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BiggerBoat
Sep 26, 2007

For that you get the head...

the tail...

the whole damned thing.

I've poked around for a general U.S. Healthcare thread and asked for links in other threads but I can't find one. If this thread is a dupe, let me know, feed me a link and I'll close it.

EDITING MY OP to make it political and less E/N



- I've heard it said that "we simply can't afford UHC" and that taxes will go up. While this is obviously true, every study I've read has shown that, on average, the tax increase for MOST people would be about equal or slightly more than what they pay in premiums, and included in that average is the tremendous amount people pay for poo poo like COBRA or plans for people who work jobs that don't offer it. Meaning the MEDIAN cost would go DOWN. So I call bullshit

- "But the Wait Times!" Bitch I'm waiting now. Waiting even more due to COVID related stuff. My understanding is that UHC prioritizes procedures based on urgency. "Well "death panels!" where the GOVERNMENT gets to decide". How is that any worse than a for profit company doing the same loving thing, denying coverage while paying CEO's millions?

- "A for profit healthcare system drives innovation!" Well...maybe. But it also leads to things like hospitals charging $150 for a single aspirin and poo poo like that. Hospitals and doctors running up costs to increase revenue, whether you need poo poo done or not, no?. I remain baffled why hospitals (or even doctors and insurance companies) ADVERTISE and market. If I get in a car wreck, I'm not gonna tell the ambulance where to take me based on brand loyalty. I work for large format graphics company and we produce a lot of interior murals and poo poo for UF Health, among others. WHY does a health insurance company need all this marketing and interior decorating? Leading to:

- "It's 1/5 of our economy/GDP" or whatever it is. Google says 17.7%. Well, that's loving obscene and probably my answer right there. "If you eliminate that, 17.7% of people are out of work!" No, most of them will just work in the public sector, right? You could STILL have private/supplemental insurers, couldn't you? And healthcare is not a commodity in the traditional sense, since WE ARE ALL GOING TO NEED TO GO TO A DOCTOR EVENTUALLY, especially when we get old. I don't have to by a TV, a PS5, a flashy car, new furniture, jewelry, expensive clothes, etc. It's not the same thing. It's a shared asset. Why do hospitals and health insurance companies need so much marketing?

- "Well, I eat right and I don't smoke. I exercise. Why should I have to pay for you getting sick?". Because we live in a SOCIETY. My son is 9 and has had 2 epileptic seizures, is insured and it's set me back THOUSANDS.. What did he do? Some kid born with autism? My best friend who died at 52 from esophagus cancer brought on by acid reflux. He didn't smoke. You want to do something, ban cigarettes then. I'd be fine with that but I think tobacco was second only in slavery to the foundation of this nation's economy from the beginning.

- Why does the Democratic platform in 2020 oppose Medicare for all?, in agreement with Republicans. Health care should not be a BUSINESS, imo. I suppose 17.7 % of GDP generates a lot of lobbyists.

- "Open up insurance across State Lines and restrict tort lawsuits". I don't know enough about this to comment intelligently on it but it smells like bullshit designed to increase profits, not provide better care. Maybe some other goon who knows more than me can weigh in?

- "Where will all the extra doctors come from?". That seems so stupid as to defy description. You're basically admitting that people have to choose between being sick and going broke. And right now, those people just go to the ER and stiff the hospital, ruining their credit in the process. Maybe, I dunno, start by funding education more and making higher education more affordable? Seems to me, right now, the main reason someone wants to be a doctor is to make money.

^^^Revised OP^^^

Original, whiny OP on how this effects me personally below:


...

Currently, the United States is the global epicenter of the Covid 19 pandemic, so I have picked the worst time to get sick.

About me:

I am 53, suffer from depression, arthritis in my hips and back and battle alcoholism. I am a smoker with a history of drug use (weed, LSD, coke, XTC) but have not used recreational drugs in some time and most of that was in my 20's and 30's.

I am "gainfully" employed, make $23/hour, commute an hour each way to work, freelance cartoons/illustrations/design on the side and have employer provided health coverage. Since the beginning of the year, I have lost about 25 pounds. I've always been thin my whole life, averaging out around maybe 155 lbs at 6'1. I have a high metabolism and can typically eat anything I want as much as I want without gaining weight. In some ways, I am the envy of the average american.

Recently, I was weighed at 130 and my neighbors and coworkers are commenting on my appearance. I FEEL fine, for the most part but I am looking like poo poo.

Alarmed at this rapid weight loss, I scheduled a physical with my PCP and was referred for blood/urine testing, cat scans, MRI, to rule out cancer. Aside from the Labcorp crap, my insurance company has denied EVERY referral so far and made me schedule other stuff. I am missing work due to these appointments and my job duties are being reassigned and shuffled around because my managers are concerned. These added steps mean I miss more work and cut into my co-parenting responsibilities for my 9 year old son.

I wanted to start this thread since it seems so vital right now and neither Trump nor Biden is gonna do gently caress all about it and it sucks that neither political party is gonna do poo poo.

And not just because of my current situation and how much light it's shined on how little private coverage helps, but due to how much I see other people suffering at the worst possible time on the rare occasions that they will see me in person rather than teleconference. I overhear so many arguments and back and forths in waiting rooms, watching people way worse off than me struggle with this stupid system, fumbling with records and appointments, old people who can barely walk unsure how to work zoom and poo poo like that. People freaking out because they don't have $200 they didn't think they'd need. I can only imagine it's about to get way worse as people lose their jobs (and their insurance), get evicted and as C19 spreads.

I get calls from doctors, labs, numbers I don't recognize, etc., so I miss some important info on occasion and I'm also not supposed to be on my phone at work either so I miss several of them due to that. Their websites and touchtone phone interfaces are abominable. If I DO get diagnosed with cancer, I am inclined to skip the treatment and liquidate what I have to leave for my boy, rather than go broke buying another 3 or 5 years. I got a prescription today for Chantix to help me quit smoking. Only thing the lab work turned up was low testosterone, which checks out.

I need therapy/psychiatric visits, pain management and now this. I haven't even touched dentistry or vision. The shrink and the pain doctor REQUIRE I visit them a month to get refills, so that's time and money I DO Not Have. What do we do?


