (i.e 2016 [2] vs 2020 [3] and 2000 [4]) can allow your second favorite candidate to lose but Democrats collectively are ok with losing every 3rd presidency (~1/10yr) as long as it doesn't eat into their powerhold (every other elected position).

There really is no reason to argue about the Republicans here. We have a bunch of states such as North AND South Dakota strictly to increase the number of republican senators [5]. Or more recently, in 2000 when Republicans in US Supreme Court overruled Florida's Supreme Court about if a recount should occur [6] (so much for states rights!). SO yes, it's a moot point that Republicans are power hungry and don't care about consistency only power.

[1]: https://www.govtrack.us/congress/members/report-cards/2016/s... [2]: https://en.wikipedia.org/wiki/2016_United_States_presidentia... [3]: https://en.wikipedia.org/wiki/2020_United_States_presidentia... [4]: https://en.wikipedia.org/wiki/2000_United_States_presidentia... [5]: https://en.wikipedia.org/wiki/Dakota_Territory#Statehood [6]: https://en.wikipedia.org/wiki/Bush_v._Gore

Re: Sick and struggling to pay, 100M people in the U.S. live with medical debt

#364

Earlier quoted context omitted.

>Nobody is forcing you to pay at gunpoint, you are free to leave at any time and no longer pay. OK so if a robber comes to my house and says pay up or leave, then that's not a forceful action at gunpoint? >you are free to leave at any time and no longer pay. That's not how it works -- allow me to inform you of tax law in the US. US Citizens are responsible for filing, and possibly paying taxes on income earned ANYWHE…

>OK so if a robber comes to my house and says pay up or leave, then that's not a forceful action at gunpoint? They are not a robber they are a landlord, you are on their land, pay taxes or leave your choice. They are not forcing you to stay and work and pay taxes at gunpoint, you have the choice to leave. However while you are there you must fund the services they are currently providing to you, if you willfully evad…

> You have agreed to the social contract [...]

People like the GP reject the notion of social contract.

Re: Sick and struggling to pay, 100M people in the U.S. live with medical debt

#365

Earlier quoted context omitted.

>OK so if a robber comes to my house and says pay up or leave, then that's not a forceful action at gunpoint? They are not a robber they are a landlord, you are on their land, pay taxes or leave your choice. They are not forcing you to stay and work and pay taxes at gunpoint, you have the choice to leave. However while you are there you must fund the services they are currently providing to you, if you willfully evad…

> You have agreed to the social contract [...] People like the GP reject the notion of social contract.

I understand the 'notion' of social contract. However I choose not to accept the terms of the contract as envisioned by above. A key element of 'contract' is consent.

Re: Sick and struggling to pay, 100M people in the U.S. live with medical debt

#366

Earlier quoted context omitted.

> You have agreed to the social contract [...] People like the GP reject the notion of social contract.

I understand the 'notion' of social contract. However I choose not to accept the terms of the contract as envisioned by above. A key element of 'contract' is consent.

Then you must move out to someplace else that you wish to consent to or forge your own social contract which will require force unless you find un-inhabited unclaimed land.

By staying within the bounds of a country you are consenting to its laws or are considered a criminal or foreign aggressor.

Re: Sick and struggling to pay, 100M people in the U.S. live with medical debt

#367

Earlier quoted context omitted.

Politics aside, money puts a cap on everything: wars, social services, etc. The issue at hand is to take something the public spends nothing on, that the government gets for "free" and to put that on the public balance sheet - a huge cost. I guess we could balance that out with a tax, but who would like that? And even if we were to raise taxes - it wouldn't help our balance sheet since we already spend 30% more than…

> Politics aside, money puts a cap What part of "we pay nearly double" didn't make it through? We can't afford the enormous premium we are paying for privatized care. > I guess we could balance that out with a tax Payroll tax. In the vacancy left by private insurance. Scribble off one memo line, write in another. Come on, this is a 101 level objection.

> Come on, this is a 101 level objection.

