Why people are afraid of universal health care

[Loren Pechtel]

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?

You see this as a scheduling error? No. This is the same thing the VA was caught doing to make their statistics look better--slipping schedules so it didn't look like patients were waiting as long as they really were.

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 are making this about her--she's saying the system isn't working. She's using herself to show what's happening, not to single herself out as having been failed by the system.

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.

I definitely agree, but I don't see how that's relevant. The reality is that an underfunded system produces less objection from the voters than a properly funded system. Thus you get underfunded systems. The fox guarding the henhouse.

I wish we could make it work, but looking at what happens that doesn't seem to be possible.

 

[Toni]

So far, we are still on private ( through employer) health insurance and because of our proximity to a stellar health care system make very good use of our access to a stellar health care system. I am extremely grateful and firmly believe everyone should have such access. I’m willing to pay more in taxes to give everyone that access.

The only thing that I am nervous about when hubby retires is going on Medicare. Many large healthcare systems are declining to accept Medicare Advantage plans starting next year. I very much want to keep our doctors and access to world class health care if we need it.

We’ve needed it before.

Re: those annoying, ‘unnecessary’ tests: Our providers have twice detected early cancer in my husband and treated it very quickly. Biopsy results within a day prior to surgery, with more biopsies done while in surgery and results to doctor in real time ensured all cancer/pre-camcer cells were removed, no metastasis. Follow ups to be certain but he’s been free of cancer. But because of one condition, they did a CT scan and discovered a life threatening condition that was not immediately of concern but required monitoring until the time when surgery was necessary. That time came a year and a half ago. In preparation for surgery, they did a very thorough physical to ensure he would survive surgery—and discovered a heart condition that would have and only by some miracle had not killed him. So he had two life saving major surgeries last year. I am very very very grateful for all of those tests and do not begrudge a single co-pay—but we could afford the copays.

My older sister was found to have a very small meningioma about 6 years ago. Surgery was not warranted but monitoring to see if it was growing was! She neglected to get monitored and last year, that tiny tumor had grown to the size of an orange. Ins Ever skull. Pressing on her brain. Which in turn had caused a serious cognitive decline, exacerbated by a UTI which led to sepsis. The growth of the tumor went unnoticed because she refused the monitoring until she was in the ER, with a fever and serious mental confusion. She nearly died. Surgery successfully removed meningioma and she regained virtually all of her cognitive abilities. But a lifelong habit of self neglect has not changed and she continues to need hospital care and then rehab because she dies not follow up as she should and has recurrent infections. She’s extremely bright, with degrees in mathematics and physics and worked in those fields along with IT in the last years of her working life. But medically, she is stupid. Or has a death wish. I am not sure which.

So yes, I am a HUGE fan of screening tests. I know how much they did to keep my husband alive and how failing to get them nearly cost the life of my sister.

For a brief time, I worked in the medical office of a local clinic and I saw insurance companies routinely deny coverage for needed screening tests if the result was negative. And since this is a very working class town, the local clinic ordered fewer tests than the one I go to out of town. If we had relied on our local clinic, my husband would almost certainly now be dead or dying from cancer or one off the other two life threatening conditions he had.

This is why I am willing to drive 30 miles to see doctors I know we can trust. And why I agree to lab tests, etc. now, we are in our 60’s. I likely will feel differently in 20 years.

 

[Loren Pechtel]

Anyway... This is going to be a long post.

Universal Health Care in and of itself is a fine idea. The devil is in the details.

Exactly.

When you're talking about UK or Canada, The government pays the bills and they set the prices. There are often quite long wait time for less common procedures and for diagnostics or surgeries; there are often much quicker turn arounds for minor illnesses and injuries. It can work well, but it's not without challenge.

Yup. The fundamental problem is that voters will look at how the system fares for them. So long as it does a good job with the routine and does a good job with emergencies a very large number of voters will consider it to be working acceptably. The patients that get royally screwed of course say it's not working, but there aren't enough of them to make the politicians vote for increasing the spending.

One of the other challenges is that the providers in the US are generally for-profit. Not just the doctors, but also the hospitals, the stand alone facilities, the urgent care centers, the labs, the diagnostic facilities, the device manufacturers, and the pharmaceutical companies. Every cog in that process is making money off of people's illnesses and injuries. Insurers have their profitability capped, due to minimum loss ratio requirements from PPACA - we are required to spend at least 80% of our premium revenue on customer health expenses. If we don't spend that much, we give the money back to our customers in the form of a rebate.