Speaking of solutions, for anyone having trouble with prescription costs, there's a good website called GoodRX that works. I;m not sure what their business model is but it's saved me a lot of money, especially when I was unemployed. That's the only good solution I've personally found to anything, but please share.

OK then.

BiggerBoat fucked around with this message at 21:15 on Aug 5, 2020

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Halloween Jack
Sep 11, 2003

Let your word be "Yes, Yes" or "No, No"; anything more than this comes from the evil one.




I've used GoodRX a lot. It's saved us hundreds of dollars. (Mostly in meds that would be a trivial cost in Canada.)

Cabbages and Kings
Aug 25, 2004

shall we be trotting home again?



I have pretty okay coverage for my family and it costs $1700 a month plus $700 a month to an HSA to cover the deductible and basic utilization AMA

Parrotine
Dec 19, 2012

Wolverine with Parrots!


Halloween Jack posted:

I've used GoodRX a lot. It's saved us hundreds of dollars. (Mostly in meds that would be a trivial cost in Canada.)

It ain't much but yeah, GoodRX is a lifesaver, cuts down one of my prescriptions about a bill each month. Granted I'm still paying about $300+ monthly, but I suppose it's better than $400

Kind of ticked that there isnt a generic of the more expensive medication on the market yet, the brand name's been in circulation since '07 and they usually have the cheaper alternative within 5/6 years after that.

Coolness Averted
Feb 20, 2007

oh don't worry, I can't smell asparagus piss, it's in my DNA

GO HOGG WILD!


Yeah I think in the current incarnation this is more E/N or ask/tell, unless you wanted it to sorta become a general hub for talking about the pathetic state of healthcare activism in the US and general resource hub for both academic stuff like why M4A is good, and how utterly hosed we are as a failed state, or general tips for navigating the healthcare hellscape.

I'm just really bummed that over the past 2 years a bunch of orgs I've volunteered with like the nurses union have pretty much made it clear their leadership was just bird dogging us and don't really want to make the system better. Or they're doing the dumb "let's be realistic, we can't make the democrats mad, so we'll have to settle for *~incremental improvements~* when the economy is good and the democrats control everything. Oh, except in states where they control everything. We can't challenge them there, because they're the only game in town!"

BiggerBoat
Sep 26, 2007

For that you get the head...

the tail...

the whole damned thing.

Coolness Averted posted:

Yeah I think in the current incarnation this is more E/N or ask/tell, unless you wanted it to sorta become a general hub for talking about the pathetic state of healthcare activism in the US and general resource hub for both academic stuff like why M4A is good, and how utterly hosed we are as a failed state, or general tips for navigating the healthcare hellscape.

Yeah, my OP kind of sucked but it was poo poo I needed to get off my chest and what you described is more what I wanted to shoot for.

I really wanted to create a political thread about the subject since so much of why I am E/N about it is directly related to that. So maybe framing it in a better way might generate the discussion I am looking for. I'll offer some bullet points and revise the OP some.:

- I've heard it said that "we simply can't afford UHC" and that taxes will go up. While this is obviously true, every study I've read has shown that, on average, the tax increase for MOST people would be about equal or slightly more than what they pay in premiums, and included in that average is the tremendous amount people pay for poo poo like COBRA or plans for people who work jobs that don't offer it. Meaning the MEDIAN cost would go DOWN. So I call bullshit

- "But the Wait Times!" Bitch I'm waiting now. Waiting even more due to COVID related stuff. My understanding is that UHC prioritizes procedures based on urgency. "Well "death panels!" where the GOVERNMENT gets to decide". How is that any worse than a for profit company doing the same loving thing, denying coverage while paying CEO's millions?

- "A for profit healthcare system drives innovation!" Well...maybe. But it also leads to things like hospitals charging $150 for a single aspirin and poo poo like that. Hospitals and doctors running up costs to increase revenue, whether you need poo poo done or not, no?. I remain baffled why hospitals (or even doctors and insurance companies) ADVERTISE and market. If I get in a car wreck, I'm not gonna tell the ambulance where to take me based on brand loyalty. I work for large format graphics company and we produce a lot of interior murals and poo poo for UF Health, among others. WHY does a health insurance company need all this marketing and interior decorating? Leading to:

- "It's 1/5 of our economy/GDP" or whatever it is. Google says 17.7%. Well, that's loving obscene and probably my answer right there. "If you eliminate that, 17.7% of people are out of work!" No, most of them will just work in the public sector, right? You could STILL have private/supplemental insurers, couldn't you? And healthcare is not a commodity in the traditional sense, since WE ARE ALL GOING TO NEED TO GO TO A DOCTOR EVENTUALLY, especially when we get old. I don't have to by a TV, a PS5, a flashy car, new furniture, jewelry, expensive clothes, etc. It's not the same thing. It's a shared asset. Why do hospitals and health insurance companies need so much marketing?

- "Well, I eat right and I don't smoke. I exercise. Why should I have to pay for you getting sick?". Because we live in a SOCIETY. My son is 9 and has had 2 epileptic seizures, is insured and it's set me back THOUSANDS.. What did he do? Some kid born with autism? My best friend who died at 52 from esophagus cancer brought on by acid reflux. He didn't smoke. You want to do something, ban cigarettes then. I'd be fine with that but I think tobacco was second only in slavery to the foundation of this nation's economy from the beginning.

- Why does the Democratic platform in 2020 oppose Medicare for all?, in agreement with Republicans. Health care should not be a BUSINESS, imo. I suppose 17.7 % of GDP generates a lot of lobbyists.

- "Open up insurance across State Lines and restrict tort lawsuits". I don't know enough about this to comment intelligently on it but it smells like bullshit designed to increase profits, not provide better care. Maybe some other goon who knows more than me can weigh in?

- "Where will all the extra doctors come from?". That seems so stupid as to defy description. You're basically admitting that people have to choose between being sick and going broke. And right now, those people just go to the ER and stiff the hospital, ruining their credit in the process. Maybe, I dunno, start by funding education more and making higher education more affordable? Seems to me, right now, the main reason someone wants to be a doctor is to make money.

...

I'm gonna C&P this into the OP to steer my thread's intent in a better direction if no one minds.

