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mrbadger





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PostPosted: Tue, 28. Nov 17, 19:46    Post subject: Health care karma? Reply with quote Print

There might be a thread this can go in, I don't know.

I know someone who has recently been diagnosed with a very serious illness. That person is American.

When I was in hospital they were intensely critical of my hospital, how awful the service was, how primitive the care and so on. I was unimpressed by their attitude, and at the time that attitude signaled an end to our friendship, but we still had friends in common.

It had been somewhat seriously strained already when they were so proud to have a job which involved them, as a non medically qualified person, using a spreadsheet or something (a program of some kind I guess) to swap prescribed drugs and some treatments for cheaper ones ‘to save the insurer millions’. Sometimes they’d just cut off treatment entirely if it seemed like it would cost too much and the person wouldn’t survive and they weren’t wealthy enough to do anything about it.

Frankly that disgusted me, but they never understood why.

Now it seems they are being subjected to exactly the same thing, by exactly the same company they saved all that money for, and it’s causing them all the stress they no doubt caused so many people themselves, while the people inflicting that stress will be happily reading their spreadsheets and congratulating themselves for doing such a great job.

Obviously it’s not their fault, it’s a wildly corrupt system. But why do so many Americans support it?

I’ll take my free ‘not so great’ system any time.


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PostPosted: Tue, 28. Nov 17, 20:30    Post subject: Reply with quote Print

mrbadger wrote:
But why do so many Americans support it?


Because they do not understand how their own system works.

The biggest flaws in the US American health care system are privatization, no or not enough government regulation and lobbyism causing abnormal high prices for even the basic medical care. (Here and here are some numbers for comparison with other countries.) Politicians, pharma companies and in a lot of cases also the media, however, make people believe that it's a problem of people cheating the system, getting drugs (medicine) and surgeries they do not need and thus increasing health insurance premiums for the lawful or healthier people. Now put one and one together, and you can imagine that reducing the costs for treatments is seen by a lot of people as "helping the system". You will also realise that the suggestion of a free* health care system does not really work for them, as they would still have to pay considerably higher amounts of money due to the increased costs of their health care system.

(* Technically, it's not free in European countries (like the UK or Germany) either, but you have to pay way lower premiums covering way more than in the USA.)


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Morkonan





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PostPosted: Tue, 28. Nov 17, 22:45    Post subject: Re: Health care karma? Reply with quote Print

mrbadger wrote:
...Obviously it’s not their fault, it’s a wildly corrupt system. But why do so many Americans support it?

I’ll take my free ‘not so great’ system any time.


Be careful, there. Smile "Corruption" is not so very widespread. Direct providers, like doctors, nurses, and other true healthcare professionals are not "widely corrupt."

Insurance companies? Well, that depends, honestly. I'd say they are all in it to make "money", not to finance healthcare... Therein lies the common disconnect between what "is" and where we "should be."

Right now, it's all kinds of screwed up. "Thanks Obama!" /sigh

It'll come to a head, soon.

One thing worth noting - The US had(s) little choice other than to revamp it's healthcare, particularly indigent healthcare, completely. We were spending 30% of our budget trying to fulfill healthcare related promises. (Medicare/Medicaid) And, practical insolvency of some of those programs was considered to be looming. We had to do something.

What we have, right now, sucks. And, "fraud" still exists, of course, particularly in Medicare, which many older people rely on.

What's wrong with our system, today? It's a big list, but primarily the costs for "insurance" have skyrocketed from their predicted levels to rates that are simply not manageable for most consumers in many areas. Why?

Private Insurance companies are in business to make money, not to finance healthcare...

And, of course, they're the loudest supporters of any program that forces people to buy private healthcare policies. Aaaaaand... screw 'em all, the greedy donkey___ing mother___ers....

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mrbadger





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PostPosted: Tue, 28. Nov 17, 23:33    Post subject: Reply with quote Print

I've seen hospitals in the US, they operate like hotels. That can't be cheap, nor could that be justified under a state funded system, you'd have to scale back, get rid of the 24 hour kitchens, the single rooms for everyone. Start to act like an actual hospital.

Not so nice maybe, but a lot nicer than losing your house and a lifetime of debt.

