Health Care and your experiences

[Toni]

Then you are indeed fortunate in your country of residence.

For now, I consider myself more fortunate than you are simply because we have not needed to wait for treatment for any significant ailment. Or for check ups, for that matter. I remember Gaynor's brother's issues. It was hard enough waiting a week longer than we should have for a biopsy but that was due to my husband refusing to listen to me and the small town doc being an egomaniac, not due to insurance.

Now after retirement, I am sure I will look at things differently. Depending on how our health holds up.

 

[Loren Pechtel]

You realize, of course, that I was not writing about your personal experience but about a general issue that I saw happen over and over again while working in the business office of a multidisciplinary medical practice.

You're letting your hatred blind you. I saw the EOBs, the same wrong date each time.

Also, while I have never done insurance billing I have checked over a lot of the paperwork that a doctor's office got back from the insurance--and I never saw an improper rejection. Plenty of people who didn't tell the doctor when they lost their insurance (coverage was verified at the first visit, not at every visit), an occasional request for more information, various gripes about errors in the information submitted or else payment. While I'm sure there are insurance companies that play games I never ran into one.

You're either letting your imagination run wild or you're projecting your own feelings onto me. You're also a little out of your depth re: medical billing. As you said, you've never done insurance billing.

I wasn't the one sending the bills in, I was going through what came back because the billing people were incompetent at figuring out which ones were supposed to produce income for my wife. (Her agreement was a % of monies collected from her services.)

 

[Loren Pechtel]

In this particular instance, the doctor was past the limit of his competence, outside of the area of his actual expertise, outdated in his knowledge but most of all driven by his ego. He was the only specialist in that specialty in town and lacked the benefit of having colleagues to help keep him up to date, and for easy consultations and referrals. But mostly, he was limited by his enormous ego that wouldn't entertain the notion that he didn't know everything (or even enough to read a biopsy report before walking into the exam room where the patient was waiting. Yep. That happened. I was present. Real kicker was that he had had the biopsy results for over a week.) And also by the fact that it was a limited practice in a small town, lacking a lot of resources that were present at the facility an hour away where my husband was ultimately treated. Oh, he also didn't like that I asked to read the biopsy report and actually understood it.

Somehow I don't find myself surprised. In my limited experience with small-town medicine I haven't encountered a doctor that seemed good. There's always only one choice for specialists, there's no competition to keep them on their toes.

If I lived in a small town and had anything serious I certainly would be seeking care in the big city.

(And there's another factor I have seen--older doctors that just aren't with it anymore. Doc, to my mother: "Oh, that's nothing." Said "nothing" was very virulent cancer, although no doubt stage IV by the time she noticed it so it didn't matter in the big picture.)

 

[bilby]

Then you are indeed fortunate in your country of residence.

For now, I consider myself more fortunate than you are simply because we have not needed to wait for treatment for any significant ailment. Or for check ups, for that matter. I remember Gaynor's brother's issues. It was hard enough waiting a week longer than we should have for a biopsy but that was due to my husband refusing to listen to me and the small town doc being an egomaniac, not due to insurance.

Now after retirement, I am sure I will look at things differently. Depending on how our health holds up.

I have never needed to wait for treatment for any significant ailment* - anything life-threatening or even with the potential to be life-threatening is handled without delay.

Appropriate pain relief is provided for anyone who has to wait for treatment where their problem is uncomfortable, but not life threateningly urgent.

After a minor car crash recently, I presented at our very busy local hospital, with chest pain. Within ten minutes of my arrival I was in the Adult Acute Care ward, getting a full cardiac work up - blood tests, ECG, chest x-ray, the works. I had minor bruises from my seatbelt, which is what I told the triage nurse to begin with - but as the cardiologist said when he pronounced me the healthiest person in the hospital (including the staff), they don't make assumptions. A man in his forties with a history of elevated cholesterol who has had a stressful day and is experiencing chest pain gets the full battery of tests immediately and without question.

Total out of pocket cost - $0.00

The stories of delay and long waiting times are true; but this is not allowed to get in the way of clinical or diagnostic need. Those who wait are, overwhelmingly, those for whom waiting will not worsen their prognosis.

Horror stories of people who have waited for years under UHC are not representative of the typical patient experience; and I have never heard of anyone having to wait for financial approval of their treatment, and nor has anyone had to wait essentially forever because they simply can't afford to be treated at all.