Coolness Averted
Feb 20, 2007

oh don't worry, I can't smell asparagus piss, it's in my DNA

GO HOGG WILD!


Go for it dude, and also there's nothing wrong with leading with your lived experiences. I was at an event where Tim Faust spoke and he had a really good phrase 'temporarily able-bodied" like it's only a matter of time before something in all of our meat sacks breaks down, so there is a very real urgency to fix the system, even for those of us who are currently healthy. It's good to remind folks what's in store for nearly all of us at some point.

TwoQuestions
Aug 25, 2011


BiggerBoat posted:


- "Open up insurance across State Lines and restrict tort lawsuits". I don't know enough about this to comment intelligently on it but it smells like bullshit designed to increase profits, not provide better care. Maybe some other goon who knows more than me can weigh in?


The same reason credit cards are in Delaware. It allows insurance companies to pick and choose which set of State laws they want to follow, which results in a race to the bottom wrt rules and taxes around insurance policy. It's basically a way around state's rights to regulate companies in general.

https://www.forbes.com/sites/claire...e/#2af6f8901119

BiggerBoat
Sep 26, 2007

For that you get the head...

the tail...

the whole damned thing.

TwoQuestions posted:

The same reason credit cards are in Delaware. It allows insurance companies to pick and choose which set of State laws they want to follow, which results in a race to the bottom wrt rules and taxes around insurance policy. It's basically a way around state's rights to regulate companies in general.

https://www.forbes.com/sites/claire...e/#2af6f8901119

Of course. We've all seen how more "affordable" your average credit has become over time and how it's led to so much LESS fuckery.

Also, my median tax increase comparison estimates left out deductibles.

EDIT:


Ok, real quick, explain THIS:

I got prescribed Chantix yesterday by my PCP to help me quite smoking.

Pharmacy says I need a "prior authorization" form from my Dr to cover it. So I need to call them. Again.

So, umm....Yesterday was prior to today and the scrip should be authorization, right? "prior authorization". To take a drug that will help me quit smoking loving cigarettes. Got it. You'd think they'd give the poo poo away.

So which lobbyists from the Chantix corporation make this happen? And why does my employee proved health insurance require "prior authorization" for a scrip he called in yesterday morning again? Also, without insurance, a 30 day supply is $500 loving dollars. Cheaper than smoking 2 packs a day.

How is UHC worse than this again? I'm listening.

BiggerBoat fucked around with this message at 22:18 on Aug 5, 2020

Dr. Red Ranger
Nov 9, 2011



Nap Ghost

I loving hate prior authorizations. It's needless busy work to discourage your doctor from writing that RX for you. Doctor sees you, writes the RX. You come to us, we try to fill it, insurance kicks it back and says no, requires prior authorization for [arbitrary reason/no reason at all]. Then we fax or call the doc to let them know, they don't even get to it until the next day unless you got it too us early enough, then they have to fill out paperwork and fight the insurance company to prove that yes, that medication they wrote a prescription for really is what they wanted you to take, they mean it, would you please cover it, then whenever the insurance decides to allow the prescription to process 2-5 days later, you can finally get *some* coverage on it. This coverage may or may not even last the life of the prescription, and will definitely stop working if you have to transfer it for some reason.

KingNastidon
Jun 25, 2004


BiggerBoat posted:

Ok, real quick, explain THIS:

I got prescribed Chantix yesterday by my PCP to help me quite smoking.

Pharmacy says I need a "prior authorization" form from my Dr to cover it. So I need to call them. Again.

So, umm....Yesterday was prior to today and the scrip should be authorization, right? "prior authorization". To take a drug that will help me quit smoking loving cigarettes. Got it. You'd think they'd give the poo poo away.

So which lobbyists from the Chantix corporation make this happen? And why does my employee proved health insurance require "prior authorization" for a scrip he called in yesterday morning again? Also, without insurance, a 30 day supply is $500 loving dollars. Cheaper than smoking 2 packs a day.

How is UHC worse than this again? I'm listening.

The "Chantix corporation" (Pfizer) isn't making you get a prior auth. Why would a drug company but any barriers in your way to purchasing their product? A prior auth is something used by insurance companies to control costs. It'll typically ask you basic information about you, your treatment history, and why the doctor thinks you need this medication. In many instances it's simply a formality or a data collection tool. In other cases it's used to verify that you've tried other less expensive therapies first (e.g., generics) before going to a more expensive therapy.

In some cases certain insurers have step edits on the formulary. A formulary puts drugs into various tiers based on whether the insurance carrier prefers them/wants to be used and often is tied to the out of pocket cost for the patient. Formulary placement is negotiated between pharma and insurers. If two pharma companies have similar drugs and have list price of $1k each the pharma company may offer a 25% discount for them to be placed in a preferred tier. Access to the less preferred treatment requires you to "step through" the preferred treatment. Generally this is all good because it lowers the actual cost of the drug and those savings are passed on to patients.

While the terminology may be different in a UHC or single payer system, the general process still applies -- if not more so. This is good in the sense that it helps constrain costs. It's bad in that it gives HCPs less power over how they treat their patients because guidelines / treatment pathways are more strictly enforced. This is why you'll typically see a lot more use of new, novel therapies in the US relative to other countries that require you to step through older therapies/generics even if they're less efficacious. That is also why the concept of off label treatment (using a drug outside its approved indication) exists in the US and doesn't occur in Europe like with NHS/NICE in UK. They're not going to pay for a patient that lacks other options based on possibility of efficacy in 1) similar disease area (e.g., approved in one type of leukemia but not another) or 2) phase 1/2 studies. It also introduces the dreaded DEATH PANELS because MD has run out of approved options and sends you to hospice.

KingNastidon fucked around with this message at 23:12 on Aug 5, 2020

BiggerBoat
Sep 26, 2007

For that you get the head...

the tail...

the whole damned thing.

KingNastidon posted:

The "Chantix corporation" (Pfizer) isn't making you get a prior auth. Why would a drug company but any barriers in your way to purchasing their product? A prior auth is something used by insurance companies to control costs. It'll typically ask you basic information about you, your treatment history, and why the doctor thinks you need this medication. In many instances it's simply a formality or a data collection tool. In other cases it's used to verify that you've tried other less expensive therapies first (e.g., generics) before going to a more expensive therapy.

