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I was talking with someone very close to me recently about her life, and how things were going for her, her daughter and her boyfriend. The situation is this: She is unemployed, on medicaid and has serious anxiety and depression issues, to the point that she can't drive a car. She lives with her daughter in her boyfriend's parent's house. Her mental state is manageable via medication, but her doctor refuses to prescribe the one that has worked for her. She decided then, that she wanted to leave said doctor, for a new PCP. In retaliation, they refuse to give up her medical records unless she pays them $250 (an egregious amount that they know she cannot afford) for printing and shipping. Her boyfriend has other issues. Now, originally, he did seasonal work landscaping and other such odd jobs to get by. The guy worked hard, and did a good job, even if it was for low pay. He doesn't have any more than a GED, suffers from extreme anxiety and worst of all, has recently developed some kind of nerve problem in his shoulder, all the way down to his arm, causing pain and muscle loss. Most importantly, he can't work in landscaping without the use of his arm. As such he's fallen into a really deep depression, and I'm starting to worry about him, his girlfriend and their daughter. Despite thier issues, unlike so many in America, they are blessed to have a rent-free home to live in, even if it is a single room that all three share. Even still, they're truly broken people when it comes to any sort of pride. Ashamed that they can't make their own way, and have no idea how to get out of the hole they're in. And I'm at a loss to how they can do it either. Which brings me to the thread here. If this is happening to someone I know and love, from two loving families who help and support them as best they can, what then about the many who don't even have that? Just what the hell are we to do with all those people? How do we fix it? And I mean specifics, not just "Full Communism Now." Medicaid is hampered by conservative assaults on all sides, ditto Social Security disability. Welfare is practically gone for the majority of people at risk, thanks to Clinton's third way period. The one thing that I realize many would say (at least outside of D&D) would be "Suck it up and get a real job." But that's not realistic. Many in these situations aren't really fit for the workforce. Whether it be physical or mental issues, some people just can't compete. "Able bodied" doesn't mean poo poo anymore. There are no proverbial "ditches" to dig to make your way in the world. Certainly not enough to support your family on. Realizing this; that some folks just aren't cut out for the workplace, and they still deserve to live in dignity, is something I want to impress on the politicians of the U.S. Somehow. What can we do? Realistically, that is.
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Feb 17, 2016 16:54
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Talmonis posted:What can we do? Realistically, that is. https://www.healthit.gov/patients-families/faqs/what-should-i-do-if-my-doctor-does-not-give-me-access-my-records The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule gives you, with few exceptions, the right to inspect, review, and receive a copy of your medical records and billing records that are held by health plans and health care providers covered by the Privacy Rule. If you want a copy, you may need to pay for copies and mailing. If you request an electronic copy of protected health information, a covered entity is required to provide you with such electronic copy to the extent it is readily producible. In most cases, you should get your copies within 30 days. A provider cannot deny you a copy of your records because you have not paid for the health services you have received. If you believe that your doctor or other health care provider violated your health information privacy right by not giving you access to your medical record, you may file a HIPAA Privacy Rule Complaint with the U.S. Department of Health and Human Services (HHS) Office for Civil Rights. The easiest way to file a complaint is to go through the HHS Office for Civil Rights. If you have questions about privacy, security, or HIPAA, visit the Department of Health and Human Services Office for Civil Rights (OCR) privacy website . You can also search OCR’s HIPAA FAQ database.
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Feb 17, 2016 16:58
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My Imaginary GF posted:https://www.healthit.gov/patients-families/faqs/what-should-i-do-if-my-doctor-does-not-give-me-access-my-records I actually advised them to do this, but she said that the $250 would be the cost to print and ship it. Which sounds like utter bullshit. The problem is proving that it's bullshit.
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Feb 17, 2016 17:01
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Talmonis posted:I actually advised them to do this, but she said that the $250 would be the cost to print and ship it. Which sounds like utter bullshit. The problem is proving that it's bullshit. Request an electronic record and have her contact HHS' Office of Civil Rights. $250 may be a reasonable price, if she is requesting her whole medical record and has had a long history with the provider, for instance if her record is 500 pages and she would be paying ~0.50 per page. Never underestimate the potential paperwork involved in healthcare provision. It may be possible for her to request relevant portions of her medical record only, such as 'Prescription History'. That may lower the total cost of her medical records request. It may be pertinent to have her request an itemized invoice for her medical records request to determine the cost per page which her provider is seeking to charge.
