Post-apocalyptic life in American health care

>> Services are requested under the duress of health problems without the ability to end the agreement.

>That is the nature of any insurance market.

I was actually thinking about when medical treatment is being received. Once you're under a hospitals care you're largely subject to their pricing for services (e.g. I can't choose to use the cheaper MRI machine down the street). There's a bundling of services at a healthcare provider that seems to contradict free market arguments as well, but I was mainly trying to get at the (effectively) binding agreement to use a particular facility once you are checked into it.

Edit: To be a little more concise, you agree to a particular payment structure for services without knowing what the cost of the services are or which services you'll be receiving when checking into a hospital, this opacity in hospital pricing also means that different parties are paying different rates for the same service at the discretion of the billing department.

So, again: the US as a whole, using a primarily market-based healthcare system, spends more money per capita for worse results than most other developed nations, most of which are using single-payer systems. Within the American healthcare system, there is a limited single-payer system that only covers a particularly high-risk patient population, and yet despite that patient population, runs more efficiently as an organization than the market alternatives. What evidence are you offering to make the argument that that limited single-payer system is actually more inefficient than the private alternatives?

[1]: http://www.politifact.com/truth-o-meter/statements/2017/sep/...

And what is 'efficient'? I think a major component of a well functioning healthcare system is that it's equitable. Our problem with healthcare is driven by the generalized problem of 'economization.' A rich person doesn't have some intrinsic quality that makes them more deserving of quality healthcare.

A healthcare system which is extremely efficient at treating the rich and letting the poor die isn't really what I'm looking for. Efficiency and equality must be balanced. What I'd say is that the US is pretty terrible at both and that's sad.

>Instead of wasting time with examples that don't go for the core of your stance, can you share what would change your mind in the general?

Some evidence that shows that mostly private healthcare systems generally function better than mostly public ones or some evidence that healthcare regulation in the US has led to worse outcomes and not better ones would at least give me a jumping point. But I'd also ask you to answer your own question here.

Multiple surgeries, months in hospital, rehab, got addicted to morphine in the process etc. etc.

At the end of it all was a handshake and "get well soon".

There was no bill.

Australia.

I'm transgender, and transgender care is a VERY complicated beast. I'm a Kaiser member, and Kaiser NorCal (though not SoCal, so I hear...) is about as good as you can get for Transgender care.

Do you know how hard it was to find someone who had some idea what Kaiser (or any insurance) did actually did cover? And even when I did find that out, it was (of course) changing. It took me talking to multiple member services reps and people at both of the regional transgender facilities before I found someone who could refer me to the person who knew.

What resonates most about the article - the "communal" aspect of it all - was around a specific surgery I need - facial feminization. Kaiser has one provider, basically. Great guy. Horribly backlogged - 2 year wait they told me.

Through lots of redditing I found the one person who knows exactly how to work this system. How to file the right grievances with the right language to put everything in order. Things like - you need an appointment with another provider so they can't merely claim there isn't a provider who can't do it. This person has basically walked me through the entire process.

A fun and related fact is that California has a board that handles disputes and does "Independent Medical Review". For facial feminization surgery, this amounts to them deciding if given traits of a face fall within feminine norms (which would make the surgery aesthetic, and not covered) or not (which would make the surgery reconstructive, and covered). I've read a bunch of them that go both ways. A really weird experience (the decisions are publicly available!)

The ability to "work the system" is entirely too necessary - never mind the cost, hassle, and everything else about it. You need "bureaucratic perseverance". You absolutely need to be ready to call, mail, file papers, whatever it takes to kick up a fuss. And if you have somebody who knows how it works on your side it's SO much easier.