In some cases certain insurers have step edits on the formulary. A formulary puts drugs into various tiers based on whether the insurance carrier prefers them/wants to be used and often is tied to the out of pocket cost for the patient. Formulary placement is negotiated between pharma and insurers. If two pharma companies have similar drugs and have list price of $1k each, the pharma company may offer a 25% discount for them to be placed in a preferred tier. Access to the less preferred treatment requires you to "step through" the preferred treatment. Generally this is all good because it lowers the actual cost of the drug and those savings are passed on to patients.

While the terminology may be different in a UHC or single payer system, the general process still applies -- if not more so. This is good in the sense that it helps constrain costs. It's bad in that it gives HCPs less power over how they treat their patients because guidelines / treatment pathways are more strictly enforced. This is why you'll typically see a lot more use of new, novel therapies in the US relative to other countries that require you to step through older therapies/generics even if they're less efficacious. That is also why the concept of off label treatment (using a drug outside its approved indication) exists in the US and doesn't occur in Europe like with NHS/NICE in UK. They're not going to pay for a patient that lacks other options based on possibility of efficacy in 1) similar disease area (e.g., approved in one type of leukemia but not another) or 2) phase 1/2 studies. It also introduces the dreaded DEATH PANELS because MD has run out of approved options and sends you to hospice.

Thanks and...uh....OK I guess That all seems totally reasonable and not at all stupid.

But all that's a petty complicated, convoluted and stupid way for my Insurance to ask for "prior authorization" for a scrip I got written yesterday and when the obvious reason it was "authorized" is "I would like to quit smoking please and heard this might help" along with a WELL documented "this person is rapidly losing weight and may have cancer" additional reason. My insurance company ALREADY HAS this information, believe me.

You totally skimmed over about how "yesterday" is "prior" to today (when I went to pick it up) and how "authorization" is "has a prescription from a loving doctor". Unless I loving forgot how to speak English or something.

And, oh, wait, because perhaps I have.

I totally skimmed over the completely reasonable and not at all idiotic "formulary" and "step edit" procedures that exist because "reasons" that might be less "efficacious" after already REPEATEDLY having to do other tests before I do the ones my PCP ordered. You'd think "this guy needs to quit smoking" would...uh...be a decent and basic enough place to start with what ails me. But maybe I'm being overly cromulent and not factoring in the hypotenuse and the bilateral precipitation involved in this carefully calculated decision to basically require my doctor to re-authorize a legit prescription he already loving wrote.

I suppose it's all for my own good though and "holds costs down". The gently caress do I know though?

Thanks for the...uh..."Explanation" though. I think in some ways you helped describe some of the problem but maybe not and I'm just old and frustrated. I'm sure there's an app I can download that makes all this much easier.

*lights a cigarette*

KingNastidon
Jun 25, 2004


My goal isn't to tell you anything is good or bad. Just talk about why things are the way they are and discuss upsides/downsides to changes.

BiggerBoat posted:

But all that's a petty complicated, convoluted and stupid way for my Insurance to ask for "prior authorization" for a scrip I got written yesterday and when the obvious reason it was "authorized" is "I would like to quit smoking please and heard this might help" along with a WELL documented "this person is rapidly losing weight and may have cancer" additional reason.

Prior auths are annoying for patients and MDs. To the poster above, some of this is just an annoyance factor to ensure that 1) patients are actually committed to getting the therapy and will be adherent/compliant and 2) MDs aren't just pill mills that are haphazardly giving out drugs. This seems silly in your example with smoking and Chantix, but there are obvious examples where these hoops make sense.

BiggerBoat posted:

My insurance company ALREADY HAS this information, believe me.

They might or might not. People change jobs and get different insurance. Maybe they have your full history but still want additional information that they don't have visibility into. One example is lab values or scan results. Again, seems absurd in your specific case, but less so in a $10k/month cancer therapy.

BiggerBoat posted:

You totally skimmed over about how "yesterday" is "prior" to today (when I went to pick it up) and how "authorization" is "has a prescription from a loving doctor". Unless I loving forgot how to speak English or something.

Any doctor can write a prescription. Given your insurance is paying for it they may want more information to fill it. This is annoying, but a cost saving measure. Plus plenty of doctors are overworked, greedy, and/or cranks.

BiggerBoat posted:

I totally skimmed over the completely reasonable and not at all idiotic "formulary" and "step edit" procedures that exist because "reasons" that might be less "efficacious" after already REPEATEDLY having to do other tests before I do the ones my PCP ordered. You'd think "this guy needs to quit smoking" would...uh...be a decent and basic enough place to start with what ails me. But maybe I'm being overly cromulent and not factoring in the hypotenuse and the bilateral precipitation involved in this carefully calculated decision to basically require my doctor to re-authorize a legit prescription he already loving wrote.

I'll never say the US health system is easy for patients/caregivers. The easiest argument against for-profit insurance companies is they're incentivized to not give you care. Restricting access to healthcare would still occur in a single payer system (e.g., are we really giving this 85 year old with major comorbidities an expensive cancer treatment that won't meaningful extend quality adjusted life years?). But at least people could rationalize that as a data driven, democratic choice in how to allocate finite healthcare spend across its population rather than for-profit corporation maximizing earnings per share.

Still Dismal
Dec 15, 2008


Hospitals themselves don't get nearly enough flack honestly. Insurance companies are the main villains in most healthcare reform arguments (not at all saying they don't deserve this), but hospitals are a huge part of the problem as well. Hospitals have much better PR but are every bit as culpable for the insane runaway cost inflation that you see in American healthcare. I think the problem is that people generally like doctors, nurses, etc., and hospitals like to conflate attacking their predatory pricing and practices with attacking the workers providing healthcare themselves.

Coolness Averted
Feb 20, 2007

oh don't worry, I can't smell asparagus piss, it's in my DNA

GO HOGG WILD!