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Feb 17, 2016 17:09
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My Imaginary GF posted:Request an electronic record and have her contact HHS' Office of Civil Rights. $250 may be a reasonable price, if she is requesting her whole medical record and has had a long history with the provider, for instance if her record is 500 pages and she would be paying ~0.50 per page. Never underestimate the potential paperwork involved in healthcare provision. This is actually super helpful. Thanks MIGF. Any ideas on what kind of legislation or systems we could put in place that would actually solve the overall problem of poverty in those not fit for capitalist competition?
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Feb 17, 2016 17:16
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Talmonis posted:This is actually super helpful. Thanks MIGF. Keep in mind, that all assumes her provider participates in HIPAA. Not all providers do. If her provider is not participating in HIPAA, then I would recommend that she save up $250. I'm not sure that there is a systematic issue here. It would seem that the provider is requesting the patient to try a different medication, which may be a reasonable request depending upon the literature available. Just as healthcare providers have responsibilities, so, too, do patients: in this case, it would be the patient's responsibility to ensure that the provider's recommendation is justified and in line with best-practices. A patient has a responsibility to ask their provider for the evidence basis behind their recommendation, and if a recommendation is being made without justification, to document that in case future issues arise. What I suspect is happening is that your friend is on a controlled substance for her anxiety, likely a benzodiazepine. On the provider side, it has become a hassle to prescribe controlled substances due to the overprescription of opiates which has occured this past decade. This overprescription has opened providers and provider networks up to the potential of class action, especially if they did not maintain documentation to justify their prescription recommendations. I think its only a matter of time before an attempt is made at forming a class over the whole opiate for manageable pain kerfuffle. So, as it has become a hassel to prescribe controlled substances, providers are under pressure to justify their recommendations. Has your friend tried a non-benzodiazepine drug for anxiety management in the past? What was their experience, and did they maintain documentation? How were they initially diagnosed, and how comprehensive has the testing been to confirm their diagnosis and rule out the anxiety and depression as symptoms of an underlying mental disorder such as bipolar or schizophrenic disorders? Basically, if your friend cannot establish that they have: 1) a diagnosis which rules out other mental illnesses, 2) a diagnosis which has been stable and well-documented over time, 3) negative response, including symptoms becoming unmanageable and inhibiting your friend's general ability to function, to less strictly controlled and less addictive substances; then your friend may not have an entirely justified case from a regulatory standpoint. If your friend expects to receive free healthcare and free drugs, then they have a responsibility to establish documentation that the care and medication they receive is medically necessary for maintaining their general ability to function. If your friend is unable to do so, then it may appear to your friend's new primary provider that they are attempting to doctor shop in order to obtain a controlled substance, and your friend may receive the same treatment as at her last primary care clinic.
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Feb 17, 2016 17:36
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Talmonis posted:This is actually super helpful. Thanks MIGF. Well. This is a thread for the ages already.  Talmonis posted:Any ideas on what kind of legislation or systems we could put in place that would actually solve the overall problem of poverty in those not fit for capitalist competition? Mincome.
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Feb 17, 2016 17:44
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Nevvy Z posted:Mincome. Agreed. a minimum guaranteed income for everybody would basically solve so many problems. No more people being unsure about if they'd qualify for the help, No worrying that if you get a job you suddenly no longer have that help, and of course, no longer having to worry that if you get fired you're basically on the streets. Sadly it'll never happen because COMMUNISM 
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Feb 17, 2016 18:22
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It would also be a natural driver of the economy due to Marginal Propensity to Consume (ie people with less money are more likely to spend it due to immediate necessities of food, shelter, etc). Food stamps have been shown statistically by Moody's, etc. to have the greatest return in terms of GDP and economic growth. Unfortunately, this would take a lot of power and control away from employers/"job creators" have over their employees, so it would be heavily lobbied against, as is the case already with labor unions.
