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2 hours ago, Lord Liaden said:

 

I think for a LOT of people it's not failing is the main issue.  I've been insured for 40+ years and minus the too-low-coverage of Dental care it's been great.  I've had multiple surgeries and ailments treated for very little out of pocket money.

 

Meanwhile I have family members who have to doctor shop because a decent (and growing) chunk of doctors will no longer accept Medicare. 

 

I tried to take one of them to PrimaCare recently and they said they wouldn't take them because they have Medicare. 

Then I offered to pay cash for the whole thing because we really didn't want to wait until Monday.  They declined.  They won't touch Medicare patients - period.

 

I had an older relative wait 3+ years for their hip surgery through the VA.  They nearly committed suicide before they got the procedure.

 

None of us are in a hurry to get more government insurance.  :(

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Part of it is that it's those that are most in need that are not being taken care of (often).  As you say, if you're insured and in generally good health, there's little issue (though out of pocket can still be pretty high...and insurance costs, even when half is footed by the employer, are VERY high compared to other countries).  It's when you're in need that things change (for the worse).  A friend of mine had been fighting cancer for years...very expensive treatments.  His insurer decided to cut him off/decline coverage.  The insurer's gamble was sound -- it would cost a large chunk of money for my friend to go after them in court and make them pay...and the insurer's legal fees were already covered by the lawyers they kept on retainer.  So they could cut him off and worst-case (for them) be forced to pay out after a lengthy court battle.

The flip side to this (and part of the reason for doctors' reluctance to take Medicare patients) is that we're a VERY litigious society. This drives up rates across the board, doctors paying higher malpractice insurance, insurers having higher rates due to payouts and legal, etc.  This is why it's not an easy solution -- any change in coverage (single payer, etc.) needs to be matched with protections for doctors (and, in turn, the insurers) from litigation. Not immunity, but protection.

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33 minutes ago, Simon said:

Part of it is that it's those that are most in need that are not being taken care of (often).  As you say, if you're insured and in generally good health, there's little issue (though out of pocket can still be pretty high...and insurance costs, even when half is footed by the employer, are VERY high compared to other countries).  It's when you're in need that things change (for the worse).  A friend of mine had been fighting cancer for years...very expensive treatments.  His insurer decided to cut him off/decline coverage.  The insurer's gamble was sound -- it would cost a large chunk of money for my friend to go after them in court and make them pay...and the insurer's legal fees were already covered by the lawyers they kept on retainer.  So they could cut him off and worst-case (for them) be forced to pay out after a lengthy court battle.

The flip side to this (and part of the reason for doctors' reluctance to take Medicare patients) is that we're a VERY litigious society. This drives up rates across the board, doctors paying higher malpractice insurance, insurers having higher rates due to payouts and legal, etc.  This is why it's not an easy solution -- any change in coverage (single payer, etc.) needs to be matched with protections for doctors (and, in turn, the insurers) from litigation. Not immunity, but protection.

 

Solid points.  I agree with pretty much everything you said.

 

But, the reason Americans (as a whole) aren't eager to change is that the system is working well enough for most of them and the government alternatives look worse than what they already have.

 

If you don't have coverage then those government alternatives undoubtedly look fantastic.

 

Also, sorry about your friend.  Cancer is horrid and the costs - even with insurance - are stupidly high.

 

 

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There is a bit of a foofarah about the arrest in Stockholm of the rapper known as ASAP Rocky. Trump has in talks with our PM, Stefan Löfvén, insisted on ASAP's immediate release, ignoring the fact that our government has no authority or jurisdiction in judicial matters. There is even a petition -- signed amongst others by one of the Kardashians, apparently -- for the artist's release on bail, despite the fact that we don't practice release on bail in our courts.

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2 hours ago, ScottishFox said:

But, the reason Americans (as a whole) aren't eager to change is that the system is working well enough for most of them and the government alternatives look worse than what they already have.