Still Dismal posted:

Hospitals themselves don't get nearly enough flack honestly. Insurance companies are the main villains in most healthcare reform arguments (not at all saying they don't deserve this), but hospitals are a huge part of the problem as well. Hospitals have much better PR but are every bit as culpable for the insane runaway cost inflation that you see in American healthcare. I think the problem is that people generally like doctors, nurses, etc., and hospitals like to conflate attacking their predatory pricing and practices with attacking the workers providing healthcare themselves.

Yeah the whole private hospital grift is terrible. Especially since anything like providing say an ER to a city and not luxury adrenachrome regeneration facilities is almost always a 'public private partnership' where the local taxpayers foot the bill when stuff is in the red, the private company hoovers up the profit, and always uses threats of closing down or reducing services to demand the ratio of public spending to private profit shifts further in their favor.

BiggerBoat
Sep 26, 2007

For that you get the head...

the tail...

the whole damned thing.

KingNastidon posted:

bunch of stuff

DO you work for an insurance company? Or have in the past? You sound like it.

I appreciate your attempt(s) at some sort of explanation for this dumb bullshit but it aint cutting it for me, sorry. You said few things that make sense to me, especially near the end there.

Wouldn't ALL this stuff be less complicated and make more sense without marketing and advertising? Or worrying about which hospital or doctor is "in network" in the event I'm barely out of a coma? And just LOL at the idea that I'm some sort of "drug seeker" that Chantix writing physicians need to be cautious about by writing me for it "willy nilly". It's not OXY or loving morphine. It's easier for me to get Vicodin right now.

And the fact that it's easier for me to buy cigarettes (or alcohol) than fill this totally legal scrip speaks volumes just about...something...unless I am ignorant about certain mechanisms, which you seem to be implying I am and that takes me back to my OP and "why is this like this?" And I'm pretty sure the politics behind how we run this poo poo in the U.S. explains 95% of it.

Also, you said, "given my insurance is paying for it". That's the point. They're NOT. I'm being denied tests and medicine at every turn and I'm "one of the good ones" who WORKS for my super duper private insurance.

Still Dismal posted:

Hospitals themselves don't get nearly enough flack honestly. Insurance companies are the main villains in most healthcare reform arguments (not at all saying they don't deserve this), but hospitals are a huge part of the problem as well. Hospitals have much better PR but are every bit as culpable for the insane runaway cost inflation that you see in American healthcare. I think the problem is that people generally like doctors, nurses, etc., and hospitals like to conflate attacking their predatory pricing and practices with attacking the workers providing healthcare themselves.

I agree with this.

I don't know much about it but there's always been something off putting and odd about hospitals advertising with billboards and poo poo. I mean...WHY? Believe me, if I need to go to the hospital, it's almost like picking a mechanic. The CLOSEST one to my house, my job or wherever the gently caress it is I got maimed, please.

I'm not choosing a pizza place here. Plus, I've heard the game and the incentive is to over bill insurance for every god damned thing and then haggle down from there, yes? What's that telling us and why are so many politicians committed to this model? People going broke for getting sick, old and dying? Which is going to happen to all of us.

I think I just answered my own question. Quite a business model when you think about it.

BiggerBoat fucked around with this message at 21:51 on Aug 6, 2020

Tomberforce
May 30, 2006


Have you ever considered that forcing someone to provide you a service is called slavery so publically funded medical care mesns making doctors into slaves. But this doesn't apply to any other public sector job for reasons.


I see this fuckin insanity trotted out all the time and I cannot wrap my head around the stupidity of this mindset.

taqueso
Mar 8, 2004









Fun Shoe

It's the mindset of "hah they don't know to beat this logic lol" not stupidity, though stupidity may be comorbid

ILL Machina
Mar 25, 2004

Glory to Arstotzka!

KingNastidon has summarized things nicely. One of the big roadblocks to improved care and improved billing is that the insurance company can question the recommended care of your provider, essentially acting as a second opinion that is usually biased because they are identified to cover as little as possible. Prior authorizations are part of this problem. Your misreading the context OP, "prior auth" means your doctor needs to get prior authorization from your insurance to even offer the prescription. "prior" meaning before pen goes to script and "auth" coming from the payer.

I don't know if it's fair to fully demonize HCPs for pricing issues like the other poster did. They are complicit and generally run by for profit boards, but the price gouging comes because so many payers are negotiating adjustment contracts. You only ever see the insane numbers if you run out of coverage and have to self-pay, and at that point the hospitals generally don't expect to receive payments and will just write off the remainder as charity or losses.

ILL Machina fucked around with this message at 23:24 on Aug 6, 2020

ILL Machina
Mar 25, 2004

Glory to Arstotzka!

Tomberforce posted:

Have you ever considered that forcing someone to provide you a service is called slavery so publically funded medical care mesns making doctors into slaves. But this doesn't apply to any other public sector job for reasons.


I see this fuckin insanity trotted out all the time and I cannot wrap my head around the stupidity of this mindset.

Rand Paul has said this publicly. He's saying if you're off duty or not on call and someone needs help, you would have to respond no matter what or the government could hold you criminally accountable. It is a tech, to be sure, and seems like would only be managed with more regulation protecting schedules, overtime, and on-call respect...which I think his libertarian sensibilities would contest.

CelestialScribe
Jan 16, 2008


My son spent two hours in an American hospital once. Docs literally just checked him out and waited to see if he had a concussion. The bill was $3,000.

I love my universal health care. Private health can get hosed.

If the United States isn't going to adopt universal health care, and it should, I feel like there are a few simple things you could do to make the current system just a tiny bit less poo poo:

- Completely ban "in network" and "out of network" arrangements. Your health insurance applies everywhere.
- A billing timeline. If you aren't billed within three months, you no longer have to pay. Too many stories of bills coming years later.
- Premiums at 10% max of income, out of pocket max at another 10% of your income.

Ideally everything would be free, but hey.

CelestialScribe fucked around with this message at 23:41 on Aug 6, 2020

ILL Machina
Mar 25, 2004

Glory to Arstotzka!

The insurance industry is the problem. I don't see any other way around it. I wouldn't have a job of the system wasn't so hosed and everyone could do accounting without machine learning leaps, but I would prefer it.

Obama said in an exit interview that he wanted to be more progressive and fight for something like a single payer system, but the insurance industry is huge and employs many thousands of people. It should happen for our own good, but it will be very disruptive.