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Feb 17, 2016 18:29
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I suppose you could try and word it properly. I mean with a GMI you might not need to have a minimum wage quite so high, so if you could use that as a leading point. Also it removes welfare aside from said GMI, and *everyone* gets it, including the rich fucks who basically use $100s as toilet paper.
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Feb 17, 2016 18:49
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^^^ There's also not a single good reason to provide mincome to every single person, even if you did implement it. Literally the only reasons I can think of are "to appease the rich" or "out of some very misguided sense of fairness." Like, why in the world wouldn't you just provide mincome to people with income (or better, liquid wealth) above a certain reasonable threshold (something pretty high just to be risk averse, like 50k a year per person or 100k per household).Nevvy Z posted:Mincome. I disagree with the idea of a mincome. It seems like a much better idea to directly provide necessary services, like shelter, food, etc (and maybe some much smaller level of mincome on top of that). Here's a question - what do you do with the people who still end up destitute even after receiving their mincome? Unless you want a bunch of people to literally starve to death because they hosed up and mismanaged their money (which is very likely; many people do not have good money management skills), you're still going to need to provide some level of "regular" welfare. I mean, I guess it would be better than the status quo, but I think it's definitely a lesser solution. Ytlaya fucked around with this message at 19:15 on Feb 17, 2016 |
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Feb 17, 2016 19:13
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Ytlaya posted:Here's a question - what do you do with the people who still end up destitute even after receiving their mincome? Unless you want a bunch of people to literally starve to death because they hosed up and mismanaged their money (which is very likely; many people do not have good money management skills), you're still going to need to provide some level of "regular" welfare. As America is a free nation in which individuals are held accountable for their choices in life, you allow those individuals the freedom to starve to death.
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Feb 17, 2016 19:24
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My Imaginary GF posted:As America is a free nation in which individuals are held accountable for their choices in life, you allow those individuals the freedom to starve to death. No, gently caress that. Failure to compete, typically the result of factors out of the individual's control, should not result in death in a civlized nation.
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Feb 17, 2016 19:32
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Talmonis posted:No, gently caress that. Failure to compete, typically the result of factors out of the individual's control, should not result in death in a civlized nation. In a civilized, Democratic society, individuals should have the freedom to make bad life choices which may result in their death. They should not be free from the consequences of their life choices. How else can you have a free society if you do not hold individuals accountable for their actions?
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Feb 17, 2016 19:37
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My Imaginary GF posted:In a civilized, Democratic society, individuals should have the freedom to make bad life choices which may result in their death. They should not be free from the consequences of their life choices. How else can you have a free society if you do not hold individuals accountable for their actions? Because externalities exist. If you have a mental illness, it's not your goddamn fault if you can't hold down a job when you can't get it treated due to a for-profit system, even with treatment life is harder than the average person. A young black man from a bad neighborhood who isn't supremely talented in the sports or music fields has few options and a shitload of ways to fail. Veterans who come home hosed up and can't get jobs or proper care from even the VA aren't at fault for their situation. Teenagers kicked out of their homes for their sexual orientation or gender identity have no loving fallback, and suffer for it; it's not their fault they were born into a household with monsters for relatives. If someone is so broken that they can't make a living, and sweet Jesus there are a lot of them, it's because society failed them, not the other way around.
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Feb 17, 2016 20:04
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Talmonis posted:No, gently caress that. Failure to compete, typically the result of factors out of the individual's control, should not result in death in a civlized nation. If they refuse to purchase food (and not because like all the bodegas near them are out of stock somehow) with the money we gave them, I don't know what to say. What's really shocking to me is Ytlaya's notion that there is a sizable portion of the people who would get a net gain from mincome, just won't buy food with it or pay rent. That's a level of disability that demands assisted living, I think.
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Feb 17, 2016 20:19
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Stinky_Pete posted:If they refuse to purchase food (and not because like all the bodegas near them are out of stock somehow) with the money we gave them, I don't know what to say. With addicts, which many thousands if not a few million Americans are, I can see that being a problem. But assisted living sounds like a solution. Even if it's not exactly a shiny, happy one.