 

 

 

Near as I can tell these are the people who simply haven't been screwed over by the system yet.  Like you I've been insured for 40+ years and like you I have paid relatively little out of pocket.  Yet I am acutely aware of the flaws in the system any time I am forced to make a treatment decision about my kids purely on the basis of cost.  Or when I have to get one insurance company to talk to another.  Or when I switch jobs.  Or when I get a surprise bill in the mail.  And looming over all of this is the fact that insurance companies will not hesitate to drop me if I get expensively sick and they think they can get away with it.

 

Americans have been massively brainwashed to accept the existing system, to the point where they flatly refuse to believe how healthcare works in civilized countries.  You can go to an ER and not get billed?  Impossible!  Who pays for that?  Taxes?  I don't want my taxes to go up!  What's "progressive taxation"?  Yeah, I'm having $15k a year deducted from my paycheck yearly for health coverage, what does that have to do with anything?  Et cetera.

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1 hour ago, Old Man said:

Americans have been massively brainwashed to accept the existing system, to the point where they flatly refuse to believe how healthcare works in civilized countries.

 

There's definitely some of this.  There's also the part where our existing government healthcare systems are worse than private coverage in many instances.

 

The number of veterans that have died while waiting for their already promised VA benefits is staggering and disgusting.  The last family member I have who got on Medicare needed a lawyer and 15 months to get on and gets to deal with several doctors not accepting their business at all.

 

Philosophically, I don't care if the insurance is private or publicly administered as long as it is run effectively.  I don't trust the American government to handle this well.

I've been paying into social security for well over 30 years and they saved literally none of the money they've collected from me.  When I'm finally old enough to retire, unless they make massive changes, the money I was promised and paid for will simply not be there.


Handing over one of the largest economic sectors in the country to the same government that has run us 22.5 trillion dollars in the hole and continues to have a trillion dollar a year deficit while the spending continues to climb seems like a very bad idea.  I would love government run healthcare for everyone.  The promises they already made to people are worth 125 trillion and change.  I just can't trust the government to deliver.

 

I think our collective batch of irresponsible politicians will run this thing into the ground before they even consider something resembling fiscal sanity.

 

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6 hours ago, ScottishFox said:

 

I think for a LOT of people it's not failing is the main issue.  I've been insured for 40+ years and minus the too-low-coverage of Dental care it's been great.  I've had multiple surgeries and ailments treated for very little out of pocket money.

 

Meanwhile I have family members who have to doctor shop because a decent (and growing) chunk of doctors will no longer accept Medicare. 

 

I tried to take one of them to PrimaCare recently and they said they wouldn't take them because they have Medicare. 

Then I offered to pay cash for the whole thing because we really didn't want to wait until Monday.  They declined.  They won't touch Medicare patients - period.

 

I had an older relative wait 3+ years for their hip surgery through the VA.  They nearly committed suicide before they got the procedure.

 

None of us are in a hurry to get more government insurance.  :(

 

Doctors not wanting to deal with Medicare patients is not in itself an indictment of government health care. It sounds like the attitudes of the doctors in question might be a bigger factor.

 

As a Canadian I can say that my country's universal health care in fact doesn't cover everything, and definitely has other flaws; but not one Canadian citizen hesitates to see a doctor when they're sick over concern for paying, and almost none of us would trade our system for America's.

 

But distrust over government administration of a health service is one of the issues the article I linked to highlighted as an impediment to health-care reform in the US. That distrust has been building in general for years, across the board in the States. But government is already responsible for administering numerous elements of modern life -- infrastructure, policing, licensing, military defense, etc. Giving up on government-run health care because of distrust of government would amount to giving up on everything government is already responsible for, rather than trying to fix the underlying problems in government itself.

 

I'll just add that saying, "for a LOT of people health insurance isn't failing," has a flip side -- for a LOT of people it is failing, as public statistics bear out. With respect, IME when folks talk about "a lot of people," they frequently unconsciously mean, "a lot of people I know."

