Instead, insurance wants to make sure that you really-super-duper-need
whatever it is they're going to give you, to the point where there's
basically no way they can say no.
And, then, when my company switched insurance providers at the beginning
of 2021, this nurse service stopped abruptly.
1. have to cover part of it in January when your deductible resets,
2. have to pay more toward it than you would when your plan invariably gets more expensive in January,
3. it will be some other insurer's responsibility by then,
4. you die before you incur any more treatment costs.
Truly sick stuff!
> The insurance company even assigned me a nurse to "check in on me" as a resource back in November and December, which sadly was more of a nuisance than anything else.
Sadly but at least that's all it was. These nurses will try to FUD you out of critical treatments, or "suggest you ask your doctor" if they're sure something is really covered. I nearly had a major treatment go seriously off the rails where I'd need to go to another hospital, before my doc's hospital was like, "wait, no, there's no problem, that's totally covered."
They spam you constantly on the phone too even once you're hip to their game. Stay away.
Another point is that our insurance systems are so needlessly complex that there is no single person or pair of people that understand what's actually going on. If the insurance is denying you get trapped in a continuous loop of appeals, approves, offices, pharmacies, prescribers, etc. and no one is able to tell you 1. Why they're denying you 2. What exactly you need to do to not fucking die.
Im sorry but the system had become both absurd and cruel. I keep trying to remind myself that 80 years ago they wouldn't have been able to save her if they tried. It's still better. But to see this carrot perpetually yanked further and further away from you as you slowly lose your ability to keep up or keep going. And then, as the last light dims from your eyes, to see someone sprinting the carrot back to you and attempting to help you as best they can even though you're nearly past the brink.
That is the story I've learned.
Our system does have success stories. It is better than nothing. But any system that has the capacity for such inhumane cruelty in the face (in spite) of genuine humans trying to help sets a dangerous precedent for the future of its society.
It isn't even about the money, I could afford the $3k out of pocket too, it's more about not having to be a "customer" who has to frequently make choices or shop around.
It's also a relief not having to think about the money or insurers. I don't need to collect receipts or bills or phone insurers or providers, I can focus 100% on getting through my chemo.
I haven't had to fill in a single form except the occassional consent form since diagnosis, and to me that's worth every penny of tax I've ever spent.
We also have private health insurance, 30-40 percent of the population take that up.
When you go public you will need to wait in a longer line, you won't get the flowers next to your bed and you might need to ring for a bit longer for a nurse to come, but you'll often be seeing the same doctor you would have seen going private.
Last time I was in hospital the only paperwork was the admission form, and then telling the desk people my insurance number as I left.
The diagnosis took way longer, in the US I'd have likely been diagnosed months earlier.
However, I was diagnosed on a Thursday, started steroid treatments by Monday in preparation for starting full treatment a few days later, and also went from an PET/CT scan to having radiotherapy just 3 days later.
I'd be wary of looking too deeply into survival statistics, especially since the much greater emphasis on diagnosis means that a lot of the cancers treated in the US are an earlier stage which is reflected in the survival statistics.
It's also important to consider that there aren't people made homeless through medical debt in the UK. There aren't people who avoid going to the doctor because they feel they can't afford it (regardless or whether they could with the appropriate allowances etc).
It's not a "religion", it's just experience of 70 years of fully public healthcare which is reflected in things like our vaccine rollout which when compared to our neighbours we have been miles ahead.
Even those countries with socialised healthcare but private provision (public insurance + private provision) have massively lagged behind because having a single provider of healthcare has been monumental in coordinating a massive vaccination effort, and as a result the UK is almost top of the per capita vaccination rate with only the much smaller Israel and Bahrain above it.
But again, I can't stress how good it is that I don't have to worry about my wallet when getting treated.
I was able to change jobs even while undergoing treatment because I didn't have to worry about losing access to health insurance. I may be wrong but if I were working the US I'd feel trapped in my previous job because I'd have been worried about not being covered for a time.
The TLDR is that I value living in a society where the poorest and the middle class both have access to the same healthcare. (And yes, like other countries we also do have a private healthcare industry, which is popular especially for elective stuff.)
https://fullfact.org/health/which-safer-us-hospital-or-engli...
I think it's hard to compare the two health systems purely on their data as there is a culture of healthcare that it is difficult to factor in.
E.g. how many people don't go to hospital and then die in the US because they cannot afford healthcare? I witnessed this first hand in New York when somebody was knocked out and as I was dialling 911 they woke up and shouted not to call an ambulance because they couldn't afford the cost.
Equally, understand that the NHS does not have the funding that the US healthcare system and that wait times are generally longer.
etc etc...
This means Americans are paying lots of money for treatment that lowers quality of life, can have serious side effects and unintended consequences, and which is mostly not allowing them to live longer.
I know which I prefer.