All of this massively outweighs any benefits from being able to get immediate treatment for minor issues if you have the luck to be in the fraction of people with excellent insurance. (And I am skeptical that even then, people with conditions that can wait never have to wait.







*I personally have never needed such treatment - the last time I spent a night in hospital was in a maternity ward; but this experience also applies to my family. Waiting at all can be stressful and unpleasant, but it's generally an indication that you are in no immediate danger.

 

[RavenSky]

I a man damn glad that I am not as 'fortunate' as you - if I were forced to accept being in your situation, I would be deeply unhappy about how much worse off it made me.

Americans really don't have a clue just how wonderful it is never to have to think twice about the cost of healthcare.

I don't think about insurance; I don't have to consider whether or not my family is covered. I don't need to do anything to secure my coverage if I change jobs, or even lose my job entirely. And I don't have to be able to find hundreds of dollars at short notice if something happens to me.

And most importantly, nor do any of my family, friends, or neighbours. Not one of them.

I would hate to live in a place where having a degree of temporary confidence in the security of my ability to afford healthcare rendered me 'fortunate'.

and yet, a horrifyingly large number of people in the USA are convinced that our so-called system is better than anyone else's

 

[braces_for_impact]

I a man damn glad that I am not as 'fortunate' as you - if I were forced to accept being in your situation, I would be deeply unhappy about how much worse off it made me.

Americans really don't have a clue just how wonderful it is never to have to think twice about the cost of healthcare.

I don't think about insurance; I don't have to consider whether or not my family is covered. I don't need to do anything to secure my coverage if I change jobs, or even lose my job entirely. And I don't have to be able to find hundreds of dollars at short notice if something happens to me.

And most importantly, nor do any of my family, friends, or neighbours. Not one of them.

I would hate to live in a place where having a degree of temporary confidence in the security of my ability to afford healthcare rendered me 'fortunate'.

and yet, a horrifyingly large number of people in the USA are convinced that our so-called system is better than anyone else's

Sometimes I think that things have been a certain way for so long that people don't realize how much better it could be. In fact, most of Republican policy depends on this.

An interesting resource for health care conversation. It shows how far behind the curve the U.S. really is.

 

[Loren Pechtel]

Horror stories of people who have waited for years under UHC are not representative of the typical patient experience; and I have never heard of anyone having to wait for financial approval of their treatment, and nor has anyone had to wait essentially forever because they simply can't afford to be treated at all.

The horror stories involve the things that won't kill you.

 

[barbos]

How small is the small town? and how big is bigger town with better doctors?
What you describe is milder version of situation in Russia. In smaller towns doctors are 40-50 years out of date and don't know shit.

Town where we live/first doctor is <30,000. Town with stellar medical facilities is > 4 times that size.

I have always wondered what happens to bad and/or old doctors in US, apparently they end up in small towns.

 

[bilby]

Horror stories of people who have waited for years under UHC are not representative of the typical patient experience; and I have never heard of anyone having to wait for financial approval of their treatment, and nor has anyone had to wait essentially forever because they simply can't afford to be treated at all.

The horror stories involve the things that won't kill you.

And so?

Is it better that a poor man goes untreated forever (even for serious and urgent issues), than that a wealthy man wait six weeks for a minor procedure to fix a non life-threatening condition?

Because that's your choice here.

 

[Toni]

Town where we live/first doctor is <30,000. Town with stellar medical facilities is > 4 times that size.

I have always wondered what happens to bad and/or old doctors in US, apparently they end up in small towns.

Not at all.

There are bad doctors everywhere. And good doctors as well.

In my town, some very good doctors. My dentist and her staff are wonderful. I feel the same about my optometrist. The second best pediatrician I've run across was in my small town until he and his family relocated, which was a big loss. A couple of his replacements also had stellar reputations (my kids had outgrown pediatricians at that point so I can't say from experience). The best pediatrician I've ever known practiced in a small town. I still miss him decades later. Two of the very best general practitioners I've ever known practiced in small towns; one retired and has since passed away and the other was pressed into service running the ER of the local hospital. Which is unfortunate. I'd love to have him as my gp again and save myself an hour long trip each way to see a doc.