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Exactly.  It's true that there are problems with Medicare and the VA.  It's also true that Americans are violently protective of Medicare despite its flaws.  And while I understand the hesitation about government management of healthcare, it could hardly be worse than the privately run corporate death panels America currently has.  I have zero say in what corporations do; in government, at least I get a vote.

 

As for the deficit, I agree that it's a problem, and I note that in my lifetime the party most responsible for its increases is the one that loudly pretends to be "the party of fiscal conservatism".  Many people make bothsiderist arguments about how neither party is willing to cut the deficit, but even if that's so, I'll vote for the one that might balance the budget on the backs of the 1%, not on me.

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3 hours ago, Old Man said:

Yet I am acutely aware of the flaws in the system any time I am forced to make a treatment decision about my kids purely on the basis of cost. 

 

What a ridiculously unnecessary dilemma for a parent to have to go through. And yet I've been there myself. Can't find a battery that came out of a toy? At what point do you stop searching through all the couch cushions and take the kids to get X-rays at $500 a pop? That shouldn't even be a decision.

 

 Having said that, $1,000 versus not being sure absolutely comes up on the side of $1,000.

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2 hours ago, Old Man said:

And while I understand the hesitation about government management of healthcare, it could hardly be worse than the privately run corporate death panels America currently has.  I have zero say in what corporations do; in government, at least I get a vote.

 

For my family specifically we were able to get one major item covered via medicare that we couldn't with our private insurance so I'll credit the gov't a win on that one (after the 15 month delay and lawyer fees).

 

However, Medicare has a higher claim denial rate than private insurance and a higher fraud rate to boot.  If they'd just run the program better I'd be all for it.  But they won't.

 

The cost per person is rising so much faster than wages there is no way to keep premiums reasonable public nor private. 

According to this article medical spending has increased almost ~70x during a time window when most things went up 7.1x with inflation.  If costs aren't controlled there's not enough money on planet Earth to make this work.

 

Sorry about the image size.  It's stupid big.  :(

 

Image result for cost of healthcare per capita 2018

 

 

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15 minutes ago, ScottishFox said:

However, Medicare has a higher claim denial rate than private insurance and a higher fraud rate to boot.  If they'd just run the program better I'd be all for it.  But they won't.

 

Why won't they? And if they won't, do you not believe enough Americans exerting pressure could force them to?

 

Since you seem to agree that the current model is unsustainable, what's the alternative to trying to make it better? Accept that millions of Americans will never be able to afford basic health care?

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As far as Medicare's denial rate is concerned, I'm not surprised given the general age and health of the participants.  I definitely would like to see the data on how it compares to private insurance for the same age group (and costs) though, because I'm inclined to agree based on what you are showing.  (No, not asking you to do my research for me ;) I have to start looking for sources for research on some of these programs, I just haven't gotten to it yet)

 

I don't want us to get too hot under the collar.  I wholly agree that the medical system costs have to be forced under control, but I don't think private insurance has been working to control this.

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53 minutes ago, Lord Liaden said:

Why won't they? And if they won't, do you not believe enough Americans exerting pressure could force them to?

 

Since you seem to agree that the current model is unsustainable, what's the alternative to trying to make it better? Accept that millions of Americans will never be able to afford basic health care?

 

1st question:  Neither party is willing to touch its 3rd rail items.  Nobody will cut enough spending to medicare, social security or the military to even slow the train wreck down.  We're upside down to the tune of 150 *trillion* dollars.  If any of us was in debt to the tune of 7.5x our annual pre-tax wages would we be pretending we're in a salvageable situation?

 

2nd question:  The kind of pressure that would be required at this point would be far beyond what voting could accomplish.  I believe our politicians are going to crash this train and then blame each other for the mess while the number of uninsured Americans leaps to catastrophic levels as medicare collapses.  It's going to get real ugly for a few years.