ILL Machina fucked around with this message at 00:57 on Aug 7, 2020

DC Murderverse
Nov 10, 2016

"Tell that to Zod's snapped neck!"



my mom works at a large university hospital as a pharmacist financial councilor, which means that if someone can't afford their drugs because they don't have insurance or their insurance won't cover for it, they get sent to her. Just through the sheer amount of people she's talked to since taking on this position she's come to the conclusion that our healthcare system is broken and government healthcare is probably the best way to go. she knows quite a bit about those drug discount cards and their equivalent foundations for people on medicare that basically function as a way for drug companies to totally soak insurers (especially the largest insurer in the country, the US Government) by pricing the drugs outrageously high so they get lots of money from insurers and if people slip through the cracks and can't afford those outrageously high prices, there are programs funded by the drug companies to help them afford their drugs, which also has the added benefit of making the drug companies look like saints (even though the problem started when they priced the drugs in the first place).

IMO capitalism is incompatible with healthcare. All of the free market ideologies that our system of capitalism are based on all traders being on equal ground in terms of information and position, so that the free market sellers will set prices where people determine is the right value for them and if they set it too high, no one will buy, forcing the prices down. The problem with that in healthcare is that the people who have the "product" that needs selling, whether it's a literal product like a drug or some sort of surgery or treatment through a hospital are not on the same position as the people doing the buying because when people need drugs/treatment, they don't have the ability to wait until the price is at a level they feel is worth it because their health is often at an immediate risk. Someone who gets diagnosed with stage 2 cancer doesn't have a whole lot of time to shop around to determine whose cancer treatment is the best and most affordable because if they wait a year, they might end up dead or past the point of no return. This means that drug pricers don't have an incentive to price these life-saving drugs to make them affordable, they can price them at the absolute highest point because they know that people will completely drop every last bit of savings that they have in order to not die. You can try to dress up the system like the United States has by putting certain people into a separate group that has essentially single payer healthcare (Veterans) or a form of government-based coverage (Medicaid/care) but ultimately this system is just going to lead people to bankruptcy because that was the better choice in the "Die/Never Have Money Again" dichotomy.

My dad has Huntington's Disease. My family knew this with enough time that they were able to get a really good long term care insurance plan when he was still healthy and now we have home health care people coming in 5 days a week to help him out, and within the next year he'll probably be put into a nursing home, and that insurance will provide us with the funds to do so. It helps that my mom's job offers great health insurance and his disability covers quite a bit as well. Me on the other hand, I got tested when I was 18 and a half and came out positive, and purchased a long-term care insurance plan with roughly the same value as my dad's and after about 10 years of paying the jumps in payments each year have gotten to the point where it's literally not worth paying any more because 30% increases in premiums aren't worth it for something I'm gonna need 25-30 years down the line. This is the reality for most people who test positive. They watch their parent slowly succumb over the course of a decade as sort of a preview to what will happen to them and many of them don't have the money to get the sort of treatment my dad has gotten because they weren't living in the right city or they didn't have the right job or they didn't have family willing to support them. Seeing what this disease is doing to my dad terrifies me; he's now to the point where he can't do anything on his own, can't eat without my mom, can't really talk except for very basic sentences, just watches TV every day as he wastes away and it sucks so much because I know that if I get to that point, all of those things that I pointed out earlier that helped us prepare won't do poo poo for me. I've already basically decided that if I get to the point where my brain starts to rapidly dissolve I'll probably find a way to end my life rather than go through the last 10 years like he has, and like my grandpa did before him.

When I first tested positive my mom consoled me with the fact that there's a lot of good work being done to find treatments for HD and other similar diseases, and that it's likely that by the time I get to the point where I might start losing my faculties there will be some form of treatment, and honestly that's held true. There are multiple potential treatments entering late stages of research and it's very likely that by the time I'm 50 or so there may be some treatment that will allow me to live out the rest of my life normally, relative to my dad. That gave me great comfort at first but I've now reached a new sort of realization: whatever this drug is, it will almost certainly be outrageously expensive, even with drug companies and their discount cards. We're talking monthly costs in the 5 digit range, and if it's a 1 time thing I fully expect a $1,000,000 price tag because the drug companies know that the choice is between essentially being in debt forever or a slow painful degenerative death, and the only reason I'm in that position is that I lost a coin flip when I was born. I see advocating for change in the healthcare system as not just the right thing to do, but the only way that people like me will be able to afford any sort of cure or treatment without crippling amounts of debt.

KingNastidon posted:

Prior auths are annoying for patients and MDs. To the poster above, some of this is just an annoyance factor to ensure that 1) patients are actually committed to getting the therapy and will be adherent/compliant and 2) MDs aren't just pill mills that are haphazardly giving out drugs. This seems silly in your example with smoking and Chantix, but there are obvious examples where these hoops make sense.

when is this an issue for things that aren't painkillers/abusable drugs?

(P.S. drug advertisers are all scum and I hope they all lose their jobs)

tl;dr: drug companies should all be nationalized, health insurers should be dissolved, and private, for-profit healthcare should not be a thing anywhere.

Kreeblah
May 17, 2004

INSERT QUACK TO CONTINUE




Taco Defender

ILL Machina posted:

The insurance industry is the problem. I don't see any other way around it. I wouldn't have a job of the system wasn't so hosed and everyone could do accounting without machine learning leaps, but I would prefer it.

Obama said in an exit interview that he wanted to be more progressive and fight for something like a single payer system, but the insurance industry is huge and employs many thousands of people. It should happen for our own good, but it will be very disruptive.

Burn it all down, salt the earth, and guillotine the people responsible for it.

If I don't have health care, I'm dead (thanks, unlucky roll of the dice), so because I have comparatively good healthcare where I currently am, it's making it really hard to find a new job. Meanwhile, even though I have insurance that covers me pretty well, I'm still completely terrified of something getting billed wrong, or some out-of-network person walking by when I'm at a hospital and then ending up with a $20k bill that I can't pay.

CelestialScribe
Jan 16, 2008


Kreeblah posted:

Burn it all down, salt the earth, and guillotine the people responsible for it.

