Why people are afraid of universal health care

[Loren Pechtel]

I've been on Medicare for 10 years, and have cared for people on Medicare for most of my 42 years as a professional nurse. I've never found that Medicare patients were treated any differently from patients who had private insurance. In fact, M'care recipients are often treated better, in my experience. I support M/care for all. If the younger folks were included, it would make care less expensive overall because most of the care we need is when we are older, statistically speaking of course.

The problem is more and more docs not taking Medicare.

When people have big copays, they often put off treatment. Even Advantage Plans have small copays, compared to some of the private insurance plans we had when younger. The biggest problem I have seen with Medicare is that people are often given aggressive end of life care or they demand aggressive end of life care. This is less of a problem compared to when I was younger and visited home health patients who were living with G-tubes and even respirators despite being almost in a vegetative state. Imo, aggressive end of life care is cruel, expensive and hospice would be a better option.

Agreed on end-of-life, but I think that's more an attitude problem. Too many doctors are focusing on the problem rather than the patient.

The problem in the US, is s that medical care if often all about profit and greed, so procedures and tests that aren't necessary are often ordered to make more money. Hopefully if we had government supported UHC, that would change over time. Doctors fuck up plenty of times, as they are only humans, but it rarely has a thing to do with which plan pays the bills. On the other hand, I have seen people without any insurance or money who were treated poorly. I saw it in home health. If a person had no way to pay, they were given about 2 visits. If a person had Medicare, they were sometimes over treated so the agency could make extra money or as one administrator put it, "we must maximize profit". That were her exact words when I was working in QA during the 90s. That's just my opinion as one who has worked as a health care professional and one who is a Medicare recipient.

Btw, I refuse a lot of things that I don't feel are necessary. I don't like to abuse the system. I support bodily autonomy and if I'm wrong for refusing something, that's on me.

Doctors rarely make money off tests. I do agree there's a problem, though.

 

[Loren Pechtel]

Ok, but when one is told they need a biopsy—and they can have one in six months, they hear: we think you have cancer but we aren’t going to bother checking for a good six months.

Which actually is not a big problem with some cancers. But with others: that’s a death sentence, possibly after rounds of chemo and surgery, and all the health consequences for you, your family and friends, your career, your ability to work and pay your bills.

Women are scared of breast cancer. They are scared of dying of this disease. Likely they know someone who has the disease and someone who died too young from this disease. They are scared of the amputation which is much more likely if the breast cancer is a rapidly growing cancer. Which they cannot know without a biopsy. They are scared they might need to lose both breasts and maybe their ovaries, going into early menopause. They are afraid the man in their life or maybe the woman in their life will no longer find them attractive. They are afraid they won’t enjoy sex anymore . They are afraid they won’t be able to have a child or more children.

But sure: just sit with that fear while telling yourself you need to suck it up so that everyone else can get their fair turn.

Why does it have to be one or the other? A needle biopsy is quick. A properly funded facility can get you the results quite quickly. Quicker diagnosis leads to cheaper, more effective treatment and better outcomes fur the patient.

Ah, somebody gets it!

And look at that blog--she's someone with well above average level of medical knowledge.

And, to me even worse is that it's not that they aren't going to check for six months, but that delays keep happening. It's not even a fixed wait.

 

[Loren Pechtel]

When a man grows older, then the tits are not necessary. But to find a likewise thinking soul - that is a problem.
Tits are for men that want back to mama.

The tits don't matter--but chemo often has life-long effects.

 

[Toni]

When a man grows older, then the tits are not necessary. But to find a likewise thinking soul - that is a problem.
Tits are for men that want back to mama.

The tits don't matter--but chemo often has life-long effects.

They matter to the woman.

FFS, Loren: it’s her body. The last thing any woman needs or wants is some man telling her what does and does not matter about her own body.

 

[bilby]

I can't even.

What has to be broken in a person's brain for them to think that one fairly trivial story of a short delay in getting a diagnostic procedure - something that also occasionally happens for fully insured patients in the US system - somehow outweighs all of the horrific consequences of the US system, and is therefore a reason to fear universal health care?

How long do uninsured women in the US have to wait for a biopsy? Is waiting their biggest problem? Do they even get a biopsy at all?

Is the whole business of being an uninsured patient in the US, who suspects she might have cancer, such a stress free stroll in the park that nobody would swap it for the hellish nightmare of the system in Canada (which is, of course, indistinguishable from the completely different UHC systems in other OECD nations - basically there are two healthcare regimes: The American Way and The Wrong Way).

FFS. I seriously can't even.

What is wrong with you?? Who would post this story with that as the headline, other than as a woefully bad attempt at satire?