 

3rd question:  No real solutions will draw votes.  Politicians avoid them like the plague.  One thing we're not dealing with at ALL is the supply of physicians and dentists.  The supply of both is going down because the schools that create them are unable to stay in business.  I have to imagine a fairly obscene level of regulatory burden and malpractice insurance rates are contributing to this.  Another problem is that there has been a very nice increase in the number of female dentists (yay!), but they tend to work a LOT fewer hours than their male counterparts which means we need MORE dentists than we did previously - not less.

 

I do not have a good answer for #3 and I'd be skeptical of anyone who said they did.  It is going to take many years of effort on numerous fronts to get healthcare back on track.  I'd also like the people who have paid decades of money into social security to get taken care since they actually put their hard earned money into the program involuntarily.

 

I often wonder why we don't take an approach similar to car insurance (low monthly premiums, coverage is basically nothing until you have a serious problem) for health care.  My car insurance rates have been lovely compared to my health insurance rates over the last couple decades.  One of the contributing cost problems is the nature of 3rd party payers.  My share of an MRI is $27?  Ok, let's get it.  Oh, my share is $2750?  No, thanks, let's try that high-res ultra-sound first. 

Still - I have no good answers here and neither does either party trying to win my vote.

 

4th question:  Nobody should accept that.  We should strive to get everyone covered (*).  We should temper that effort with caution and be wary of making things worse.  Possibly catastrophically so.

 

* - Side Note:  Insurance and coverage aren't even the right paradigm which shows how far misaligned the whole conversation is.  People need affordable healthcare.  Not insurance - healthcare.

 

http://www.slate.com/articles/life/the_american_way_of_dentistry/2009/09/the_american_way_of_dentistry_3.html

 

 

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8 hours ago, Lord Liaden said:

Since you seem to agree that the current model is unsustainable, what's the alternative to trying to make it better? Accept that millions of Americans will never be able to afford basic health care?

 

That seems to be the plan this administration espouses. Better to be uninsured than to be a Socialist.

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Medical pricing is extremely variable, even with insurance. Last year, I had a life-threatening reaction to a medication, and the back of my mouth swelled shut. My options were to call an ambulance (at a minimum co-pay of $1200+the ambulance ride cost per my plan), or drive myself before my airway also closed up (which I did). I went to the ER, which triggered a $1500 co-pay. If I had gone to a quick-care first, my co-pay would have been $60, and they would have included transport to the hospital and the ER bill, as they had for a co-worker who was experiencing chest pains.

 

The hospital and doctors billed the insurance about $15,000. Most of that was absorbed under some sort of agreement with the insurance company, and the rest was paid through a combination of insurance and co-pay.  I have no clue what it would have been if I didn't have insurance, as that would have been a different set of magical accounting figures.

 

If I had gone to the closest hospital, I would have needed to pay for everything out of pocket, as they are not affiliated with my insurance. 

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Reading medical bills is the pathway to Cthulu-esque madness.

 

I had an outpatient surgery about 15 years ago.  The bill was over $35,000.  The insurance only paid about $12,000.  Then there was a stream of numbers and arcane symbols only a mage specialized in billing can read and my share was less than $400.

 

It makes no sense.

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16 minutes ago, Ternaugh said:

If I had gone to the closest hospital, I would have needed to pay for everything out of pocket, as they are not affiliated with my insurance. 

 

And this here is why I hate the current insurance system.  Plus, with people who have ongoing conditions, their strategy is to 'wait it out and hope you die before paying for something'.

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43 minutes ago, TrickstaPriest said:

 

And this here is why I hate the current insurance system.  Plus, with people who have ongoing conditions, their strategy is to 'wait it out and hope you die before paying for something'.

 

Sadly this is the same approach the VA used - for years.

 

Medicare denies more claims than private insurance as well.

 

There's no Hero in this story.  :(

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2 hours ago, Starlord said:

I use VA, everything is free.