The doc I've been so hard on? I had previously liked him well enough and I think he was fine for routine stuff, the stuff he saw/did every day. He had practiced in our town...for decades, long before we arrived. He retired a few years ago and it was definitely time.

I also don't think that age necessarily is predictive of quality of doctor. The pediatrician I miss so much? My kids were his patients near the end of his career. Ditto one of the GPs I really liked.

 

[RavenSky]

The horror stories involve the things that won't kill you.

And so?

Is it better that a poor man goes untreated forever (even for serious and urgent issues), than that a wealthy man wait six weeks for a minor procedure to fix a non life-threatening condition?

Because that's your choice here.

I don't think Loren was criticizing. He does seem to be in favor of a proper UHC system for the U.S.

What I find ridiculous is that the U.S., we have outrageous waits as well but in our case it is not based on whether it is a life-threatening illness or not. It is not even always based on whether one is poor or not, though that will be a huge determinate.

In the U.S., if you are very rich, you wait for nothing, no matter how minor.

But in the U.S., even if you are the typical middle class with the typical decent insurance, you are still constrained by the availability of doctors in the speciality you need that are also "in network". I ran into this quite a bit with my daughter's diabetes. There is, apparently, a shortage of pediatric endocrinologists in Miami. Every time we had to change doctors because the insurer changed, we had to wait 6 months for the first appointment - nevermind that diabetes must be closely monitored, especially in a teenager. After the first appointment, we would schedule the next appointment immediately... and don't even think about trying to re-schedule if you want to keep to a proper medical schedule.

But no worries... we could also go to the emergency room in the interim!

For me, the emergency room wasn't even an option. I have a rather severe condition of hypothyroidism. Left untreated, it is not immediately life-threatening but:

When thyroid hormone levels are too low, the body’s cells can’t get enough thyroid hormone and the body’s processes start slowing down. As the body slows, you may notice that you feel colder, you tire more easily, your skin is getting drier, you’re becoming forgetful and depressed... If you keep your hypothyroidism well-controlled, it will not shorten your life span.

But because of how fucked up the U.S. health care system is, there have been times I have had to go without any medications at all because I could not afford the doctor's visits, required blood tests, and/or the medication. Great quality of life we have here!

 

[Toni]

The horror stories involve the things that won't kill you.

And so?

Is it better that a poor man goes untreated forever (even for serious and urgent issues), than that a wealthy man wait six weeks for a minor procedure to fix a non life-threatening condition?

Because that's your choice here.

Not really.

I realize that I didn't write very clearly or that you misunderstood: the fact that my family has excellent health insurance allows us to get excellent care with very little additional costs to us.

The fact that we live within an hour's drive of a world class medical facility allows us to have excellent care. That same medical facility does a great deal of charity work, and provides care for a very significant number of low income patients and Medicare patients.

For us, it's a question of geography. We're fortunate in where we live. We've lived in large metropolitan areas of major cities in the US and have had good access to good doctors, but not the same quality of medical care because of geography, not money.

Our first child was born when my health insurance would not cover prenatal/maternity care. That did not prevent me from receiving excellent medical care at a good practice and a good hospital. I would have chosen the same practice that I chose if I had had tons of money. It meant that we paid for the care ourselves, which was difficult as we had a very low income. But we were young and dumb and full of hope if not much sense. Also naive and ignorant enough to not even consider that we were a)poor or b)qualified for Medicaid for the delivery and honestly, I don't think I would have applied anyway. It frankly never occurred to me. I talk a lot about being 'poor' in those days and it is true that for the first 5 years or so of our marriage, our income put us below the poverty line. But because the poverty or let's be honest: 'poverty' was temporary while my husband was a grad student, I can put the quotes around poverty. He was immediately employed after he finished grad school. And we had medical coverage for all of us (aside from the birth of our first child.) That alone kept me from feeling insecure or fearful or too poor, and allowed me to mentally put those quotes around the word poor. We were and are extremely fortunate.

Prenatal care is one of the very best benefits of Obama Care and the lack of prenatal/maternity benefits is one of the horrors of the proposed replacement.

Now, today, medical costs have skyrocketed so much I am certain in the same situation today, there would have been no choice but to get on Medicaid for me and the baby. That would not have changed where I was able to be seen by doctors/hospital. Also, things have changed enough that I would have been up front counseled to apply for Medicaid when I first presented at the ob/gyn's office, in order to ensure that a)they'd be paid and b) I wouldn't skip appointments because of $. I didn't skip appointments or any other care. We just lived...very very close to the line.