We do have the option of private health care if we chose it in the UK, where all those things are available, they're just not routine.
Single rooms happen in the NHS, but only if justified by your condition, so for medical reasons only. I had one post brain injury for a few weeks, then it was out into a shared room. Less nice, but I coped, because my care was excellent, and free (well, paid via my National Insurance).


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Morkonan





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PostPosted: Wed, 29. Nov 17, 01:38    Post subject: Reply with quote Print

I agree that some "frills" could be done without. However, once you have them, then what? Take them away?

Hospitals have private rooms so they can charge more. (At least, for those who don't come under special "precaution" procedures due to disease/recovery issues.)

We have a medical system that is generally "full service." You need it? You can gett it. With exception for certain relatively sparsely populated areas, manys regions literally have hospitals... everywhere. And, not far from many places? Research and teaching hospitals with cutting-edge tech and practices.

All of that is funded by money and lots of it.

But, the thing is, the system has grown too much, become too top-heavy with insurance, health-care profits, corporate interests, publicly traded companies, etc...

Hey, the whole insurance, profit-making, questionable practices, etc, sucks, no doubt. BUT, the actual healthcare? It's good. It's darn good.

The trouble is just making sure everyone can get it.

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Mightysword





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PostPosted: Wed, 29. Nov 17, 04:50    Post subject: Reply with quote Print

I said this the last time this topic came up: the reason car insurance is so affordable not because it's universal/private (it's also private here in the US), not because of special government regulation. It's affordable because everyone participated. That's why I also said Obamacare had the "right idea" to fix the problem. The only issue is it was carried out in the most irresponsible manner. The biggest piece of legislature since the Social Security Act was passed by the complete sideline of one political party. In a way it's not hard to understand why Republican refused to work with Obama. I always hear about the "racism" factor, and yes it's probably of it, but one thing the media probably never want to mention is the other big factor is because Obama basically gave the Republican the biggest middle finger of the century. Thinking back, it's probably the trigger of this partisan era that we're living in. So chalk that one up as another Obama's legacy.

I don't claim to know how it works in other developed country, but the throughput in the US is really terrible comparing to what I had seen in my own country. There are so much red tape, procedure, formality to go through here just to receive basic care. Where I came from, a doctor and his secretary probably can see 50 patients a day in a general care clinic. Here in the US, a doctor, his nurse, his tech ... with amount of busy work that needs to happen in between, I'll be surprise if they see more than 20 patients a day. So even if you hold everything else equal, I feel here you have to pay the worker 3 times as much to see to the same amount of patient.

Which leads to the lack of basic care. In my experience, if you catch some kind of illness in American and schedule up an appointment, chance is by the time it's your call your illness either too developed and you had to go into emergency already, or your body already fought it off by itself. Before I came here, I was used to the idea of "oh I feel a bit under weather tonight, I'll take tomorrow morning off to see the doctor". Walking clinics are readily available, and at most you wait for an hour. Here, the only way to get care that fast is via the emergency room. So maybe someone who just came down with a bad cold and the family panic and don't want to wait, go to emergency room, lay on the bed for a few hours, get an IV, some generic Tylenol, and discharged with a $4000 bill ... which would not cost more than a $100 in a clinic, a family doctor can get you the samething with like $50 even without Insurance ... if you get lucky with your appointment that is. And you can't really blame the hospital for this, even if you check in with a cold they still have to call all the specialists and give you a full diagnostic, they still have to charge you the premium even if all the test turn up nothing. And this happens WAY MORE OFTEN then most people think. I was amazed during the few times I had to stay in emergency room with relatives, how often people went into ER just to be dis-chard a couple hours laters.

And one of the most important factor when it comes to America: it's simply not a very healthy population. Before blaming the system people need to reflect upon themselves. I'm sorry my fellow Americans on here but our eating habit is ... simply disgusting, both in term of what we like to eat and what allowed to go into our food. When your population is not healthy, the cost of health care goes up.

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felter





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PostPosted: Wed, 29. Nov 17, 05:54    Post subject: Reply with quote Print

Mightysword wrote:
the reason car insurance is so affordable


I wasn't able to read the rest, because of my tears from laughter.


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PostPosted: Wed, 29. Nov 17, 09:31    Post subject: Reply with quote Print

felter wrote:

I wasn't able to read the rest, because of my tears from laughter.


