Coronavirus: Triple Edition

[Pidesco]

The discussion is about everything in healthcare. Overall cost, premiums,  deductibles, quality and availability of care across the country. The US pays more per capita for healthcare than any other country in the world, and gets worse health outcomes as a result.

 

And while the news articles about ridiculous bills are mostly about outrage clicks, the bills are still an underlying problem that contributes to how much the US overpays for healthcare.

[Gromnir]

close to 40% o' the emt in nyc don't have health insurance. were a couple stories 'bout such when pandemic first hit the city. after obamacare, employers had to pay health insurance... for full-time employees. so many employers take a bunch o' full-time jobs and make 'em part-time, just to avoid health insurance coverage. the emt also need make hard choices. food, housing and basic utilities is kinda non-negotiable costs o' living, so if you is making bare enough to survive, particular if you is needing pay off student loans, then you need make hard choices 'bout health insurance. 

restaurant staff. delivery people. small business owners... who ironic may be paying for insurance for multiple employees, but not themselves. is hundreds o' different jobs which see a large % o' those employed nevertheless unable to afford health insurance.

if monetary penalty for not having insurance is less than one or two months o' health insurance premiums you cannot afford...

and it always were as much 'bout the premiums as anything else, 'cause that is the actual functional cost o' insurance for most americans, though is just another way the poor (disproportionate minority) get screwed by the system. if you got co-pays which is also expensive 'cause you may only afford cheapest health insurance, then you are going to avoid doctor visits n' such unless they is absolute necessary. only first three dr. visits a year is covered? have a $10k deductible (ordinary), which goes extreme fast for any serious med issue, and we see how even a single person w/o amish numbers o' kids, may be on the hook for near $15k in out-pocket med expenses in a given year even if they have insurance. making maybe $40k a year in a part-time job and that $15k is enough to start a credit death spiral leading to bankruptcy.

me and mine. doesn't affect me and mine, so is not real or is qq worthy.

HA! Good Fun!

 

Edited June 16, 2020 by Gromnir

[Gfted1]

24 minutes ago, Pidesco said:

The discussion is about everything in healthcare. Overall cost, premiums,  deductibles, quality and availability of care across the country. The US pays more per capita for healthcare than any other country in the world, and gets worse health outcomes as a result.

 

And while the news articles about ridiculous bills are mostly about outrage clicks, the bills are still an underlying problem that contributes to how much the US overpays for healthcare.

I think weve discussed it on the forums before, but isnt your "free" UHC financed by VAT's, and in your case 57.1% income tax? How much tax did your spiffy new PC cost (Im curious)?

[Hurlshort]

So the current system:

1. Charges you thousands of dollars every year in premiums, which are probably matched by your employer, whether you use it or not

2. Charges you co-pays for most services. Sure, $20 to see the doctor seems reasonable, but that doesn't count towards your deductible. This gets trickier with extras. I went to the ER a few weeks ago, and even though my deductible is met, I have a co-insurance bill of $90 from the ER, $15 from radiology, and I will get another one from the ER doctor, I assume.

3. My family max deductible is $2000 for in-network coverage. That's not crazy. We hit it every year, because I believe in preventative care and we are super active. Of course, if you end up out of network for something, this ratchets up to $40,000. Basically I am an emergency room visit to a non-network hospital away from massive debt. Gfted, you probably are too.

Of course, if you get something like cancer, you can expect all of these numbers to go crazy. All the while, the insurance company profits by providing as little service as possible. It's a dumb system that isn't built around health, it is built around profits. Which unless you are seeing those profits, I don't see why you would defend it. 

[Pidesco]

17 minutes ago, Gfted1 said:

I think weve discussed it on the forums before, but isnt your "free" UHC financed by VAT's, and in your case 57.1% income tax? How much tax did your spiffy new PC cost (Im curious)?

I pay about 25% of my income in taxes. About 40% of that goes to healthcare apparently. VAT here is 25%.

 

The point, however, that you seem to be missing is that even when taking taxes into account, people in the developed world pay much less for healthcare than the US.

[Hurlshort]

Eh, we've talked this to death with Gfted1. I suppose it is good he doesn't stress about it, as that could lead to a lot of health issues, and the bills from that may surprise him.

[Gromnir]

didn't think there ever were a claim uhc or alternatives would be free o' a price tag. has been a few studies which show uhc may actual be cheaper overall than current system. am not wholly convinced, particular as is just as many reputable studies which show different. regardless, particular given current charlie fox situation in many cities, should be concerns regarding all kinda secondary social costs which result from the expanding gulf in income disparity.  those who have less/not enough, tend to become angrier and more fearful o' a government which consistent does not look out for them. is not a new phenomenon. 