Most UHC systems still have business entities involved.

Most of the proposals for UHC put forth by congress in the US have been framed as "guaranteed insurance benefits", much more similar to Medicare where the customer still has cost sharing for their coverage. Those proposals haven't included any measures to reduce the cost of delivered care, which means that it's still going to be very expensive. An expansion of Medicare to include a younger population would be a really good start... but that gets push back from the entire medical community because Medicare's fee schedule isn't as high as they would like it to be - it doesn't give them enough profit to keep building new fancy medical centers in highly populated urban areas, regardless of the fact that there isn't a need for more hospitals or infusion centers there, and less populous areas are in health care deserts with no reasonable care available to residents at all.

It's not just fancy medical centers. When you see providers in any field with regulated prices dropping out it means you've pushed too far.

There are some reasonable possibilities out there. Maryland did a thing a while back that has been working pretty well by all accounts - the state more or less defined the fee schedule for all services and all hospitals in the state, and that's just what providers get. IIRC (and I might not) they use the same schedule for all employer, individual, and Medicaid coverage - I think it doesn't supplant Medicare fee schedules though. Despite all their complaints, hospitals and doctors haven't gone bankrupt and it hasn't caused delays in accessing care.

I haven't seen anything on this.

I generally like the idea of making the delivery of healthcare a public good. Under my preferred approach, all doctors, nurses, hospitals, and other facilities would be owned and operated by the federal government, with professional staff paid a salaried wage. The government could then set a reasonable fee schedule to charge insurers - and potentially even offset the needed taxes through that means. It would allow employers to continue providing health insurance to their employees, since that's one of the ways that companies compete for staff. It would allow the current insurance industry to continue under something much more like Medicare Advantage. I think that would cause the greatest benefit to citizens with the least disruption and job loss. I'm sure there are some wrinkles that need to be ironed out, but that's generally my starting point.

I disagree because this is putting the fox in charge of the henhouse. We need the rule-makers completely separate from the spending.

 

[Elixir]

Heh. Before he hooked up with his PA, pulled up stakes and left town, my previous Doc referred me to a slew of specialists. I started cancelling screenings/tests immediately, but kept the consultation appointments. So far the only consult that did NOT make me feel free and unconcerned about declining stuff, was with the dermatologist, who helped me get rid of the pre-cancerous lesions that came from sun exposure. Other than that …I took a pass on most all the rest. I cancelled the “follow up consultation” with the cardiologist yesterday. He had some concern about swelling of the lower aorta, but all they can do is scan after scan after scan - no mention of interventions in case they don’t like what the scans show. From what I gather, it would come down to “ok you’re gonna die, go into hospice”.
I am not interested in spending the rest of my life trying to extend the rest of my life. But I am very interested in how much of our total medical resources are going to unnecessary, possibly harmful, and manifestly ineffective procedures, tests and treatments. I think UHC would cut down on that crap.

I have been on an Advantage plan for five years. It's criminal how much money they waste trying to get my wife and myself into these additional procedures. I just got another call today to remind me about their additional "free" service. If it was actually insurance and not a money making boondoggle it wouldn't be so expensive.

I chose to forego the Advantage (scam) offer. The number of private Vompaies advertising it is a dead giveaway. Instead I have enlisted an advisor who helped me shop the Medicare menu and order a la carte. Advantage would have “disadvantaged” me to the tune of another 3k/yr. The only tangible upfront “benefit” would have been the “Silver Sneaker” program that would have gotten me a free pass to the pool (my main regular exercise is lap swimming). But the pool pass only costs around $300 annually, so … no.

 

[Loren Pechtel]

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.

Corporations generally own labs and imaging centers. There might be some very few exceptions, but doctors don't own them - more likely the doctors are employed by the same corporation that owns the labs and imaging centers.

I suspect that what's happening is bashers looking at cases where doctors send patients to facilities they own and calling that unethical. Between us I believe the count of the number of times we have been sent to doctor-owned facilities is six. Unethical profiting?? No--in every case the doctor was a part owner of a facility where they actually did the procedure you went to the doctor for. Specifically, colonoscopies and cataract surgery.