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Feb 17, 2016 20:23
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My Imaginary GF posted:In a civilized, Democratic society, individuals should have the freedom to make bad life choices which may result in their death. They should not be free from the consequences of their life choices. How else can you have a free society if you do not hold individuals accountable for their actions? I agree with this. There's no sense taking every possible police state measure to keep people from jumping off bridges. We can put suicide hotline phones there, but ultimately we have to allow some viable means of self-harm for the exceptionally self-destructive, and in some cases we can get them institutionalized (I just wish the institutions that we -alize people into were better at improving people's inner strength and capacity for success), but trying to stop all of them would swiftly lead to a totalitarian world.
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Feb 17, 2016 20:26
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Stinky_Pete posted:I agree with this. There's no sense taking every possible police state measure to keep people from jumping off bridges. We can put suicide hotline phones there, but ultimately we have to allow some viable means of self-harm for the exceptionally self-destructive, and in some cases we can get them institutionalized (I just wish the institutions that we -alize people into were better at improving people's inner strength and capacity for success), but trying to stop all of them would swiftly lead to a totalitarian world. He's referring to starving or dying of exposure due to destitution via bad life choices.
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Feb 17, 2016 20:34
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Talmonis posted:He's referring to starving or dying of exposure due to destitution via bad life choices. Yeah, but he was answering someone who was talking about people who fall through the cracks even with a strong safety net like mincome. And... he's kind of right. There's only so much you can do once you've made sure that people have to resources to keep themselves alive. You'd still want to have readily available access to mental health services, but what else can you do after that? If people willfully starve themselves to death and either refuse care or do nothing to indicate to anyone that they need it then your hands are kind of tied.
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Feb 17, 2016 20:38
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Talmonis posted:With addicts, which many thousands if not a few million Americans are, I can see that being a problem. But those addicts are somehow not starving to death, without mincome. I think that institutionalizing people who are so addicted they spent every last cent on just the drug, then they'll either OD anyway, or their vagrancy could get them put in the (reformed) system, where they would receive treatment. But that's just my absurd pipe dream of a sensible America.
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Feb 17, 2016 20:46
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Paradoxish posted:Yeah, but he was answering someone who was talking about people who fall through the cracks even with a strong safety net like mincome. And... he's kind of right. There's only so much you can do once you've made sure that people have to resources to keep themselves alive. You'd still want to have readily available access to mental health services, but what else can you do after that? If people willfully starve themselves to death and either refuse care or do nothing to indicate to anyone that they need it then your hands are kind of tied. I don't think anyone intentionally starves themselves or remains homeless if there is an actual alternative. As for refusing care? I'd say it depends on if it's out of the stigma of mental illness, which we need to keep chipping away at, or if it's just that the person is so far gone they can't comprehend their surroundings, in which case yes, care should be given before they hurt themselves or others. Addicts in this situation should be mandated treatment. Their sickness has after effects that harm the community around them via the illegal drug trade (which will still exist even after legalization/decriminalization of some substances), crime to supplement income for their habit, etc. (Now of course, someone's going to mention the SoCal beach bumbs who surf and are technically homeless) I'm aware that I'm more authoritarian leaning than a lot of others on the left. Stinky_Pete posted:But those addicts are somehow not starving to death, without mincome. I think that institutionalizing people who are so addicted they spent every last cent on just the drug, then they'll either OD anyway, or their vagrancy could get them put in the (reformed) system, where they would receive treatment. But that's just my absurd pipe dream of a sensible America. In a lot of cases it's crime. Theft, muggings, robbery, etc. are all a problem increased by drug addiction. But yes, institutionalization is a (and IMO the) solution. Talmonis fucked around with this message at 20:49 on Feb 17, 2016 |
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Feb 17, 2016 20:46
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Talmonis posted:With addicts, which many thousands if not a few million Americans are, I can see that being a problem. While I agree that nobody should die because of a stupid decision with money, if you're talking about people who refuse to buy food and pay rent then nothing short of incarceration and forced feeding is going to do jack poo poo. Drug addiction is covered via mental illness and would result in them being taken someplace safe to ensure they get off the stuff as well as get a hand rebuilding their life. It's not a perfect solution, but there's never a perfect one. This seems like it might be the best until we reach a post scarcity society. Which probably will never actually happen. 
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Feb 17, 2016 20:54
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