Comment by sh34r | Hacker News Reader

Comment by sh34r | Hacker News Reader

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If you're unemployed, you almost certainly qualify for Medicaid in 41 states. It's the best insurance money can't buy. It covers everything. You pay for nothing. In fact, it's illegal to charge you for anything. Balance billing doesn't exist. You cease to be a mark for the healthcare racket if you can engineer your income to $0 on paper. The vast majority of medical providers will accept it. It is the best insurance I've ever had. If it were possible to get private insurance for $0 premiums, or pay $500 a month out of pocket for individual Medicaid coverage, I'd pick Medicaid every single time. I cannot overemphasize how much I despise the private insurance racket. The only reason we don't have a public option is because it would destroy the private racket overnight.

Mental healthcare is a different story, but it's not any better with private insurance. Every therapist or psychiatrist in the insurance racketeer's provider directory is either dead, moved out of state, or not taking patients. "Ghost networks," they're called...

The worst insurance I've ever had was at a FANG, via United Healthcare. It covered nothing. Hardly anyone accepted it, apart from the on-site health clinic. It was worse than a university health plan, for god's sake. As to quality, you say it's the best in the world, but the fact that the US now has a life expectancy lower than China, Cuba, and Albania determines that this is a lie.

Unpopular truth on this forum: the healthcare system in this country is owned and operated by organized crime entities. It is completely illegitimate. It consumes 19% of GDP of the richest country on the planet, and Americans are some of the least healthy people outside of active war zones. Unless you're using your doctor as your Xanax dealer (John Mulaney explains how that hustle works: https://www.tiktok.com/@funkytownmc/video/722624028419819447...), this system sucks for you too.

I would be shocked if the Mexican cartels weren't deeply involved with United Healthcare and all these other corporate gangsters. This industry is the greatest crime of all time.

Good luck finding high quality doctors though, especially specialists, that take Medicaid and don't make you wait over an hour beyond your scheduled appointment time. The reimbursement rates for Medicaid are notoriously low, and as a result, a lot of doctors severely limit the number of patients they'll see on it.

I kept the same PCP at an Ivy League affiliated medical center. I had to see a couple specialists, no issues whatsoever with them accepting insurance. It might vary by state, but that's not my experience whatsoever. Private insurance plans are far worse in this regard.

It's really just mental healthcare and dentistry that are basically impossible, but again, not much better with a private health plan.

Take the blinders off, stop pretending you're not getting robbed, and maybe we can fix it. There is no silver lining to private healthcare. You're not getting better care. Social determinants of health are very real, but they're driven by those 9 states without Medicaid expansion dragging the averages way down, a lifetime of bad care before the ACA, and also that medicine can't solve the many problems caused by poverty.

We would all be better off in literally any other system. Everyone thinks they're an above average driver. Everyone thinks they'll live longer than average. The truth is, you're just not that special. Unless you're a politician that gets to go to Walter Reed, or you have a wing in the hospital named after you, you're getting the abysmal standard of care that everyone gets.

I tried to find a GP for a young adult on Medicaid this year, and the first half dozen that I tried (selecting specifically places that said on their website they took Medicaid) would not take a new patient on Medicaid. So yes, your experience as someone who already had a doctor may be much better than it is for the normal Medicaid recipient, who did not start with private insurance.

At the same time, I was looking for a new dentist for myself and for this kid. There are a half dozen dentists who would see me within ten minutes walk. I finally found her a dentist some 20 minutes drive away (bonus: she can't drive).

And the mental health provider we found who would take Medicaid did intake for new patients on Friday mornings between 9am and 12 noon, no appointments, recommend you arrive early in order to be seen.

This is in WA.

Have you tried to find a new GP for an adult with private insurance recently? Many areas have a shortage in general. This has little to do with insurance coverage, and everything to do with the bad incentives of the medical profession. Who would become a GP with your MD, when you can make twice as much money as a specialist instead? It's like getting a CS degree from Stanford and deciding to become a sysadmin at a high school with it, instead of becoming a SWE.

Conversely, I'm surprised you found a dentist and a mental health provider that takes any insurance at all, and didn't have a months-long wait list. I've almost always had to self pay for both...

Yes, in fact several of the doctors I called would have been happy to take her on if she had private insurance. This has everything to do with insurance.

Mental health providers are nearly impossible to find in the Seattle area, no matter the insurance, or even paying cash.

For whatever bloody reason they just don't exist in anything near enough quantity.

> As to quality, you say it's the best in the world, but the fact that the US now has a life expectancy lower than China, Cuba, and Albania determines that this is a lie.

The sad truth about those stats is that if you split them by social class, you get two distinct groups: disenfranchised people with some of the worst health outcomes in the world, and privileged people with some of the best.

The childibrth related mortality rate for black american women is 3x higher than for white women, for example.

The US is also extremely segregated, and a substantial percentage of black Americans live in those confederate states that have not expanded Medicaid yet. Texas has a higher maternal mortality rate than Iran.

Geography is a greater determinant of health than race. People die a full 7 years earlier on average in Mississippi than California or Massachusetts, and 6 years earlier in West Virginia.

There's a clear correlation with income here, but one can easily argue that both income and life expectancy are downstream of policy. Red state policies are simply bad for your health and your wallet.

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