 

[Loren Pechtel]

Finally, a rheumatologist I saw for my arthritic pain did a CBC and discovered I was severely anemic. That happened over 25 years ago. A CBC is a common test that should probably be checked yearly on all adults. Then my primary doc was convinced I had a GI bleed. Nope, the tests were all normal. Why the fuck did my primary doc and the cardiologists not even consider that my symptoms which included mild palpitations might be related to something as simple as anemia? I don't expect perfection from doctors, but I did find it strange that nobody bothered to check a CBC on a 50 year old woman who was a bit tired and having mild palpitations on exertion.

I'm not going to fault the cardiologist over this, but I certainly will fault your primary care doc. Why should the cardiologist be going over ground that should already have been covered?

I will add this. A lot of doctors don't take Medicaid, the federally and state funded insurance for the poor. It reimburses a bit less than Medicare, which older adults and the disabled who have paid in for at least ten years during their working lives all are entitled to at age 65 or 2 years after receiving SS for a disability. If we all had Medicare that would solve that problem. I had problems finding doctors for some of my poorest patients who had never been able to work and only had Medicaid for insurance. Even when Medicaid is the secondary insurance, some doctors won't take it. I know that from experience working as a nurse and advocating for some people who had Medicare with Medicaid for back up. Advantage Plans may have solved some of that problem, but I haven't worked in 6 years, so I'm not sure of all the details. Yes. Our system is a mess!

Except as it stands a lot of docs limit the number of medicare patients because it doesn't pay enough.

 

[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.

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

But I do not lack the means of feeding myself. Do you have any other grounds to think the cost of providing me breakfast should have been shared by the community?

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

ummm... soup kitchen? Food banks? DUH!

Soup kitchens and food banks have better uses for their limited resources than providing breakfast to a rich guy like me. DUH!

What appears to have escaped you two, though probably not bilby, is that this is not a debate about whether the cost of providing health care to poor people who can't afford it should be shared by the community. It's a debate about whether the cost of providing health care to people who can afford it should also be shared by the community anyway even though we're perfectly capable of paying the doctor or a private cost-pooler ourselves. It's a debate about the U.S. model vs. the British model. The U.S. has long socialized the cost of care for the impoverished; it's called "Medicaid". (The U.S. even abolished private medical insurance, back in 2010 -- although what we have instead is still labeled "insurance", it stopped being the real thing when the ACA outlawed exclusion of preexisting conditions.)

The point of Marshall's philosophical claim Bilby quoted upthread (and of similar claims Bevan actually made*) was never that poor people should get their care paid for by the rest of us, but rather that "no element of commercialism should enter between doctor and patient".

My point is that that's an idiotic way to decide public policy. Whether socialized care of the poor and/or socialized feeding of the poor is better done by socializing the whole system from top to bottom, or instead by providing subsidies and directed attention to the poor while leaving those capable of fending for ourselves to do so, is a complicated technical question with costs and benefits in both directions to be traded off. Any intelligent attempt to answer it for health care needs to focus on the problems specific to health care, not on philosophical nonsense that doesn't know the difference between a medical clinic and a kitchen.

(* For instance, "The essence of a satisfactory health service is that the rich and the poor are treated alike, that poverty is not a disability, and wealth is not advantaged.")

 

[laughing dog]

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.

The problem here is that it's not a patient being failed, but that widespread failure is the normal operating mode. She's not simply saying she was mistreated, she's simply giving her case as an example of the problem.

In order for a anecdote to be a persuasive argument, it needs to be a pervasive argument. One example is not pervasive.

You've see more than one example of violent police misconduct, yet you do not fear the police.

 

[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.

But I do not lack the means of feeding myself. Do you have any other grounds to think the cost of providing me breakfast should have been shared by the community?

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

ummm... soup kitchen? Food banks? DUH!

Soup kitchens and food banks have better uses for their limited resources than providing breakfast to a rich guy like me. DUH!