Car insurance may have gone up a bit in the last few years, but it's still pretty darned affordable--costs me about £500 a year to insure my car, which is about two-fifths of what the car loan that's paying for it is costing. As I understand it, healthcare insurance in the US is *far* higher than that.

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PostPosted: Wed, 29. Nov 17, 15:49    Post subject: Reply with quote Print

pjknibbs wrote:

Car insurance may have gone up a bit in the last few years, but it's still pretty darned affordable--costs me about £500 a year to insure my car.


A bit OT (sorry)

@pjknibbs - What are you driving now a days (you used to have a Seat?)or is the location?- £500 seems a bit steep! (as I known you are of a similar vintage to me - just a bit younger Wink ). Both our cars and under £330 and the expensive one does 0-60 in 5.8s. and the cheap one is a Skoda Very Happy


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Morkonan





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PostPosted: Wed, 29. Nov 17, 15:51    Post subject: Reply with quote Print

Mightysword wrote:
I said this the last time this topic came up: the reason car insurance is so affordable not because it's universal/private (it's also private here in the US), not because of special government regulation. It's affordable because everyone participated....


I have to disagree, there. Car Insurance has a "ceiling." Every single car out there has a fixed value past which it is deemed "unfixable" and the owner, at best, is awarded a fair-market value. In other words, car insurance is weighted according to the cost of vehicle and there is a known value.

You can't do that with health insurance. At least, you can't apply it in the same way. Some insurance policies do/did have a "maximum payout per year. But, as far as any known ceiling or "value" placed on a human life, it just can't be done so potential "costs" for healthcare could run into the millions for one person, no matter how crappy and beat up their life is. Smile

Quote:
...There are so much red tape, procedure, formality to go through here just to receive basic care. Where I came from, a doctor and his secretary probably can see 50 patients a day in a general care clinic. Here in the US, a doctor, his nurse, his tech ... with amount of busy work that needs to happen in between, I'll be surprise if they see more than 20 patients a day.


I've been intimately involved with the healthcare industry this past year. (On the receiving end.) You can walk into any Emergency Room and, after a few questions, get seen fairly rapidly, depending on their current patient load and your condition. If you can get to a clinic, and those are sprouting up all over the place, you can get seen in about the same time for much less. "Paperwork" comes on the back end, not the front. At least for the patient.

As far as doctors and how many patients they see, twenty may be right. And, at least those twenty get a bit more attention per patient than they would if there were fifty being seen per day.

There is a definite rise in Physician's Assistants and Nurse Practitioners seeing and managing patient care, too. They're usually paired with a physican and work in their office, seeing their own patients, but under the supervision of the consulting physician. That speeds up general care, too.

Quote:
So even if you hold everything else equal, I feel here you have to pay the worker 3 times as much to see to the same amount of patient.


Compared to some other counties, I'd say that was correct. But, do we care about how many patients are seen or do we care about the quality of care they receive?

Quote:
Which leads to the lack of basic care. In my experience, if you catch some kind of illness in American and schedule up an appointment, chance is by the time it's your call your illness either too developed and you had to go into emergency already, or your body already fought it off by itself. Before I came here, I was used to the idea of "oh I feel a bit under weather tonight, I'll take tomorrow morning off to see the doctor". Walking clinics are readily available, and at most you wait for an hour. Here, the only way to get care that fast is via the emergency room. So maybe someone who just came down with a bad cold and the family panic and don't want to wait, go to emergency room, lay on the bed for a few hours, get an IV, some generic Tylenol, and discharged with a $4000 bill ... which would not cost more than a $100 in a clinic, a family doctor can get you the samething with like $50 even without Insurance ... if you get lucky with your appointment that is. And you can't really blame the hospital for this, even if you check in with a cold they still have to call all the specialists and give you a full diagnostic, they still have to charge you the premium even if all the test turn up nothing. And this happens WAY MORE OFTEN then most people think. I was amazed during the few times I had to stay in emergency room with relatives, how often people went into ER just to be dis-chard a couple hours laters.


If you don't have walk-in clinics near you, I suppose you may have no other choice than to go to an emergency room for basic care. But, clinics are sprouting up all over the place. But, should one really be running off to the clinic for a "cold?" If you have a good general care physician and have a good relationship with them, I'd imagine you could get seen pretty easily for an acute illness. That being said, I do admit that many general and family practices would tell you to go to a clinic or emergency room if symptoms were severe and you needed immediate attention.