Edit: no blood, please!
The reason single payer systems work is because they're at a specific advantage for all of the constraints that healthcare systems face, including a better overall incentive alignment.
That's exactly my argument, regulatory capture precludes a market from being free.
> It has a unique set of constraints
I fail to see how the points you list make it unique.
> lack of choice (you don't get to choose which hospital you go to in a lot of circumstances)
Then make that possible. I live in Japan, I choose the hospital/clinic/doctor that I see, for everything.
> high barrier to entry
For whom at with what?
> constantly changing regulatory environment
Yes, so deregulate and move towards a freer market.
> The reason single payer systems work
Do they? If you have a heart attack in the US vs one in the UK then you are more likely to survive in the US. Blanket statements about what "works" are meaningless when talking about complex systems with multiple outcomes across large populations. The US outranks many countries that aren't using its system in many health outcomes, and if you have insurance then you will get a very high standard of care. Poor health outcomes for those at the bottom are bad but that's only one way to measure efficacy.
Japan has a single payer insurance system but I can also point to many negatives, as well as many positives. None of these provide any refutation to a free(r) market providing the benefits that other markets receive.
I don’t believe you will be choosing which hospital you go to if you’re unconscious, or facing a serious acute medical concern placing you in desperation. Coincidentally, those tend to be the times when costs also skyrocket.
—
The issue with treating healthcare like a free market is that some people just won’t get healthcare. Free markets aren’t going to build a hospital in a small enough town because the cost can’t be justified.
Your point that the US outranks most other countries is perhaps true for some things, but completely false for baseline measures such as infant mortality, life expectancy, cost per capita, etc. As a country the US can sometimes pull ahead on specialized care in part because of a prevalence of supporting technology compared to other countries, and I’ll grant that. But our system is hardly “better” than other developed nations on almost any objective measure.
Firstly, emergency treatment is a tiny sliver of all healthcare, in terms of volume and cost. If you want to argue about healthcare in general based on that - nay, on the miniscule number of unconscious people admitted to hospital - be my guest, "never interrupt your enemy when he is making a mistake" and all that.
Secondly, I think you should look into how the Japanese system works before making statements about it. Your beliefs are of no concern to truth or proper analysis, especially when they don't accord with reality.
> The issue with treating healthcare like a free market is that some people just won’t get healthcare. Free markets aren’t going to build a hospital in a small enough town because the cost can’t be justified.
The issue with treating computing like a free market is that some people just won’t get computers. Free markets aren’t going to provide computers to small businesses because the cost can’t be justified.
I think the 70s is calling and wants your argument back. Before you reply with "computing and healthcare aren't comparable" they are, in fact, incredibly comparable. Health is like computing power, the more you have the more you want and can do, and hence - due to demand and people seeking to satisfy that demand - the more you can get. Reading these forums it seems like a quite profitable endeavour that is unlikely to end soon, much like healthcare.
> Your point that the US outranks most other countries is perhaps true for some things, but completely false for baseline measures such as infant mortality, life expectancy, cost per capita, etc.
That is something we agree on because that is the accepted starting point of the discussion, not a refutation to anything I have written or proposed.
> But our system is hardly “better” than other developed nations on almost any objective measure.
Back to the black and white thinking.
It is better in several ways and yet I am not an advocate of it because it is not a free market so I might ask why you're responding to me as if I am an advocate of it, but that is black and white thinking in a nutshell so I won't.
The problem is how to get more and better healthcare to more people. Aside from the endless examples outside of healthcare, less regulated markets in healthcare have met these requirements. For example, cosmetic surgery and things like lasik, the quality has gone up, the costs have dropped, availability is widespread and even approach normal.
Yes, and healthcare is a good thing to regulate, you know, cause of all those pesky ethics and morals that get involved with human life.
brigandish 2 days ago | parent | on: Notes on My Chemotherapy
> Capitalism can't work its magic because healthcare is not a free market.
That's exactly my argument, regulatory capture precludes a market from being free.
> It has a unique set of constraints >> I fail to see how the points you list make it unique.
If you can't seen why healthcare a specifically constrained market, you're being either intentionally obtuse or incredibly naive.
> I live in Japan, I choose the hospital/clinic/doctor that I see, for everything.
Yeah, I choose my dentist, too dawg, doesn't mean that I can choose what E.R. I get dropped off at when I get in a car wreck. I can't shop around for prices on concussion doctors when I'm unconscious in a gurney. Don't be obtuse. Sure, emergency services are only a small part of the pie, but they're the ones that bankrupt people. No one went bankrupt getting their contacts done, and dental and vision are frequently separated _for the exact reason_ that they're not ever medical emergencies, and when they are, they send you to a specialist anyway.
> high barrier to entry >> For whom at with what?