What appears to have escaped you two, though probably not bilby, is that this is not a debate about whether the cost of providing health care to poor people who can't afford it should be shared by the community. It's a debate about whether the cost of providing health care to people who can afford it should also be shared by the community anyway even though we're perfectly capable of paying the doctor or a private cost-pooler ourselves. It's a debate about the U.S. model vs. the British model. The U.S. has long socialized the cost of care for the impoverished; it's called "Medicaid". (The U.S. even abolished private medical insurance, back in 2010 -- although what we have instead is still labeled "insurance", it stopped being the real thing when the ACA outlawed exclusion of preexisting conditions.)

The point of Marshall's philosophical claim Bilby quoted upthread (and of similar claims Bevan actually made*) was never that poor people should get their care paid for by the rest of us, but rather that "no element of commercialism should enter between doctor and patient".

My point is that that's an idiotic way to decide public policy. Whether socialized care of the poor and/or socialized feeding of the poor is better done by socializing the whole system from top to bottom, or instead by providing subsidies and directed attention to the poor while leaving those capable of fending for ourselves to do so, is a complicated technical question with costs and benefits in both directions to be traded off. Any intelligent attempt to answer it for health care needs to focus on the problems specific to health care, not on philosophical nonsense that doesn't know the difference between a medical clinic and a kitchen.

(* For instance, "The essence of a satisfactory health service is that the rich and the poor are treated alike, that poverty is not a disability, and wealth is not advantaged.")

No, I think people should provide for necessities for themselves if they can.

I hate to break it to you but unless you are extremely wealthy, if you have a very serious health condition and require expensive treatment, you are not rich enough to afford it on your own. 15 years ago a cancer surgery cost upwards of $250K for my husband and fortunately did not require chemo or radiation. The cancer was caught very early. I never looked at the statements at for his more recent, unrelated surgeries but they certainly must have been $500K in total. Again, no chemo, no radiation, no expensive meds after the hospital.

 

[Loren Pechtel]

That happened over 15 years ago and I'm still alive, without any symptoms of heart disease. I'm not claiming that all doctors are greedy but quite a few are.

Heh. Before he hooked up with his PA, pulled up stakes and left town, my previous Doc referred me to a slew of specialists. I started cancelling screenings/tests immediately, but kept the consultation appointments. So far the only consult that did NOT make me feel free and unconcerned about declining stuff, was with the dermatologist, who helped me get rid of the pre-cancerous lesions that came from sun exposure. Other than that …I took a pass on most all the rest. I cancelled the “follow up consultation” with the cardiologist yesterday. He had some concern about swelling of the lower aorta, but all they can do is scan after scan after scan - no mention of interventions in case they don’t like what the scans show. From what I gather, it would come down to “ok you’re gonna die, go into hospice”.
I am not interested in spending the rest of my life trying to extend the rest of my life. But I am very interested in how much of our total medical resources are going to unnecessary, possibly harmful, and manifestly ineffective procedures, tests and treatments. I think UHC would cut down on that crap.

The problem here is an awful lot of people want to know even when the information is useless.

 

[steve_bank]

Heh. Before he hooked up with his PA, pulled up stakes and left town, my previous Doc referred me to a slew of specialists. I started cancelling screenings/tests immediately, but kept the consultation appointments. So far the only consult that did NOT make me feel free and unconcerned about declining stuff, was with the dermatologist, who helped me get rid of the pre-cancerous lesions that came from sun exposure. Other than that …I took a pass on most all the rest. I cancelled the “follow up consultation” with the cardiologist yesterday. He had some concern about swelling of the lower aorta, but all they can do is scan after scan after scan - no mention of interventions in case they don’t like what the scans show. From what I gather, it would come down to “ok you’re gonna die, go into hospice”.
I am not interested in spending the rest of my life trying to extend the rest of my life. But I am very interested in how much of our total medical resources are going to unnecessary, possibly harmful, and manifestly ineffective procedures, tests and treatments. I think UHC would cut down on that crap.

I have been on an Advantage plan for five years. It's criminal how much money they waste trying to get my wife and myself into these additional procedures. I just got another call today to remind me about their additional "free" service. If it was actually insurance and not a money making boondoggle it wouldn't be so expensive.

A consequence of a free market nuisance business. Profit enables instance manifesto add benefits.

I have had an Advantage zero premium plan for over 10 years.

I periodically get paper mail urging me to use the cmpany mail order pharmacy. I complained to the company about telephone calls and they stopped.