Quote:
And one of the most important factor when it comes to America: it's simply not a very healthy population. Before blaming the system people need to reflect upon themselves. I'm sorry my fellow Americans on here but our eating habit is ... simply disgusting, both in term of what we like to eat and what allowed to go into our food. When your population is not healthy, the cost of health care goes up.


Obesity is a problem. General health is a problem. But, one of the biggest "problems" is that we're the third-largest country in the world with over 300 million people, we're the most advanced of any country in our population range, and our citizens expect all the miracles they seen on medical-show-drama television every time they get a sniffle...

We have a definite issue in serving our population. For far too long, we ignored the value of "neighborhood clinics" and the care they can provide, quickly and cheaply, for non-life-threatening ailments. Instead, we relied more on "Emergency Rooms" equipped to handle "everything" with their own much higher per-hour-per-patient costs. That is changing fairly rapidly, in most regions, but some are still getting left out of this important development.

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mrbadger





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PostPosted: Wed, 29. Nov 17, 16:15    Post subject: Re: Health care karma? Reply with quote Print

Morkonan wrote:


Be careful, there. Smile "Corruption" is not so very widespread. Direct providers, like doctors, nurses, and other true healthcare professionals are not "widely corrupt."


I was a nurse, I didn't mean the nurses or doctors, I meant the insurers, the people who operate, and profit from the system, and who somehow have managed to get people so screwed up that they will get more riled up about loot boxes in games then the rampant financial abuse they get subjected to whenever they get sick.

Honestly I'm baffled by that.


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Mightysword





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PostPosted: Wed, 29. Nov 17, 16:25    Post subject: Reply with quote Print

Morkonan wrote:
I have to disagree, there. Car Insurance has a "ceiling."


Yes and no, if you compare it to health insurance, think about the people with pre-condition is someone with a bad driving record, their number will go up. But the point is, the insurance is reasonably priced per income, whether insurance may or may not.

Quote:

Compared to some other counties, I'd say that was correct. But, do we care about how many patients are seen or do we care about the quality of care they receive?


The point here is how accessible general care is. For many to receive access to this is a daunting task. I'm using simple cold as an example for this reason, with truly accessible care, I feel it should be the case where I can see the doctor when I want, not only when I think something is serious. I don't need all that 'busywork' when I show up with a simple cold, at least I think so, so the quality of care in the context you're talking is irrelevant.

If it's something simple, I walk home after some consultant, if it's truely serious the doctor can escalate. My aunt who still lived back home had this happened, felt a bit weird so 'casually' visit the doctor, he discovered something serious and sent her to the hospital right that evening. In fact, a big big issue in our country was the old mentality of "seeing doctor is such a hassle I only go when it's serious", where in many case it's really too late. If you have a less intimidating system, you encourage people to go more early and more often, that's the point.



Quote:

We have a definite issue in serving our population. For far too long, we ignored the value of "neighborhood clinics" and the care they can provide, quickly and cheaply, for non-life-threatening ailments. Instead, we relied more on "Emergency Rooms" equipped to handle "everything" with their own much higher per-hour-per-patient costs. That is changing fairly rapidly, in most regions, but some are still getting left out of this important development.


This summed up and I don't think it really run counter to what I had said. Notice you use the word "recently" a lot, and it's true. I have been living in the same area for the last 15 years, right at the state capital county, and a clinic just opened right outside of my house last year. Is it enough? No where enough, and before then I was one of those people who I described as by the time you receive an appointment you're already passed it. We can say the last few years American have become more aware of the bad eating habit we have, but these things take time to have an effect, and by that I don't mean a few years, we're talking about generations here. Just like not because you quite smoking after 30 years, your lung will be better next year, chance is it's already written off. But the perceived bad health care is far more than just a one, or even two, or even three bulletin points problem.

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Morkonan





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PostPosted: Wed, 29. Nov 17, 16:53    Post subject: Re: Health care karma? Reply with quote Print

mrbadger wrote:
...Honestly I'm baffled by that.


You and me, both!

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felter





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PostPosted: Wed, 29. Nov 17, 17:36    Post subject: Reply with quote Print

pjknibbs wrote:
felter wrote:

I wasn't able to read the rest, because of my tears from laughter.