If I don't have health care, I'm dead (thanks, unlucky roll of the dice), so because I have comparatively good healthcare where I currently am, it's making it really hard to find a new job. Meanwhile, even though I have insurance that covers me pretty well, I'm still completely terrified of something getting billed wrong, or some out-of-network person walking by when I'm at a hospital and then ending up with a $20k bill that I can't pay.

The out of network thing is what scares the poo poo out of me. So you can do the right thing, go to an in-network hospital, but by bad luck have an out-of-network doctor, and be stuck with the bill? Such bullshit.

Quick question: do out-of-network costs count towards your out of pocket maximum? Or does it depend on the plan?

Coolness Averted
Feb 20, 2007

oh don't worry, I can't smell asparagus piss, it's in my DNA

GO HOGG WILD!


CelestialScribe posted:

The out of network thing is what scares the poo poo out of me. So you can do the right thing, go to an in-network hospital, but by bad luck have an out-of-network doctor, and be stuck with the bill? Such bullshit.

Quick question: do out-of-network costs count towards your out of pocket maximum? Or does it depend on the plan?

Depends on the plan, and also circumstances. They're usually a little more forgiving of emergency procedures, but even then the default is "Screw you over, then see how much you protest."

You can also wind up with there just literally not being anyone in the hospital that does what you need who is 'in network.' A common gotcha there is anesthesiologists.
So your hospital is in network, the doctor is too, and the procedure is approved/listed as covered or with a specific copay or whatnot. Then you wake up and get a surprise 6 figure bill.

Coolness Averted fucked around with this message at 02:07 on Aug 7, 2020

Craptacular!
Jul 9, 2001

Fuck the DH


States are beginning to notice the out of network hospital thing and legislate change. Because politics is all about wordplay, the phrase "Surprise Billing" has been used for this and seems to be effective in making change. Ambulance takes you to a non-partner hospital and you're too knocked out to object? Your problem, tough cookie. But you're a victim of Surprise Billing? Nobody wants to be surprised billed. Somebody fix that poo poo!

I have a choice of two providers for Medicaid coverage, and from what I could tell the most major difference was that one of the three hospital chains in my region didn't support the outfit I went with, and one of their hospitals is the physically closest hospital to me. I made this choice because they have the better Doctor network, and I figure a person in their 30s who hasn't lived a hard life is going to need a regular PCP more than they're going to need the ER. However, if I did need the ER, I would have wanted to be driven several more miles than the closest hospital is to the one that isn't going to bill me personally.

This changed when the state capped ER bills on people with unaccepted plans and smoothing out the other difficulties in the way where the out-of-network hospital would basically have to eat the cost. And then, suddenly, the nearby hospital worked out a deal with the provider I chose and now I can go there now. Apparently if you reduce the opportunities for hospitals to bankrupt people and force them to take losses in those situations instead, they get far more negotiable with every insurance network that they can. Who knew?!

Craptacular! fucked around with this message at 02:25 on Aug 7, 2020

Kreeblah
May 17, 2004

INSERT QUACK TO CONTINUE




Taco Defender

Craptacular! posted:

This changed when the state capped ER bills on people with unaccepted plans and smoothing out the other difficulties in the way where the out-of-network hospital would basically have to eat the cost. And then, suddenly, the nearby hospital worked out a deal with the provider I chose and now I can go there now. Apparently if you reduce the opportunities for hospitals to bankrupt people and force them to take losses in those situations instead, they get far more negotiable with every insurance network that they can. Who knew?!

This, right here, is one major source of bullshit (of many) in this system: insurance networks that are so narrow so you have a choice of like three doctors to go to (with the only one that's accepting new patients being a two hour drive, one way, and God help you if you have to take the bus), and providers that deliberately don't contract with insurers so that they can gently caress people with huge bills and then strongarm them down to merely excruciatingly extortionate payments rather than blatantly crippling ones.

Coolness Averted
Feb 20, 2007

oh don't worry, I can't smell asparagus piss, it's in my DNA

GO HOGG WILD!


Kreeblah posted:

This, right here, is one major source of bullshit (of many) in this system: insurance networks that are so narrow so you have a choice of like three doctors to go to (with the only one that's accepting new patients being a two hour drive, one way, and God help you if you have to take the bus), and providers that deliberately don't contract with insurers so that they can gently caress people with huge bills and then strongarm them down to merely excruciatingly extortionate payments rather than blatantly crippling ones.

Yeah, or treatments that are technically covered on paper but in practice they offer such a pittance in compensation no one offers it in network. You of course wouldn't know this if you say pay extra for the next tier of coverage during open enrollment because you really want or need that treatment. Mental health care is especially notorious for that. I've known people who specifically jumped through all the hoops to get cognitive behavioral therapy approved by their insurance only to have the rug pulled out from them and no therapists that offer that are in their network within 100 miles.

Kreeblah
May 17, 2004

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Taco Defender

Coolness Averted posted:

Yeah, or treatments that are technically covered on paper but in practice they offer such a pittance in compensation no one offers it in network. You of course wouldn't know this if you say pay extra for the next tier of coverage during open enrollment because you really want or need that treatment. Mental health care is especially notorious for that. I've known people who specifically jumped through all the hoops to get cognitive behavioral therapy approved by their insurance only to have the rug pulled out from them and no therapists that offer that are in their network within 100 miles.

Oh, mental health is its own special brand of hosed. If I go to my health insurance's site and put in my plan number, it gives me a huge list of providers to choose from, but if I actually try to use it at one of them, I find out later that my employer had mental health carved out and given to a different company that has almost nobody in network in my area (and completely stonewalled my last therapist when he tried to get into their network; they basically never returned his calls). Their web site straight up lies to me, plus the tiny mental health network means that I've been paying my therapist a heavily-discounted cash rate for years.

Coolness Averted
Feb 20, 2007

oh don't worry, I can't smell asparagus piss, it's in my DNA

GO HOGG WILD!


loving hell, I'm amazed we haven't seen more people do minecraft poo poo to insurance executives.
If I was terminally ill, or lost someone I loved due to these games I know I would try to before I got too sick.