There are panty of horror stories about insurance companies. There was a scanal about companies denying obviously covered items hoping customers will give up.

I has one prblem with a pharmcy. I called Medcare to complain and it was quicky resolved.

 

[Loren Pechtel]

This anecdote is exceptionally trivial (as compared to talk of breast cancer, double knee replacements, et al) but I offer it only because it happened yesterday.
My wife and I both got the current flu shot and COVID vaccination shot —one in each arm— and the total was $20 per shot for a bill of $80. Not exorbitant or unreasonable, most would agree.

I thought copays for the standard vaccines were a thing of the past. Neither of us have paid anything for our shots in a long time. Not surprising for her as she's on a Medicare Advantage plan but I'm on a bronze ACA plan and my shots are still $0. I would only have to pay for something that's not on the CDC guidelines.

The two aspects I found more objectionable were
A) to get that price, I had to go way across town (I know; waah, waah, first-world problems. Then again, this is Cleveland, Ohio, not some podunk town with two traffic lights.) Most of the much closer providers, like CVS/Walgreen’s/Rite Aid drugstores, would have charged $100 for each COVID shot and around $30 for each flu shot, so about $260 total. I could have gone to my primary care physician’s office, but, no shot without a complete physical (!) and the COVID would still be about $100 (and flu would be…either free, or like $7 or so.)

AFIAK neither of our primaries even carries shots.

B) I have private insurance now; a decent plan that costs about $500 per month. (I retired from an excellent, comprehensive corporate-subsidized plan almost two years ago.) In those (almost) two years, knock on wood, I’ve never used my health care for so much as a sprained ankle, meaning, I’ve paid around $12,000 into this system, while taking out NOTHING, and yet…PREVENTITIVE care like flu shots are not covered—at all. That seems fundamentally wrong to me—more accurately, perhaps, it reflects just who this arrangement is really meant to benefit—and its inequities like this that make me envy UHC systems abroad.
Now, I realize a couple of things: I could have opted for a health care plan that covered more routine/preventative procedures—but…at what premium cost?
$500 a month already feels steep—especially considering what it’s done for me, which, again, is nothing.

I'd love to be paying only $500/mo. Bronze plan, at least very close to the cheapest offered, over $700/mo.

The other thing I get is that, if I had NOT been so healthy/fortunate these past two years (or if I get hit by a bus tomorrow), that insurance suddenly starts looking pretty good. Healthy payees (like me) are kinda subsidizing those less-fortunate souls who are physical wrecks (whether through poor lifestyle choices like smoking/overeating/drug addiction, or genuinely “blameless” afflictions, accidents and such) and that if that were suddenly me some day, I’d be the one benefiting. That’s basically health insurance in a nutshell (at least, American style.) I am not yet old enough for Medicare/Medicaid, so that doesn’t impact the situation.
I just know that, as a country, America could—and should—do better than this. I won’t pretend to know the answer…but what we have is broken.

That's always how insurance works--the people who don't have a problem subsidize those who do.

 

[gmbteach]

This anecdote is exceptionally trivial (as compared to talk of breast cancer, double knee replacements, et al) but I offer it only because it happened yesterday.
My wife and I both got the current flu shot and COVID vaccination shot —one in each arm— and the total was $20 per shot for a bill of $80. Not exorbitant or unreasonable, most would agree.
The two aspects I found more objectionable were
A) to get that price, I had to go way across town (I know; waah, waah, first-world problems. Then again, this is Cleveland, Ohio, not some podunk town with two traffic lights.) Most of the much closer providers, like CVS/Walgreen’s/Rite Aid drugstores, would have charged $100 for each COVID shot and around $30 for each flu shot, so about $260 total. I could have gone to my primary care physician’s office, but, no shot without a complete physical (!) and the COVID would still be about $100 (and flu would be…either free, or like $7 or so.)
B) I have private insurance now; a decent plan that costs about $500 per month. (I retired from an excellent, comprehensive corporate-subsidized plan almost two years ago.) In those (almost) two years, knock on wood, I’ve never used my health care for so much as a sprained ankle, meaning, I’ve paid around $12,000 into this system, while taking out NOTHING, and yet…PREVENTITIVE care like flu shots are not covered—at all. That seems fundamentally wrong to me—more accurately, perhaps, it reflects just who this arrangement is really meant to benefit—and its inequities like this that make me envy UHC systems abroad.
Now, I realize a couple of things: I could have opted for a health care plan that covered more routine/preventative procedures—but…at what premium cost?
$500 a month already feels steep—especially considering what it’s done for me, which, again, is nothing.
The other thing I get is that, if I had NOT been so healthy/fortunate these past two years (or if I get hit by a bus tomorrow), that insurance suddenly starts looking pretty good. Healthy payees (like me) are kinda subsidizing those less-fortunate souls who are physical wrecks (whether through poor lifestyle choices like smoking/overeating/drug addiction, or genuinely “blameless” afflictions, accidents and such) and that if that were suddenly me some day, I’d be the one benefiting. That’s basically health insurance in a nutshell (at least, American style.) I am not yet old enough for Medicare/Medicaid, so that doesn’t impact the situation.
I just know that, as a country, America could—and should—do better than this. I won’t pretend to know the answer…but what we have is broken.