You are obviously a very smart guy, jjoonathan. Why do you suppose the Democrats didn't even propose this when they had 60 Senate votes, the Presidency and the House? If its a 101 level problem why do you think that is?

Re: Sick and struggling to pay, 100M people in the U.S. live with medical debt

#368

Earlier quoted context omitted.

I'm trying to understand what point you're trying to make here. Are you saying America's system is better or worse than that of your country? I'm in America, and I have fantastic health insurance (by American standards) and waited over a year for a hip replacement surgery. Even with insurance, I paid almost $10,000 for the surgery. Without insurance it would have cost well over $100k. I suspect that in any other coun…

Why do you assume you would have gotten authorized for a hip replacement at all? Many elective qualify of life surgeries aren’t covered in European health care systems. Look, there is no free lunch. The UK NHS has strict standards of “cost effectiveness” that would shock Americans: https://www.nice.org.uk/media/default/guidance/lgb10-briefin... . 20-30,000 pounds per quality adjusted life year. American end of life c…

It wouldn't be safe to assume that I'd have been authorized for an elective surgery, so fair point.

I also never suggested that it should be free.

> American end of life care can cost hundreds of thousands of dollars for a year or two of extra life and American insurance companies will pay it without blinking.

This hasn't been my experience. Before my dad died from glioblastoma last year, his insurance refused to pay anything for his treatment. They refused to pay for anything, fighting us every step of the way. A single chemo pill cost over $2200, and he needed 60 of them, and they wouldn't cover any portion of them. And that was just one of many the things they wouldn't pay for. They wouldn't even cover anti-nausea medication. I did, and it cost less than $30. They wouldn't even cover hospice care.

My dad paid premiums to that same insurance company for 20 years, and was healthy the entire time. No major health issues, non-smoker, non-drinker, no heart problems, no accidents. He learned about his rapidly growing tumor on his own. He decided, mostly out of curiosity about the technology, to pay for a full body MRI (at his own expense of course) and found it. He spent his life savings trying to fight the cancer and the insurance company, just so he could have enough time to say goodbye to people. He died within 8 months of discovering the tumor.

The money he paid that insurance company over a 20 year period would have covered all of the costs had he put the money into a savings account, even if he made zero interest and accounting for inflation.

I know that there will be those who say "but what about Medicare/Medicaid?" - he didn't qualify for either of them.

The only outside help he might have had was from an organization that houses people near cancer facilities, but they pulled their support the moment the pandemic was declared, shutting down all their housing facilities. The irony there, as well, is that that particular organization, even in non-pandemic times, required 6 months lead time before they could place an individual. He'd have been dead before they were able to place them. I paid for an AirBnB instead, which cost me close to $5k for the duration of his treatment, which he paid for out of pocket.

My dad's story isn't uncommon either. Why would insurance companies have any incentive to step up when they know that if they just wait things out, they'll be able to keep their money?

The American health care system is utterly broken, perhaps even criminally corrupt.

Re: Sick and struggling to pay, 100M people in the U.S. live with medical debt

#369

Earlier quoted context omitted.

I understand the 'notion' of social contract. However I choose not to accept the terms of the contract as envisioned by above. A key element of 'contract' is consent.

Then you must move out to someplace else that you wish to consent to or forge your own social contract which will require force unless you find un-inhabited unclaimed land. By staying within the bounds of a country you are consenting to its laws or are considered a criminal or foreign aggressor.

>Then you must move out to someplace else

How about you move. It's hilarious to suggest the contract is still intact when the government violates the contract itself, such as abridging 4th and 2nd amendment rights, rendering the contract void. Just a few months ago, I had a warrant served where a homeland security official lied and said a drug dog had "alerted on my buttocks" and I was forcefully strip-searched and dragged to a hospital to be "internally examined." Sorry the government themselves violated the contract.

And it's worth noting, even though the "contract" legitimize this, the last president didn't even have the assent of the majority of voters.