Car insurance may have gone up a bit in the last few years, but it's still pretty darned affordable--costs me about £500 a year to insure my car, which is about two-fifths of what the car loan that's paying for it is costing. As I understand it, healthcare insurance in the US is *far* higher than that.


You say ONLY £500, that's because you can afford £500, what if I was to say I don't have £500, I cannot afford £500, is it still cheep to me.


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Morkonan





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PostPosted: Wed, 29. Nov 17, 17:43    Post subject: Reply with quote Print

Mightysword wrote:
Yes and no, if you compare it to health insurance, think about the people with pre-condition is someone with a bad driving record, their number will go up. But the point is, the insurance is reasonably priced per income, whether insurance may or may not.


Automobile insurance isn't priced "per income." It is, in general, reasonably priced according to "age" (Actuariies and their input, which I'm sure you're probably familiar with - Statistics) and the price/value of the automobile. "Driving Record" is an individual multiplier. But, in most cases, IMO, it's simply an excuse for the insurer to raise rates. Smile

Quote:
The point here is how accessible general care is. For many to receive access to this is a daunting task. I'm using simple cold as an example for this reason, with truly accessible care, I feel it should be the case where I can see the doctor when I want, not only when I think something is serious. I don't need all that 'busywork' when I show up with a simple cold, at least I think so, so the quality of care in the context you're talking is irrelevant.


Physical access is one thing, financial access is another. I agree that more physical access is truly needed, especially for non-emergency conditions. This was one of the primary issues revolving around increasing Medicaid/Medicare costs - People couldn't get access to quick care for non-emergency situations, so they went to the emergency rooms instead. That was simply where they were used to going even after "clinics" and "rapidcare" facilities started to spring up. In some cases, that's still the case.

Quote:
If it's something simple, I walk home after some consultant, if it's truely serious the doctor can escalate. My aunt who still lived back home had this happened, felt a bit weird so 'casually' visit the doctor, he discovered something serious and sent her to the hospital right that evening. In fact, a big big issue in our country was the old mentality of "seeing doctor is such a hassle I only go when it's serious", where in many case it's really too late. If you have a less intimidating system, you encourage people to go more early and more often, that's the point.


I agree. In fact, because I waited to go see a doctor, my situation was complicated. However, if I hadn't finally gone to an emergency room, I would likely have not received the diagnostic treatments that revealed other issues that has thrown me into a medical tornado all year. Luckily, for now, it appears that I'm healthy as a horse with the exception of things that look weird on a CT/MRI scan... I'm probably an extraterrestrial, trapped here on Earth in order to experience arcane Earther "medicine" so I can complete my doctorate at E.T. University in "Primitive Medical Practices in Pre-Sentiennt Biped Populations." Smile



Quote:
This summed up and I don't think it really run counter to what I had said. Notice you use the word "recently" a lot, and it's true. I have been living in the same area for the last 15 years, right at the state capital county, and a clinic just opened right outside of my house last year. Is it enough? No where enough, and before then I was one of those people who I described as by the time you receive an appointment you're already passed it. We can say the last few years American have become more aware of the bad eating habit we have, but these things take time to have an effect, and by that I don't mean a few years, we're talking about generations here. Just like not because you quite smoking after 30 years, your lung will be better next year, chance is it's already written off. But the perceived bad health care is far more than just a one, or even two, or even three bulletin points problem.


All this is true. But, there are more clinics and rapidcare facilities opening up every day. One long-standing issue is that in regions where populations can't necessarily support such services, access to care is behind the curve. This has always been true. During residency, many physicians are shuffled off to regions where healthcare is sparse or small facilities are overwhelmed. Nurse Practitioners and Physician's Assistants get in mobile "clinic" vehicles equipped with x-rays, etc, just to go out and service some remote areas twice a month. And, for some heavily populated urban areas, what facilities there are end up getting overwhelmed because there's not as much "profit" in servicing what are likely to be Medicaid customers. ("Medicare" is entirely different and people used to fall all over themselves trying to attract older Medicare customers, since they could rack up the charges left and right.)

Yes, the situation is screwed up and there are issues with actual physical access in some regions. That's not too surprising, really. Our population density is very low, despite being the third-most populous country. That's crazy, isn't it? And, all our citizens expect the very same level of service in everything.

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