Ummmmm you had to pay for flu and Covid shots?

Here they are free. While at first they were only free for people at risk (of which I am mum thanks to psoriatic arthritis and the plaquenil I am on), within a year they were free for everyone. Flu shots are free for over 65 and at risk people, I think. I think I saw on my GP’s wall that they were free, full stop.

Besides, my school offers the flu shot every where, at school! On a work day! And bring in TRS in case of reaction.

Let me guess,,,, you guys have to pay for kids to be vaccinated also?

 

[Elixir]

That happened over 15 years ago and I'm still alive, without any symptoms of heart disease. I'm not claiming that all doctors are greedy but quite a few are.

Heh. Before he hooked up with his PA, pulled up stakes and left town, my previous Doc referred me to a slew of specialists. I started cancelling screenings/tests immediately, but kept the consultation appointments. So far the only consult that did NOT make me feel free and unconcerned about declining stuff, was with the dermatologist, who helped me get rid of the pre-cancerous lesions that came from sun exposure. Other than that …I took a pass on most all the rest. I cancelled the “follow up consultation” with the cardiologist yesterday. He had some concern about swelling of the lower aorta, but all they can do is scan after scan after scan - no mention of interventions in case they don’t like what the scans show. From what I gather, it would come down to “ok you’re gonna die, go into hospice”.
I am not interested in spending the rest of my life trying to extend the rest of my life. But I am very interested in how much of our total medical resources are going to unnecessary, possibly harmful, and manifestly ineffective procedures, tests and treatments. I think UHC would cut down on that crap.

The problem here is an awful lot of people want to know even when the information is useless.

I think they mostly need attention. And the shelters are full of dogs.

 

[gmbteach]

Isn't insurance intended to protect from very expensive misfortunes? People don't buy house insurance that pays the water bill, but doesn't reimburse for fire or flood damage "because the premiums for such coverage would be too high."

Hush. You're making too much sense. If health insurance actually worked like you suggest it would be one tenth the cost.

@bilby would know how much we pay. I know for our UHC I pay 2% of my taxable income. Not sure how much our private one is (which is offset by the government who gives you a reduction on how much Medicare levy you pay).

We only use private health to choose the dr and hospital so that waiting time is reduced for surgery that isn’t life saving and urgent.

 

[bilby]

The problem here is that it's not a patient being failed, but that widespread failure is the normal operating mode.

The problem here is that even more widespread and even more abysmal failure is the normal operating mode of US style healthcare, and that to determine which of two alternatives is better, you need to look at the flaws (and sucesses) of both.

Looking for flaws in the one you have an ideological grudge against, and then recommending that people should fear it when you find them, is both stupid and ineffective.

UHC is the worst healthcare idea ever, apart from all of the others.

 

[Loren Pechtel]

Heh. Before he hooked up with his PA, pulled up stakes and left town, my previous Doc referred me to a slew of specialists. I started cancelling screenings/tests immediately, but kept the consultation appointments. So far the only consult that did NOT make me feel free and unconcerned about declining stuff, was with the dermatologist, who helped me get rid of the pre-cancerous lesions that came from sun exposure. Other than that …I took a pass on most all the rest. I cancelled the “follow up consultation” with the cardiologist yesterday. He had some concern about swelling of the lower aorta, but all they can do is scan after scan after scan - no mention of interventions in case they don’t like what the scans show. From what I gather, it would come down to “ok you’re gonna die, go into hospice”.
I am not interested in spending the rest of my life trying to extend the rest of my life. But I am very interested in how much of our total medical resources are going to unnecessary, possibly harmful, and manifestly ineffective procedures, tests and treatments. I think UHC would cut down on that crap.