'course there is also the whole morality issue regarding American willingness to ignore homelessness and healthcare issues.  the most depraved and soulless me and mine character might balk if we begin talking 'bout kids. children make up a large % o' folks receiving insufficient health care or enduring homelessness, and am thinking it takes an impressive amount o' callous indifference to ignore the plight o' kids. perhaps those kids shoulda' thought ahead, planned better, and chose better and more responsible parents? 

as hurl noted, we already endure evils o' socialism. when it comes to basic education, infrastructure spending, and bailouts for farmers when a President decides to have a trade war with china, we got many folks cheering socialism. that said, am knowing many see the world as being made o' teflon and one big slippery slope which only needs a slight tip towards the abyss to send us all plummeting. *sigh* we, as a people, may make choices 'bout how much o' a grip we wanna maintain on the image o' American self-reliance. is not a flippant observation. American self-reliance, while deride elsewhere, is important to many voters. is core value kinda stuff. nevertheless, am thinking is only possible to ignore the growing health care, homelessness and income disparity issues if one is either psychopathic indifferent, or consciously unaware. gotta be a tipping point for most, and such a tipping does not result in an inevitable and inexorable slide down the new created unidirectional slope. 

HA! Good Fun!

[Gfted1]

40 minutes ago, Hurlshot said:

3. My family max deductible is $2000 for in-network coverage. That's not crazy. We hit it every year, because I believe in preventative care and we are super active. Of course, if you end up out of network for something, this ratchets up to $40,000. Basically I am an emergency room visit to a non-network hospital away from massive debt. Gfted, you probably are too.

Emergency room! Well look at Mr. Fancypants.  I exclusively use "Emergacare's" which offer a copay under 100 US Dollars.

[Skarpen]

Well it's ridiculous in itself that Americans pay for insurance AND still have to pay for healthcare. Like, what the hell is that? I've never heard of deductible in any insurance I ever had. If an agent would tell me that my insurance will only kick in after I've spent some crazy amount like 40k  I would probably need medical assistance from the amount of laughter.

The bigger problem however I think is that Americans pay tens of thousands of dollars on medicine and procedures that costs pennies everywhere else. 

I wonder how did that happen?

[Amentep]

Insurance companies have to show their stockholders a profit; private healthcare the same.  Public healthcare has to show politicians they're not a mismanaged drain on the tax money they're given to operate.  Doctors have to pay back all the loans they took to get to and through medical school.

Since the insurance companies can negotiate rates with hospitals, hospitals often increase costs on the uninsured to make up what they lose to keep the insurance companies happy.  Businesses of a certain size are required to offer insurance, which means they are shouldering most of the cost, so a lot of the cost gets passed to them, which get passed on to the employee. 

Research costs are usually factored into costs - that new medicine was #572 in the trials, so you're not just paying for your drug and its manufacturing, but the failed trials that came before its success.  With patents on medicine having a short term (because generics are in the public interest), there is only a short window that a company can maximize its profits before the medicine can be offered in a generic form.

Etc. 

[Bartimaeus]

[Gromnir]

1 hour ago, Skarpen said:

 

I wonder how did that happen?

inch at a time. is ironic, but core and most fundamental problem seems simple to fix, but only in retrospect. the more that people failed to pay their increasing impossible to pay bills, the more hospitals had to charge new patients to stay afloat.  hospital accountants kept the unpaid stuff on the books as long as possible while increasing costs for every other service to cover the eventual loss. such insane behaviour were universal and caused inflation in all aspects o' medical service. 

the industry is now so large it is requiring dramatic efforts to change. the number o' folks employed to do nothing but medical billing is many thousands, and those folks lose jobs almost overnight if any number o' single-payer/uhc plans is adopted. 

just as we cannot let mega banks fail 'cause o' cascade effect on economy, sudden fixing the healthcare system is gonna be equal disastrous for any number o' folks who is now dependent on the system in its current bloated form.

HA! Good Fun!

[ShadySands]

36 minutes ago, Gromnir said:

the number o' folks employed to do nothing but medical billing is many thousands, and those folks lose jobs almost overnight if any number o' single-payer/uhc plans is adopted. 

I do sympathize with them but something has got to change eventually and hopefully sooner than later

[Zoraptor]

2 hours ago, Skarpen said:

I've never heard of deductible in any insurance I ever had.

I'd be willing to bet that you have, just under a different name*. In most of the anglosphere it's called 'excess' rather than 'deductible', no idea what it would be in Polish though, and it's been on every property type insurance policy I've ever had. It's an amount set to stop frivolous claims from gumming up the system in theory at least, practically it's to keep costs down and discourage small claims in general. So if you put a hammer through a wall in the house while putting up a picture frame while that would technically be an insurable incident you don't claim on it because the $1000 excess is more than just going to the hardware store for some filler and a can of paint yourself. Having said that, waiving excess is not uncommon, the one time I've had to make a claim they waived it (house fire which I put out before the fire brigade arrived, their assessor even got them to pay for a replacement fire extinguisher).

*Don't bother with the wikipedia article on deductibles though, it's 100% US centric.

