Comment by cael450 | Hacker News Reader

Comment by cael450 | Hacker News Reader

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I'm married to a provider. It is absolutely insane what she has to do for insurance. She's not a doctor, but she oversees extensive therapy for 5-10 kids at a time. Insurance companies completely dictate what she can and can't do, and frequently she is unable to do more in-depth, best-practice analysis because insurance won't pay for it. So her industry ends up doing a lot of therapy based on educated guesswork. Every few months, she has to create a 100+ page report for insurance. And on top of it, insurance denies the first submissions all the time which then cause her to burn a bunch of time on calls with the company appealing the peer review. And the "peer review" is almost always done by people who have no background in her field. It's basically akin to a cardiologist reviewing a family therapist's notes and deciding what is or isn't necessary. Except that my wife's job can be the difference between a child ever talking or not, or between a child being institutionalized or not when they become an adult. People who think private insurance companies are more efficient than government-run healthcare are nuts. Private insurance companies are way worse and actively degrade the quality of care.

> Insurance companies completely dictate what she can and can't do, and frequently she is unable to do more in-depth, best-practice analysis because insurance won't pay for it.

The distinction between "can't do" and "can't get paid for" seems to get lost a lot with medical providers. I'm not saying this is necessarily what's happening with your wife, but I've had it happen to me where someone says, "I can't do this test. Your insurance won't pay for it," and then I ask what it costs and it's a few hundred or a couple thousand dollars and I say, "That's OK. I'll just pay for the test myself," and something short-circuits and they still can't understand that they can do it.

The most egregious example was a prescription I needed that my insurance wouldn't approve. It was $49 without insurance. But the pharmacy wouldn't sell it to me even though my doctor had prescribed it because they couldn't figure out how to take my money directly when I did have insurance.

I get that when insurance doesn't cover something, most patients won't opt to pay for it anyway, but it feels like we need more reminders on both the patient and the provider side that this doesn't mean it can't be done.

> The distinction between "can't do" and "can't get paid for" seems to get lost a lot with medical providers. I'm not saying this is necessarily what's happening with your wife, but I've had it happen to me where someone says, "I can't do this test. Your insurance won't pay for it," and then I ask what it costs and it's a few hundred or a couple thousand dollars and I say, "That's OK. I'll just pay for the test myself," and something short-circuits and they still can't understand that they can do it.

Tell me you've never lived in poverty without telling me.

An unexpected expense of several hundred to a couple thousand dollars, for most of my lived life both as a child and a young adult, would've ruined me. If it was crucial, it would've been done, and I would've been hounded by medical billing and/or gone a few weeks without something else I need.

This is inhumanity, plain as.

This would be comical but for the years I did live in poverty. In what world does my being able to afford it now mean I've somehow always been well off?

This is ignorance, plain as.

I generally agree (and sympathize with your wife), but let's not present an overly rosy view of government run healthcare or single-payer systems. In many countries with such systems, extensive therapy simply isn't available at all because the government refuses to pay for it. Every healthcare system has limited resources and care is always going to be rationed, the only question is how we do the rationing.

Every healthcare system has problems, yes. However the spectre of medical debt and bankruptcy is a uniquely American one, so, IMHO, even if we moved to single-payer healthcare and every other problem stayed the same, but we no longer shoved people into the capitalist fuck-barrel for things completely outside their control, I think that's an unmitigated, massive improvement.

Well now you're talking about a different problem and moving the goalposts. It would be impossible for every other problem to stay the same under a single-payer system. That would solve some existing problems and create other new problems. In particular the need to hold down government budgets would necessarily force increased care rationing and longer queues. Whether that would be a net positive or negative is a complex question with no clear answers.

The statistics you see about bankruptcy due to medical debt are highly misleading. While it is a problem, very few consumers are directly forced into bankruptcy by medical expenses. What tends to happen is that serious medical problems leave them unable to work and then with no income and then with no income all of their debts pile up. What we really need there is a better disability welfare system to keep consumers afloat.

> Well now you're talking about a different problem and moving the goalposts.

I am absolutely not. I am reacting to what's been replied to what I've said. In common vernacular, this is called a "conversation."

To recap: the person who replied to me left a long comment about the various strugglings and limitations of healthcare when subjected to the whims of insurance companies. You then replied:

> I generally agree (and sympathize with your wife), but let's not present an overly rosy view of government run healthcare or single-payer systems. In many countries with such systems, extensive therapy simply isn't available at all because the government refuses to pay for it. Every healthcare system has limited resources and care is always going to be rationed, the only question is how we do the rationing.

Which, at least how I read it, attempts to lay the blame for the lack of availability of extensive therapies at the feet of a government's unwillingness to pay, citing that every system has limited resources and care is always being rationed.

I countered, implying that while that may or may not be true, that lack of availability is effectively status quo for the majority of Americans under our much more expensive, and highly exploitative insurance-and-pay-based healthcare system, and that, even if those issues around lack of availability persisted through a transition to a single-payer healthcare system, it would at least alleviate us from the uniquely American scourge of people being sent to the poorhouse, sometimes poor-lack-of-house, for suffering illnesses or injuries they are in no way responsible for which in my mind is still a huge improvement.

> The statistics you see about bankruptcy due to medical debt are highly misleading. While it is a problem, very few consumers are directly forced into bankruptcy by medical expenses. What tends to happen is that serious medical problems leave them unable to work and then with no income and then with no income all of their debts pile up.

I mean we can expand this if you like into a larger conversation about how insurance itself being tied to employment and everyone being kept broke on purpose to incentivize them to take on debt to survive, placing them on a debt treadmill their entire lives which has been demonstrably shown to reduce quality and length of life, as well as introducing the notion that missing any amount of work for no matter how valid a reason has the potential to ruin your life, is probably a highly un-optimal and inhumane way to structure a society.

> What we really need there is a better disability welfare system to keep consumers afloat.

On that at least, we can agree.

>> extensive therapy simply isn't available at all because the government refuses to pay for it.

I don't know any country that has banned paid healthcare just because they have government run one.

If you can pay out of your pocket for it in USA system when denied by insurance company then you would be able to afford it when denied by goverment. Since the criteria of whats necessary wouldn't shift (hospitals might even more money per patient)

Government run healthcare can be done well or it can be done poorly. I’ve lived under both kinds and I would take the bad over America’s system. In Japan, I had to have a ton of cardiac work done, and it was done faster than I’d get it here.

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