And to then include this gem as an aside in the anecdote about how much better the US system is:

We were arguing with the insurance about it six months later

I have never argued with health insurance about anything, ever. No insurer has ever told me what treatment I can or can't have, or which hospitals or clinics I can or can't attend. If I need a diagnostic test, I get one. And am out of pocket no more than the cost of parking at the hospital (which is admittedly hair-raisingly expensive, but we are talking tens of dollars, not thousands).

Ok, but when one is told they need a biopsy—and they can have one in six months, they hear: we think you have cancer but we aren’t going to bother checking for a good six months.

Which actually is not a big problem with some cancers. But with others: that’s a death sentence, possibly after rounds of chemo and surgery, and all the health consequences for you, your family and friends, your career, your ability to work and pay your bills.

Women are scared of breast cancer. They are scared of dying of this disease. Likely they know someone who has the disease and someone who died too young from this disease. They are scared of the amputation which is much more likely if the breast cancer is a rapidly growing cancer. Which they cannot know without a biopsy. They are scared they might need to lose both breasts and maybe their ovaries, going into early menopause. They are afraid the man in their life or maybe the woman in their life will no longer find them attractive. They are afraid they won’t enjoy sex anymore . They are afraid they won’t be able to have a child or more children.

But sure: just sit with that fear while telling yourself you need to suck it up so that everyone else can get their fair turn.

Why does it have to be one or the other? A needle biopsy is quick. A properly funded facility can get you the results quite quickly. Quicker diagnosis leads to cheaper, more effective treatment and better outcomes fur the patient.

I don't disagree with any of this, and nor do I understand how it is in any way related to my post, to which it apparently forms a reply.

The story presented in the OP is one of a patient being failed by a healthcare system. Such things shouldn't happen, but unfortunately all systems have imperfection, so you can find such stories anywhere. Including amongst Americans with top-notch insurance.

As such, it is disingenuous to the point of outright falsehood, for the OP to present this tragic story as a flaw in the idea of UHC, that would somehow cause a rational person to prefer the clearly inferior US healthcare model, or to fear UHC.

 

[bilby]

The two systems have different types of failure. It's not a case of one being categorically better.

UHC is categorically and objectively better. Unless your measure of merit is how much profit the system makes.

In UHC systems, the total cost of the system is lower, patient outcomes are better for all but the wealthiest cohort of the population, patient stress levels are lower, long term financial consequences of illness or injury are less severe, long term medical consequences are less severe (particularly for lower income patients), and rates of uptake of preventative care and early intervention are higher.

Yoir attempt at a "both sides" argument is noted, and rejected as counterfactual.

 

[Henry-Finland]

When a man grows older, then the tits are not necessary. But to find a likewise thinking soul - that is a problem.
Tits are for men that want back to mama.

The tits don't matter--but chemo often has life-long effects.

They matter to the woman.

FFS, Loren: it’s her body. The last thing any woman needs or wants is some man telling her what does and does not matter about her own body.

Yes of course, but I write about what matters to a grown-up man - soul before looks.

 

[Bomb#20]

Needing to eat is neither an indulgence nor an offence, but a misfortune. So if the above quote attributed* to Bevan were valid reasoning then it would imply agriculture should be socialized. Capitalist agriculture is so good at delivering food to the people that obesity is a disease of the poor; socialist agriculture has caused famine after famine. Not commenting on the merits of the NHS model for health care delivery, just pointing out that moral philosophy is an utterly garbage way to decide how to solve the hard technical problems of economics.

(* Bevan didn't say it; the quote is from the sociologist T. H. Marshall.

)

 

[gmbteach]

I've been on Medicare for 10 years, and have cared for people on Medicare for most of my 42 years as a professional nurse. I've never found that Medicare patients were treated any differently from patients who had private insurance. In fact, M'care recipients are often treated better, in my experience. I support M/care for all. If the younger folks were included, it would make care less expensive overall because most of the care we need is when we are older, statistically speaking of course.

When people have big copays, they often put off treatment. Even Advantage Plans have small copays, compared to some of the private insurance plans we had when younger. The biggest problem I have seen with Medicare is that people are often given aggressive end of life care or they demand aggressive end of life care. This is less of a problem compared to when I was younger and visited home health patients who were living with G-tubes and even respirators despite being almost in a vegetative state. Imo, aggressive end of life care is cruel, expensive and hospice would be a better option.