Griefor
Jun 11, 2009


BiggerBoat posted:

- "A for profit healthcare system drives innovation!" Well...maybe. But it also ...

This is just plain false. Huge pharma coorporations have been buying up smaller companies that just developed an effective new treatment, jacking up the prices and slashing the R&D department because there is no short term profit in R&D. Even though that R&D department researched the treatment they are now making bank on. Dozens of smaller companies that still did research have been gobbled up by big pharma for the patents and had their R&D shut down.

Kreeblah
May 17, 2004

INSERT QUACK TO CONTINUE




Taco Defender

Griefor posted:

This is just plain false. Huge pharma coorporations have been buying up smaller companies that just developed an effective new treatment, jacking up the prices and slashing the R&D department because there is no short term profit in R&D. Even though that R&D department researched the treatment they are now making bank on. Dozens of smaller companies that still did research have been gobbled up by big pharma for the patents and had their R&D shut down.

It also incentivizes finding ongoing treatments rather than cures. Why let somebody pay $200,000 for a cure when they could be paying you $10,000/month for years?

How much that actually happens is something that will probably never be publicly known, but I have no doubt it's more than never.

Binary Badger
Oct 11, 2005

Trolling Link for a decade




Anybody know how GoodRX actually stays in business?

How can they afford to keep hiring Martin Sheen to shill their product?

Or are they propped up by some big Pharma to steer people to only their product..

BiggerBoat
Sep 26, 2007

For that you get the head...

the tail...

the whole damned thing.

I've wondered the same thing. Usually the answer is "advertising" so I'm gonna go with that.

ILL Machina posted:

Rand Paul has said this publicly. He's saying if you're off duty or not on call and someone needs help, you would have to respond no matter what or the government could hold you criminally accountable. It is a tech, to be sure, and seems like would only be managed with more regulation protecting schedules, overtime, and on-call respect...which I think his libertarian sensibilities would contest.

Oh, cool.

Then he'll agree with my refusal to monitor my work emails when I'm off the clock and link my work messages to my personal phone since I am paid by the hour.

Nah, he'd tell me if i don't like it to get another job.

BiggerBoat fucked around with this message at 18:48 on Aug 7, 2020

Griefor
Jun 11, 2009


Kreeblah posted:

It also incentivizes finding ongoing treatments rather than cures. Why let somebody pay $200,000 for a cure when they could be paying you $10,000/month for years?

How much that actually happens is something that will probably never be publicly known, but I have no doubt it's more than never.

Oh, that too! It's even driven Purdue to turn temporary pain into a need for ongoing treatment by getting people addicted to their painkiller, OxyContin. People switch to heroin after a time because it is more affordable, though.

Edit: Well, I guess I have to admit that that is pretty innovative.

Griefor fucked around with this message at 19:20 on Aug 7, 2020

BiggerBoat
Sep 26, 2007

For that you get the head...

the tail...

the whole damned thing.

So...

What are the healthcare PLANS of the two parties/candidates exactly again?

You'd think during a global pandemic that healthcare coverage would be front and center in the discourse, but all I hear is LAW AND ORDER and "the economy", but we've already pointed out that the economy is 17% related to healthcare. So...uh...

And I was surprised to learn that pre-existing condition coverage still exists. Because I got to thinking about all these all these unemployed and uninsured people facing a $569 monthly COBRA premium and lord help you if you let that slip. So all those lazy people gettin that sweet sweet UEI cash can skim 1/4 off the top and, if you have epilepsy like my 9 year old son and he get's bounced for a month, it seems to me that the GOP wants to make it so he never gets his medicine again.

A cursory google search of GOP Healthcare plans gives me something from a guy named Mike Johnson and a lot of articles dated from 2 or 3 years ago. So nothing. Same with the Democrats but slightly better.

Here you go. Here's Joe Biden's "platform" on this issue, which is basically "Stop repealing the ACA". Jesus loving christ.

https://joebiden.com/healthcare/

At LEAST there's a public option buried in there if you can suffer reading all that horseshit and swiping past the solicitations for money. I mean....at least it's a PLATFORM. Built on poo poo but a platform. GO read it. See how inspiring it is.

Here's all I could find on the Trump/GOP end from whitehouse.gov

quote:

Obamacare is hurting American families, farmers, and small businesses with skyrocketing health insurance costs. Moreover, soaring deductibles and copays have made already unaffordable plans unusable. Close to half of U.S. counties are projected to have only one health insurer on their exchanges in 2018. Replacing Obamacare will force insurance companies to compete for their customers with lower costs and higher-quality service. In the meantime, the President is using his executive authority to reduce barriers to more affordable options for Americans and U.S. businesses.

I mean...

UHC has to happen SOON if for no other reason that there's just no other loving option, right?

RIGHT?

Complications
Jun 19, 2014



BiggerBoat posted:

I mean...

UHC has to happen SOON if for no other reason that there's just no other loving option, right?

RIGHT?

20% of the economy buys a lot of lobbyists, donations, bribes, and advertising. Plus it makes up a ton of investments for the upper class, since the healthcare industry is only going to grow in the coming decades. The upper class which makes up our professional politician class. So no, UHC is not going to happen. Too many powerful people would see a lessening of the growth of their unfathomable fortunes.

BiggerBoat
Sep 26, 2007

For that you get the head...

the tail...

the whole damned thing.

Complications posted:

20% of the economy buys a lot of lobbyists, donations, bribes, and advertising. Plus it makes up a ton of investments for the upper class, since the healthcare industry is only going to grow in the coming decades. The upper class which makes up our professional politician class. So no, UHC is not going to happen. Too many powerful people would see a lessening of the growth of their unfathomable fortunes.

I get that but...

Doesn't this require people to have money to not just lie down and die in the streets?

The 5% already already have 95% of the money so the orange is squeezed dry. They can't lock us all up can they?

Oh wait.

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Kreeblah
May 17, 2004

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Taco Defender

BiggerBoat posted:

What are the healthcare PLANS of the two parties/candidates exactly again?

See the thread title. You should be paying into the system until you're bled dry, and then you can go die in a gutter when there's nothing left to squeeze out of you.

This is the position of both the Dems and the GOP. The only difference between them is whether the ACA should be the vehicle to do it.

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