>By staying within the bounds of a country you are consenting to its laws or are considered a criminal or foreign aggressor.

I'm not too worried about whatever ad-hominem you'd like to label.

>Note since you are US citizen you still benefit from their social service while living abroad, the are many protections upheld to US citizens traveling abroad you would no longer have if you renounce.

This is so hilarious as to make me wonder if you've ever actually been to a US consulate abroad. I have, against my wishes due to riding in the same taxi with a 'friend.' We had both overstayed our visas, and the consular services basically said "lol get fucked, good luck!" I could have obtained the same services talking to a wall. I'm good on their services.

>Exactly, you must pay your final rent payment and get out, no one is forcing you to stay. I

If I've already "gotten out" including paying my taxes this rent analogy makes even less sense, not that it was a good one to begin with. I never signed a contract saying if I leave the non-existent contract I agree to pay $2000 to back out.

> you don't have to defend your property and life through force on a daily basis

I wonder if you've even been to the United States? It was not so long ago someone tried to rob me at gunpoint. I still have a scar from fighting back. On a daily basis, people are violently assaulted in my city. Nowadays I'm forced to have "protection" that I have daily in case someone tries to use lethal force against me again. The police have no legal duty to "defend" you per the supreme court. The type of protection police provide here, I wouldn't wish on my worst enemy.

As for military protection, I actually have fought as a self-funded volunteer in a foreign militia (YPG) against ISIS, so I'm willing to put my money where my mouth is about not using tax money to defend life.

>However while you are there you must fund the services they are currently providing to you

You don't get to just provide services for someone, who never agreed to it, and then demand payment. Payment for services is predicated on the parties consenting to the transaction. Providing service without the other party agreeing is charity at best, unwelcome intrusion at worst.

>no one is forcing you to stay

Except some people have had their passports revoked, and occasionally without even owing anyone anything ("for national security reasons.") In fact DHS has threatened to revoke my passport before, despite not breaking any law. It is a crime to leave the US without a passport. So the US does 'force' some people to stay.

>People are social animals, they work together to solve problems no individual could on their own, money facilitates this and is needed to fund the large social framework

People are capable of doing this in a consensual manner. In fact many businesses operate on this principle of consensual mutual benefit.

>You may not like it but that doesn't matter because others will form large groups and impose it on you regardless and you will have no choice over its form.

Back to your contradictory argument of "no one is forcing you at gunpoint" -- except you reneg and say actually they are.

Re: Sick and struggling to pay, 100M people in the U.S. live with medical debt

#370

Earlier quoted context omitted.

Proposed colossal change: a common practice of paying for healthcare out of pocket, instead of through healthcare insurance. Yes, this sounds unreasonable right now because prices are so high. But bear with me for a second. Most healthcare in the US is paid through insurance. Insurance creates moral hazard. Insured patients generally don't even need to know the prices of what they're buying, much less negotiate those…

> My point is that we know properly functioning markets set fair prices For frequently-repeated purchases of goods with robust competition for close alternatives where the approximate total infinite-horizon costs and utilities resulting from the decision are both entirely experienced by the participants to the exchange and very clear before or quickly after it occurs so that behavior can rapidly adjust to more optima…

Yeah, although the negotions between insurance companies and providers theoretically should approach a functioning market.

It painfully obviously does not. It is literally a market with both buyer and seller colluding to raise the prices!

Why? A few reasons. Insurance profit is capped as a percentage of expenditure, so if they think there is more money they could extract from the insurance customers total if things cost more, it is in the insurance company's interest for prices to go up. Providers are not going to balk at getting mopre money.

This is only one of the many ways the system is screwed. The fact that medical billing coders need to customize the codes they submit for the exact same procdure to depending on what insurance company it is being sent to (for example, this is common for a procedure that is not a perfect fit for any standardized codes, or where some insurers are still using the older revisions of the medical coding standards, etc) and other similar nonsense also artificially inflates costs.

Basically everything about the system from top the bottom seems to be designed to prevent market based price discovery from working well.

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