The problem in the US, is s that medical care if often all about profit and greed, so procedures and tests that aren't necessary are often ordered to make more money. Hopefully if we had government supported UHC, that would change over time. Doctors fuck up plenty of times, as they are only humans, but it rarely has a thing to do with which plan pays the bills. On the other hand, I have seen people without any insurance or money who were treated poorly. I saw it in home health. If a person had no way to pay, they were given about 2 visits. If a person had Medicare, they were sometimes over treated so the agency could make extra money or as one administrator put it, "we must maximize profit". That were her exact words when I was working in QA during the 90s. That's just my opinion as one who has worked as a health care professional and one who is a Medicare recipient.

Btw, I refuse a lot of things that I don't feel are necessary. I don't like to abuse the system. I support bodily autonomy and if I'm wrong for refusing something, that's on me.

DING! DING! DING! Give the lady a cigar! That's the whole problem.

I have had two world renowned surgeons operate on my knee. One went to 'third world countries' to teach and perform orthopedic surgery. One was a world renowned lecturer on shoulder surgery - he actually wrote and presented a paper on my knee (it was that problematic if you recall) and the eventual use of an allograft over any other treatment.

The one who goes to Third World Countries charged me $1000 co-pay for the very first surgery he performed on my knee. He didn't charge me for the second... and the other one who performed the last two surgeries charged me nothing more than what Medicare and my private health insurance would pay.

The anesthetist in all operations was also covered by what Medicare and the private health insurer would pay.

The biggest insurance payout was for the hospital - which was private - and was for a total of around 20 days.

I bet you are asking if I got substandard treatment resulting in all the surgeries? No. I am prone to infections, which was the problem.

My point is that neither surgeon, nor the anesthetist were going to charge me more than Medicare and Private Health deem are enough. They still make more than adequate money. FFS my second surgeon buys clothes at airports when he travels to lecture on his procedures and chucks them out. Saves him carrying luggage..

 

[bilby]

Our system is not good at handling the people just above the point of needing government assistance. And, since it isn't mandated there are those who choose not to spend the money on insurance and then find out the hard way why that's a bad idea. Since the ACA was introduced nobody can be denied insurance, it's only a matter of money.

"It doesn't matter whether you are rich or poor, as long as you've got money" - Joe E. Lewis.

 

[bilby]

Needing to eat is neither an indulgence nor an offence, but a misfortune. So if the above quote attributed* to Bevan were valid reasoning then it would imply agriculture should be socialized food should be provided to hungry people

FTFY.

 

[gmbteach]

You think them basically playing Russian Roulette with her life is a reasonable approach??

You think it has anything at all to do with UHC??

Of course it does. We are seeing the fundamental failure of UHC: lowering standards instead of meeting them. So under capacity that there's a huge backlog on something that should be resolved quite promptly. You don't dick around when a cancer screening test comes back with an issue!

We don't have UHC here and yet people here are denied by insurance companies needed testing all the time.

not angry at you - angry as fuck as insurance companies who think they are god and decide who needs tests and who doesn't.

 

[bilby]

And, to me even worse is that it's not that they aren't going to check for six months, but that delays keep happening. It's not even a fixed wait.

Which should tip you off that it's a mistake (or a series of mistakes) and not a fundamental attribute of the system as designed.

Any sufficiently large system will exhibit this, and always will for as long as people are imperfect.

 

[southernhybrid]

I've been on Medicare for 10 years, and have cared for people on Medicare for most of my 42 years as a professional nurse. I've never found that Medicare patients were treated any differently from patients who had private insurance. In fact, M'care recipients are often treated better, in my experience. I support M/care for all. If the younger folks were included, it would make care less expensive overall because most of the care we need is when we are older, statistically speaking of course.

The problem is more and more docs not taking Medicare.

When people have big copays, they often put off treatment. Even Advantage Plans have small copays, compared to some of the private insurance plans we had when younger. The biggest problem I have seen with Medicare is that people are often given aggressive end of life care or they demand aggressive end of life care. This is less of a problem compared to when I was younger and visited home health patients who were living with G-tubes and even respirators despite being almost in a vegetative state. Imo, aggressive end of life care is cruel, expensive and hospice would be a better option.

Agreed on end-of-life, but I think that's more an attitude problem. Too many doctors are focusing on the problem rather than the patient.

The problem in the US, is s that medical care if often all about profit and greed, so procedures and tests that aren't necessary are often ordered to make more money. Hopefully if we had government supported UHC, that would change over time. Doctors fuck up plenty of times, as they are only humans, but it rarely has a thing to do with which plan pays the bills. On the other hand, I have seen people without any insurance or money who were treated poorly. I saw it in home health. If a person had no way to pay, they were given about 2 visits. If a person had Medicare, they were sometimes over treated so the agency could make extra money or as one administrator put it, "we must maximize profit". That were her exact words when I was working in QA during the 90s. That's just my opinion as one who has worked as a health care professional and one who is a Medicare recipient.