I have been on an Advantage plan for five years. It's criminal how much money they waste trying to get my wife and myself into these additional procedures. I just got another call today to remind me about their additional "free" service. If it was actually insurance and not a money making boondoggle it wouldn't be so expensive.

I chose to forego the Advantage (scam) offer. The number of private Vompaies advertising it is a dead giveaway. Instead I have enlisted an advisor who helped me shop the Medicare menu and order a la carte. Advantage would have “disadvantaged” me to the tune of another 3k/yr. The only tangible upfront “benefit” would have been the “Silver Sneaker” program that would have gotten me a free pass to the pool (my main regular exercise is lap swimming). But the pool pass only costs around $300 annually, so … no.

Around here you save money by going the MA route. When I hit that age I'm not going to, though--they make their money by limiting access.

 

[Toni]

This anecdote is exceptionally trivial (as compared to talk of breast cancer, double knee replacements, et al) but I offer it only because it happened yesterday.
My wife and I both got the current flu shot and COVID vaccination shot —one in each arm— and the total was $20 per shot for a bill of $80. Not exorbitant or unreasonable, most would agree.

I thought copays for the standard vaccines were a thing of the past. Neither of us have paid anything for our shots in a long time. Not surprising for her as she's on a Medicare Advantage plan but I'm on a bronze ACA plan and my shots are still $0. I would only have to pay for something that's not on the CDC guidelines.

The two aspects I found more objectionable were
A) to get that price, I had to go way across town (I know; waah, waah, first-world problems. Then again, this is Cleveland, Ohio, not some podunk town with two traffic lights.) Most of the much closer providers, like CVS/Walgreen’s/Rite Aid drugstores, would have charged $100 for each COVID shot and around $30 for each flu shot, so about $260 total. I could have gone to my primary care physician’s office, but, no shot without a complete physical (!) and the COVID would still be about $100 (and flu would be…either free, or like $7 or so.)

AFIAK neither of our primaries even carries shots.

B) I have private insurance now; a decent plan that costs about $500 per month. (I retired from an excellent, comprehensive corporate-subsidized plan almost two years ago.) In those (almost) two years, knock on wood, I’ve never used my health care for so much as a sprained ankle, meaning, I’ve paid around $12,000 into this system, while taking out NOTHING, and yet…PREVENTITIVE care like flu shots are not covered—at all. That seems fundamentally wrong to me—more accurately, perhaps, it reflects just who this arrangement is really meant to benefit—and its inequities like this that make me envy UHC systems abroad.
Now, I realize a couple of things: I could have opted for a health care plan that covered more routine/preventative procedures—but…at what premium cost?
$500 a month already feels steep—especially considering what it’s done for me, which, again, is nothing.

I'd love to be paying only $500/mo. Bronze plan, at least very close to the cheapest offered, over $700/mo.

The other thing I get is that, if I had NOT been so healthy/fortunate these past two years (or if I get hit by a bus tomorrow), that insurance suddenly starts looking pretty good. Healthy payees (like me) are kinda subsidizing those less-fortunate souls who are physical wrecks (whether through poor lifestyle choices like smoking/overeating/drug addiction, or genuinely “blameless” afflictions, accidents and such) and that if that were suddenly me some day, I’d be the one benefiting. That’s basically health insurance in a nutshell (at least, American style.) I am not yet old enough for Medicare/Medicaid, so that doesn’t impact the situation.
I just know that, as a country, America could—and should—do better than this. I won’t pretend to know the answer…but what we have is broken.

That's always how insurance works--the people who don't have a problem subsidize those who do.

That’s called shared risk. That is literally how insurance works—ALL insurance.