 

[braces_for_impact]

The problem is that the U.S. system (or lack of it, really) is designed around health care insurance. The main goal of health care insurance isn't health care, it's keeping your shareholders happy. Obamacare is flawed because it attempts to work within that system. Any system designed to replace it that is based on the same premise will also be flawed. The system is designed (for lack of a better word) to allow everyone involved in the health care chain to extract profit, but unfortunately it's the end user that feels the pinch at the end. There are pharmaceuticals, doctors, rehabilitation services, hospitals, medical equipment providers, and insurance, just to name a few of the services one will use in a visit for a single condition. Every one of those (and many more!) expect to be able to extract a profit from their end of the business along the chain. While I'm a fan of the free market where it's appropriate, I've come to see that there are some institutions where the profit motive will not provide services that are in the end user's best interest. One of these is health care. Another is (law enforcement) corrections, yet another is journalism. Our Republicans simply cannot understand this, because they're not just fiscally or even socially conservative. They worship the free hand of the market with the same zeal and despite the same lack of evidence with which they worship God. There is no magic bullet for every and any situation, and that includes cutting taxes to stimulate growth top down, and a free market answer to any conceivable economic situation.

 

[another1]

Va hospital failed Grampa in his last days. He broke his hip and they didn't know it for 3 days. I showed up to find them calling him by the wrong name and trying to feed him this disgusting Porridge I wouldn't feed to a dog. They were treating him like a child and verbally abusing him as they replaced his blue pad and bedding. It was a nightmare. He fought in two wars man. He deserved respect. His room mate witnessed his fall, but his room mate is dead now. Can't sue them but I guess I can complain and stress out about it. That is my health care experience dealing with loved ones.

Oh, and my Aunt took him to a lawyer and changed his Will when he was 95 and suffering from Alzheimer's. Does that sound legal? I don't think she should get everything. She is a hoarder and a cat collector. Those people can be very dangerous when threatened, so I am making moves without her knowledge. I took his SS# and got into his bank. There was over $300,000 in there. Plus he had bonds and tons of other stuff. She looked me in the face and said "it is pretty much all gone". I believed her at the funeral but my spying nature revealed the hundreds of thousands she is screwing the fam out of. People wanna go back to school, pay their utilities... maybe get out of the hood, but nooo, it is "pretty much all gone". This is where letter writing skills come in handy because I have notified the rest of the fam in prison. Considered blackmailing her and making out for myself, but no I have too much poor family to screw them like that. That is my experience with doll hoarding, cat collecting psychopaths - soon to be in prison themselves.

As for me, I can't get any help. I have Cobra or something like that. My ex paid for my back surgery. I think it was like 40 thou. Now that I don't have her, I spend an average of $300 a month on medical. $500 on marijuana. I have tons of chronic conditions to address, but I notice that not worrying about your health is the healthiest thing you can do.

Send $5.00 to your billers and they can't sue you because you're making an effort to pay. The goal is to get them to stop accepting the $5.00 payments, because there is a trick you can pull on them in court if they refuse a payment. An old trick that works, depending on what you owe and how the judge feels about your appearance and demeanor. You gotta wear cheap clothes to court and speak a certain way. Pity is the only thing keeping me alive, now that I think about it. I'll never be able to afford the stuff I need done medically. The only way is juking the billing system and applying a skill called Slack, which seems to have worked since I became an adult. The billing can be patient and forgiving but it never goes away. I probably owe about a million dollars, no joke. I send $5.00 when I get a letter, and God help them if they are unfortunate enough to do a collection call on me. I have some recordings of hilarious bill collector's calls. I think they all "F12'd" me, also known as do not call back.

 

[Loren Pechtel]

The horror stories involve the things that won't kill you.

And so?

Is it better that a poor man goes untreated forever (even for serious and urgent issues), than that a wealthy man wait six weeks for a minor procedure to fix a non life-threatening condition?

Because that's your choice here.

No, the problem is that you consider underfunding to be proper that you think this should be a choice in the first place.

And the record holder I'm aware of is 5 years of the sort of pain that's been known to drive people to suicide. Followed by "you're too old"--making it lifetime.