Btw, I refuse a lot of things that I don't feel are necessary. I don't like to abuse the system. I support bodily autonomy and if I'm wrong for refusing something, that's on me.

Doctors rarely make money off tests. I do agree there's a problem, though.

Where I live, every doctor takes Medicare, maybe because the area is full of older adults. On the other hand, I've had private insurance that some doctors didn't take, when we were both working and I'm not referring to an HMO. There are a small percentage of doctors that don't take insurance at all, so you have to do your own billing, but they are all or mostly all in Atlanta, where there are plenty of other doctors. I go for convenience. I don't want to have to drive far or have someone drive me far, so I'll take my chances with the local doctors. I've also read that a lot of doctors are so tired of dealing with private health insurance denying things as well as being pushed to make profits for corporately owned health care groups, that more doctors are supporting MfA. I doubt it will happen but we need UHC. The premiums could be based on income, like Part B Medicare is. The system we have now is a terrible mess.

 

[Bomb#20]

Needing to eat is neither an indulgence nor an offence, but a misfortune. So if the above quote attributed* to Bevan were valid reasoning then it would imply agriculture should be socialized food should be provided to hungry people

FTFY.

I was hungry this morning. The cost of providing me breakfast should have been shared by the community.

 

[ZiprHead]

You think them basically playing Russian Roulette with her life is a reasonable approach??

You think it has anything at all to do with UHC??

Of course it does. We are seeing the fundamental failure of UHC: lowering standards instead of meeting them.

Ir maybe we are seeing one outlier that is only consisered typical by people who desperately want UHC to be a disaster in order to avoud having to review their prejudices against it.

When things go wrong in exactly similar ways in the US system, does that indicate that that system too is fundamentally a failure?

The two systems have different types of failure. It's not a case of one being categorically better.

Another unsubstantiated claim.

And what is the difference between a scheduling error under UHC and a scheduling error under retail insurance based systems?

So under capacity that there's a huge backlog on something that should be resolved quite promptly.

One case is not a "huge backlog".

But why should we think she is an outlier? Look around at her blog--she isn't doing it to present tales of woe. And she doesn't see herself as an outlier.

So you're trying to claim that something she is NOT complaining about is proof of your OP??? Do you realize how daft that sounds?

You don't dick around when a cancer screening test comes back with an issue!

No, and nor do any developed workd UHC systems, as a rule.

Obviously false, as Canada certainly is dicking around. I've heard similar things out of England.

You do realize that there are a crapton of right wingers in power in both Canada and England that want to destroy the universal systems and are doing everything in their power to do so.

But all large systems make mistakes. The US system makes more - because there are multiple large bureaucracies, some private, some governmental, some a bit of both.

I don't think this is simply making a mistake.

Well. Why haven't we been listening to Loren all along? He's identified all the healthcare problems in both the US and Canada. We should all bow down to his astute conclusions.

 

[Emily Lake]

Doctors rarely make money off tests. I do agree there's a problem, though.

Doctors don't, but labs do.

 

[Toni]

Needing to eat is neither an indulgence nor an offence, but a misfortune. So if the above quote attributed* to Bevan were valid reasoning then it would imply agriculture should be socialized food should be provided to hungry people

FTFY.

I was hungry this morning. The cost of providing me breakfast should have been shared by the community.

If you lack the means of feeding yourself, it should be.

 

[bilby]

Needing to eat is neither an indulgence nor an offence, but a misfortune. So if the above quote attributed* to Bevan were valid reasoning then it would imply agriculture should be socialized food should be provided to hungry people

FTFY.

I was hungry this morning. The cost of providing me breakfast should have been shared by the community.

Sure, why not? Food is cheap and plentiful. We can afford, as a community, to provide food to anyone who wants it. Most communities already do this, although in the US it is typically managed by neglect, and ends up as a quasi-religious thing; You could almost certainly get breakfast free of charge in your home town, with the wider community picking up the tab, as long as you are prepared to sit through a sermon, or otherwise have your ear bent about God.

The idea of taxes and/or donations funding food for people who don't then pay at the point of consumption is hardly radical or novel.

You can even stay in an expensive hotel where breakfast is included, and the guests who prefer a light breakfast or no breakfast at all are communally subsidising that guy who wants to push the boundaries of "all you can eat".

Sharing food may or may not be "communism", but if it is, then communism is observably a practically universal human trait.

 

[ZiprHead]

Doctors rarely make money off tests. I do agree there's a problem, though.

Doctors don't, but labs do.

Sometimes doctor own labs they send their patients to. And imaging centers.