This is starting to border on bad-faith. I'm not going to spell out every piece of my argument here. If you can't accept the premise that healthcare is a high barrier to entry market, then you're not familiar with the problem.
> constantly changing regulatory environment >> Yes, so deregulate and move towards a freer market.
You can't just deregulate things and hope it'll fix it. de-regulate _what_? You haven't even proposed a solution here, you've just yelled "Free market!" and "Deregulate healthcare!" But all that will do is worsen the quality that we see and encourage a bunch of snake oil companies to become even more common.
> The reason single payer systems work >> Do they?
Yes, the evidence says a resounding yes in basically every country, including the U.K., even when the NHS is underfunded. Like another poster pointed out, basically any base-line metric puts the U.S. in ranks with most third-world countries. It's embarrassing.
In a thread where I've already warned about black and white thinking we have this:
> Yes, and healthcare is a good thing to regulate, you know, cause of all those pesky ethics and morals that get involved with human life.
Since when does deregulation mean to remove all regulations and laws? Then we have this:
> you're being either intentionally obtuse or incredibly naive.
Aside from more of the inability to show basic respect we've already touched on, it's like a parody of black and white thinking with the invidious false dilemma, but it doesn't end there:
> Yes, the evidence says a resounding yes in basically every country, including the U.K., even when the NHS is underfunded. Like another poster pointed out, basically any base-line metric puts the U.S. in ranks with most third-world countries
Imagine turning a complex issue into this statement. It's not beyond parody but it's approaching that point.
> This is starting to border on bad-faith.
No, it's not. You continue about how you're unwilling to spell out your argument and then, further into your response, continue by saying that I'm "just yelling" without expanding on my points.
a) I'm not yelling. No one is yelling. Try not to react emotionally to those who disagree with you and/or project emotions onto them that they haven't at least alluded to.
b) If you're unwilling to state your argument clearly and succintly then it is hypocritical to accuse others of also not doing so (and you're incorrect anyway, so it's blatant hypocrisy).
> If you can't accept the premise that healthcare is a high barrier to entry market, then you're not familiar with the problem.
I'm not going to accept the premise until you state the reasoning behind the premise. Perhaps you react the way you have because you're unused to being challenged. If so, you shouldn't engage in discussion on the internet, and certainly not here.
Regardless, let's answer some of these from the absurd straw man you've perpetrated, and hopefuly, afterwards, you'll take some time to acknowledge the benefits of not reducing everything down to binary, childish imitations of an argument.
> > I live in Japan, I choose the hospital/clinic/doctor that I see, for everything.
> Yeah, I choose my dentist, too dawg, doesn't mean that I can choose what E.R.
I've already responded to the fatuous ER argument elsewhere, but if you'd done any research into Japan - where you claim single payer "works" without it being "embarrassing" - you'd know that the way ambulances are provided and hospitals are chosen in an emergency is embarrassing, but then you're clearly "not familiar with the problem".
I'd explain it to you myself but I'm not in a generous mood for some reason (note the allusion to an actual emotion I'm experiencing).
> You can't just deregulate things and hope it'll fix it
I'm not basing my ideas on hope but on reason and consideration.
> You haven't even proposed a solution here, you've just yelled "Free market!" and "Deregulate healthcare!"
The Socratic method would blow your mind. Regardless, I provided some explanation in the form of comparison in another comment.
> But all that will do is worsen the quality that we see
Perhap you could tell us, with regards to LASIK[1]:
a) Has the cost come down since FDA approval?
b) Has the quality gone down?
c) Is the availability greater now than then, and to what extent?
d) Has there been a lesser or greater number of unethical actions in the provision of LASIK than other, more regulated treatments?
e) Has there been a lesser or greater number of bothched treatments in the provision of LASIK than other, more regulated treatments?
You may pick the regulated treatment to compare with.
> Like another poster pointed out, basically any base-line metric puts the U.S. in ranks with most third-world countries. It's embarrassing.
What's embarrassing is not knowing the difference between the mean, mode and median (a look at the average salary of baseball teams is always good for this). This is why any analysis made should be multivariate and not black and white, or you end up with childish conclusions.
For analyses that take into account more than one measure, you get very different outcomes[2]:
> if you remove deaths from fatal injuries from the life expectancy tables? Among the 29 members of the OECD, the U.S. vaults from 19th place to…you guessed it…first. Japan, on the same adjustment, drops from first to ninth.
That's just one, small example. The article contains others and there's more out there. If you're able to respond in the way befitting of the vast majority of HNers then we could discuss those.
Then we can get on to why there are more doctors taking the R.O.A.D. path and why this might do well to be applied to things like surgery, and the actual OECD figures for the UK and US. They'll be highly instructive.
[1] https://www.webmd.com/eye-health/news/20191220/twenty-years-...
[2] https://www.forbes.com/sites/theapothecary/2011/11/23/the-my...