 

[Loren Pechtel]

I don't think Loren was criticizing. He does seem to be in favor of a proper UHC system for the U.S.

Sort of. I'm opposed to a single-payer system because that leads to the sort of thing that Bilby considers normal: The acceptance of the suffering of those with non-fatal conditions. When the same agency does it and sets the standards for doing it you have problems.

However, I would favor something along the lines of taking the ACA, making the minimum plan Gold and have the government pay the cost of the cheapest plan in your zip code.

But in the U.S., even if you are the typical middle class with the typical decent insurance, you are still constrained by the availability of doctors in the speciality you need that are also "in network". I ran into this quite a bit with my daughter's diabetes. There is, apparently, a shortage of pediatric endocrinologists in Miami. Every time we had to change doctors because the insurer changed, we had to wait 6 months for the first appointment - nevermind that diabetes must be closely monitored, especially in a teenager. After the first appointment, we would schedule the next appointment immediately... and don't even think about trying to re-schedule if you want to keep to a proper medical schedule.

I would be complaining to the insurance commissioner as they aren't providing medically acceptable access.

 

[bilby]

Sort of. I'm opposed to a single-payer system because that leads to the sort of thing that Bilby considers normal: The acceptance of the suffering of those with non-fatal conditions. When the same agency does it and sets the standards for doing it you have problems.

However, I would favor something along the lines of taking the ACA, making the minimum plan Gold and have the government pay the cost of the cheapest plan in your zip code.

But in the U.S., even if you are the typical middle class with the typical decent insurance, you are still constrained by the availability of doctors in the speciality you need that are also "in network". I ran into this quite a bit with my daughter's diabetes. There is, apparently, a shortage of pediatric endocrinologists in Miami. Every time we had to change doctors because the insurer changed, we had to wait 6 months for the first appointment - nevermind that diabetes must be closely monitored, especially in a teenager. After the first appointment, we would schedule the next appointment immediately... and don't even think about trying to re-schedule if you want to keep to a proper medical schedule.

I would be complaining to the insurance commissioner as they aren't providing medically acceptable access.

I do not consider normal, nor acceptable, the suffering of patients with non-fatal conditions; nor do the UHC systems in either of my countries of citizenship.

You appear to be yet again more invested in propaganda that allows you to dismiss the obvious, than you are in actual reality.

Non-urgent patients can wait. Patients who are experiencing unmanaged pain are not considered non-urgent; Not by me, nor by clinicians in the U.K. or Australia.

This remains true even if you are able to find a handful of instances where a patient has not received the care that should have been provided - a circumstance that occasionally and regrettably occurs under any system - there are examples of people in the US system who have been failed in this way despite having the ability to pay (and countless examples of people in the US system who are currently suffering due to being completely disregarded by the system for the crime of being poor, uninsured, or underinsured).

You are attempting to defend the indefensible. I would thank you not to do so by misrepresenting my position.

 

[barbos]

I am hoping AI development will resolve health care problem soon.

 

[ZiprHead]

I am hoping AI development will resolve health care problem soon.

 

[southernhybrid]

I can tell you about something that happened at work yesterday. A young worker asked me if I knew of anything that would help her skin condition, which was once diagnosed as eczema, but that was year's ago. She's done google searches but came up with nothing that she hasn't already tried. She has no insurance and only makes the minimum wage. I felt very helpless because I couldn't think of anything to help her. She needs a dermatologist, but most require several hundred dollars upfront if you lack insurance and the young woman has no savings.

Another worker's husband finally was accepted into a low cost clinic in my town. They gave him some Rx. for his damaged knee but then referred him to a specialist. Hopefully, the specialist is associated with the clinic and won't charge him more than he can afford.

And finally, I have a dear friend who can't afford insurance, she was hospitalized a couple of weeks ago with severe diverticulitis. The bill was very large. She's in the process of trying to get temporary Medicaid, something that Georgia offers for people like her. First she has to bring proof of her income and tax statements before she will be approved. I'm hoping it works out for her, because otherwise, she will be paying on that bill for years and she still needs more tests before we're sure she doesn't have something worse going on. Her 27 year old daughter has just recovered from bowel cancer, but fortunately, she's an attorney with good insurance. She received excellent health care, from what I can discern.