 

Cincinnati VA is excellent.

 

I don't understand what you folks are whining about.

 

:)

I am a veteran, from a family of veterans, and I am glad your local VA is a good one. But going to see the VA is considered a last ditch effort for my whole family.😥

 

When I became disabled, I had to sue the SS to get coverage (wait till he dies) and my lawer suggested the VA both I and my brother started giggling because it seemed so crazy a suggestion. I then horrified her with a story or two of "The VA" in action. Maybe the VA has gotten better though....

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I have said this before.  I worked and lived in Nashville, TN for two years.  One of the major reasons for coming home (the other was to marry my girlfriend) was the insecurity I felt over there, even though I was barely ill.  I came back and appreciate the NHS so much more than I did before I went to the US. 

 

I am not saying that we have got it perfect, the politics and negotiations surrounding health and the mission creep are immense.  I am saying that when anyone in my extended family has been sick, our only concern was getting them to a doctor/hospital to get it fixed.  When my wife collapsed saying her heart was racing we went to the nearest accident and emergency where the only bad thing that might happen is that she might die.  If she survived

 

she did 🙂

then there would be no down side.

 

I do not know how you guys live with the uncertainty and expense.

 

Doc

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22 hours ago, Lord Liaden said:

 

Doctors not wanting to deal with Medicare patients is not in itself an indictment of government health care. It sounds like the attitudes of the doctors in question might be a bigger factor.

 

 

Every couple of years, the US government tries to bail out Medicare's financial situation by having another round of cuts to the amount it reimburses a doctor for doing anything for a Medicare patient.

 

The government requires more paperwork for Medicare patients than many private insurances require for their patients while at the same time Medicare pays doctors only a small fraction of what the doctor would have received from a private insurer.  And the government is continually reducing the amount of money it gives to doctors for seeing Medicare patients so that the little the doctor gets paid to see a Medicare patient this year will most likely be even less the next year.

 

A doctor only has so many hours in a day to see patients and most doctors are running a business which has a significant and fixed amount of overhead (paying nurses, office staff, rent, electric bill, buying equipment, etc.) which it has to pay out regardless of how much money is coming in.

 

So I find it hard to write the problem off as being an "attitude" problem of the doctors, even speaking as a Medicare patient who has had endless problems finding willing doctors and keeping them.

 

The real problem I have with Bernie Sanders' Medicare-for-All plan isn't that the proposed benefits are substantially better (and more expensive) than the benefits available under the current Medicare system but that it would explicitly end private insurance which is all which is allowing many doctor's offices across the country to remain financially viable.

 

The practice my wife's doctor works out of has been wildly unstable over the last five years. Even with their move to smaller and cheaper offices, the doctor's in the practice who accept Medicare patients haven't been able to pay their portion of the bills and contribute anything toward having a profitable practice. So there's been a constant stream of doctor's who accept Medicare coming into the practice, going broke and having to drop out of the practice or having to quit taking Medicare patients. And while I live in one of the largest metropolitan areas in the country, rent and salaries for staff here is nothing like what doctors have to pay in Boston or New York City. I honestly have no idea how general practitioners who accept Medicare patients manage to stay in business in the northeastern US cities at all.

 

Whatever changes are made in the US healthcare system in the future, part of the solution isn't to continually cut the reimbursement rates paid to doctors of Medicare patients.

 

< /rant >

 

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2 hours ago, archer said:

 

Every couple of years, the US government tries to bail out Medicare's financial situation by having another round of cuts to the amount it reimburses a doctor for doing anything for a Medicare patient.

 

 

I strongly suspected something like this (as the reason doctors would refuse to see Medicare patients).  This is very helpful to comment on, as I'm never satisfied without hearing the underlying "boots on the ground" reality of a situation.  This is quite a different problem from the issues I've seen with the behavior of the insurance companies (much closer to my own experiences), and its good to get an account of what is happening there.

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