 

[Elixir]

Heh. Before he hooked up with his PA, pulled up stakes and left town, my previous Doc referred me to a slew of specialists. I started cancelling screenings/tests immediately, but kept the consultation appointments. So far the only consult that did NOT make me feel free and unconcerned about declining stuff, was with the dermatologist, who helped me get rid of the pre-cancerous lesions that came from sun exposure. Other than that …I took a pass on most all the rest. I cancelled the “follow up consultation” with the cardiologist yesterday. He had some concern about swelling of the lower aorta, but all they can do is scan after scan after scan - no mention of interventions in case they don’t like what the scans show. From what I gather, it would come down to “ok you’re gonna die, go into hospice”.
I am not interested in spending the rest of my life trying to extend the rest of my life. But I am very interested in how much of our total medical resources are going to unnecessary, possibly harmful, and manifestly ineffective procedures, tests and treatments. I think UHC would cut down on that crap.

I have been on an Advantage plan for five years. It's criminal how much money they waste trying to get my wife and myself into these additional procedures. I just got another call today to remind me about their additional "free" service. If it was actually insurance and not a money making boondoggle it wouldn't be so expensive.

I chose to forego the Advantage (scam) offer. The number of private Vompaies advertising it is a dead giveaway. Instead I have enlisted an advisor who helped me shop the Medicare menu and order a la carte. Advantage would have “disadvantaged” me to the tune of another 3k/yr. The only tangible upfront “benefit” would have been the “Silver Sneaker” program that would have gotten me a free pass to the pool (my main regular exercise is lap swimming). But the pool pass only costs around $300 annually, so … no.

Around here you save money by going the MA route. When I hit that age I'm not going to, though--they make their money by limiting access.

It depends what you can take “advantage” of. I did a realistic assessment and there was no contest. Your situation - and the plan benefits - may vary.

 

[gmbteach]

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.

But I do not lack the means of feeding myself. Do you have any other grounds to think the cost of providing me breakfast should have been shared by the community?

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

ummm... soup kitchen? Food banks? DUH!

Soup kitchens and food banks have better uses for their limited resources than providing breakfast to a rich guy like me. DUH!

What appears to have escaped you two, though probably not bilby, is that this is not a debate about whether the cost of providing health care to poor people who can't afford it should be shared by the community. It's a debate about whether the cost of providing health care to people who can afford it should also be shared by the community anyway even though we're perfectly capable of paying the doctor or a private cost-pooler ourselves. It's a debate about the U.S. model vs. the British model. The U.S. has long socialized the cost of care for the impoverished; it's called "Medicaid". (The U.S. even abolished private medical insurance, back in 2010 -- although what we have instead is still labeled "insurance", it stopped being the real thing when the ACA outlawed exclusion of preexisting conditions.)

The point of Marshall's philosophical claim Bilby quoted upthread (and of similar claims Bevan actually made*) was never that poor people should get their care paid for by the rest of us, but rather that "no element of commercialism should enter between doctor and patient".

My point is that that's an idiotic way to decide public policy. Whether socialized care of the poor and/or socialized feeding of the poor is better done by socializing the whole system from top to bottom, or instead by providing subsidies and directed attention to the poor while leaving those capable of fending for ourselves to do so, is a complicated technical question with costs and benefits in both directions to be traded off. Any intelligent attempt to answer it for health care needs to focus on the problems specific to health care, not on philosophical nonsense that doesn't know the difference between a medical clinic and a kitchen.

(* For instance, "The essence of a satisfactory health service is that the rich and the poor are treated alike, that poverty is not a disability, and wealth is not advantaged.")

So why shouldn’t the wealthy assist those less fortunate?

Bilby and I are ion a reasonable income, but we still help those less fortunate than us - particularly in my job as a teacher. I buy fruit for brain break, and so many pencils (fuck me can those kids eat them or what?), just so my kids can learn.

Only arrogant selfish people think that the poor shouldn’t receive assistance.

Hey, if I can afford to go to a better dr for surgery through private health insurance, sure.. my arugument is that that same surgeon should, and mostly would, offer their services to someone not insured. The only difference, IMO, is the use of private to ‘jump the queue’ for non essential life saving surgery.

Case in point, a lady at school and I are the same age. We both have horrible knees….. she waited a year for a knee replacement because she went public. It was deemed category three with means get to it within a year. I needed knee surgery and it was was done within a few weeks. I still didn’t pay much (as per above), which is how insurance is supposed to work.

The US system sucks! Plain and simple. Health care should be for everyone. Simple.