1 hour ago, Bartimaeus said:

Much as I might dislike Trump and his response to covid that did make some sense in the context of reported cases. He was claiming the US response looks bad because they are doing a lot of testing so detect most cases, and if they did less testing the stats would look better. Which is true, so far as it goes. India and Brazil at least would have far higher reported cases if they were doing more testing, and neither would be doing well in terms of reporting deaths; and even in OECD level countries excess deaths in the UK are ~20k higher than the formal covid death toll (and even the official death rate is 2x that of the US per capita).

We also have our first cases in over three weeks. Thanks to some tearjerking reporting about how inhumane it is for quarantine to be enforced on grieving families and a judge deciding to overturn the no exceptions rule the two effected people traveled all the way from Auckland to Wellington too for a funeral. Cue multiple surprised pikachu faces and selective amnesia from the media who'd been complaining about the 'inhumane' policy for the previous 3 months. Ho hum.

Edited June 16, 2020 by Zoraptor

[Gfted1]

Maybe after the Europeans are done rallyin' over US police abuses they can rally about the plight of US healthcare costs.

 

 

[Gromnir]

12 minutes ago, ShadySands said:

I do sympathize with them but something has got to change eventually and hopefully sooner than later

agreed. nevertheless, is one o' the many less than obvious costs of fixing US busted health care. 

regardless, question were asked 'bout how we got to this improbable place and answer is less sinister than some may imagine, but worse 'cause it is everyday ordinary. US income disparity got worse and fewer people were able to pay hospital bills. indigent population got worse, but not so significant as to cause a serious need to shift billing. accounting logic had hospitals raising prices o' procedures to help cover losses from previous unpaid bills, which common sense predictable led to even more folks failing to be able to pay hospital bills and yet hospitals continued with same busted logic in an attempt to stay ahead o' the debt.  so now we got this improbable bloated system which is nevertheless seeming self-sustaining. obvious there will be a breaking point, but we ain't quite hit it.

shady is correct in that something needs change sooner. problem is the fix is gonna be bad for a whole lotta people regardless o' what efforts is taken to mitigate, and there is not enough discussion 'bout mitigation efforts.

charlie fox.

HA! Good Fun!

[Hurlshort]

7 minutes ago, Gfted1 said:

Maybe after the Europeans are done rallyin' over US police abuses they can rally about the plight of US healthcare costs.

 

 

So far you are the only person in the thread that seems to think the US system is alright. It's not a Euro vs. US thing. 

[Gfted1]

Ah, I see you subscribe to our residential clown alley school of thought processes and conclusions. I would be fascinated to see where I posted that the "US system is alright".  And for the cheap seats, it cracks me up that Europeans are so invested in various US problems that they decide to rally in "solidarity". Maybe they can help solve the problems of the common North American street bum? 

[Hurlshort]

56 minutes ago, Gfted1 said:

Ah, I see you subscribe to our residential clown alley school of thought processes and conclusions. I would be fascinated to see where I posted that the "US system is alright".  And for the cheap seats, it cracks me up that Europeans are so invested in various US problems that they decide to rally in "solidarity". Maybe they can help solve the problems of the common North American street bum? 

My apologies. I must have misunderstood your stance on the issue. 

[ShadySands]

My dad and stepmom are finally recovering after a little over two weeks of being sick from this. My dad had it the worst and there were a couple of days where it got pretty close for him (he stopped breathing one of those nights) but since the hospitals in AZ are overfilled he didn't really have many options other than toughing it out and hoping to either pull through or pass quickly. Of course I didn't know about any of this until a day or so ago once he was feeling better.

Edited June 17, 2020 by ShadySands

[Skarpen]

8 hours ago, Amentep said:

Insurance companies have to show their stockholders a profit; private healthcare the same.  Public healthcare has to show politicians they're not a mismanaged drain on the tax money they're given to operate.  Doctors have to pay back all the loans they took to get to and through medical school.

Since the insurance companies can negotiate rates with hospitals, hospitals often increase costs on the uninsured to make up what they lose to keep the insurance companies happy.  Businesses of a certain size are required to offer insurance, which means they are shouldering most of the cost, so a lot of the cost gets passed to them, which get passed on to the employee. 

Research costs are usually factored into costs - that new medicine was #572 in the trials, so you're not just paying for your drug and its manufacturing, but the failed trials that came before its success.  With patents on medicine having a short term (because generics are in the public interest), there is only a short window that a company can maximize its profits before the medicine can be offered in a generic form.

Etc. 

Well, insurance companies have to show profit all over the world and so is private healthcare. Yet I didn't heard of some ridiculous deductibles or astronomical bills for simple procedures outside the US. So I don't think we can blame universal economic factors for something that occured in one country.

As for the research costs. Unless you claim that US still pays Flemming tantiems then I think it doesn't hold water. First of all other countries also use the new medicine, even the same medicine and they have much lower prices. Also in US the price for long established basic medicine and procedures are higher then everywhere else and research cost for those are I think long paid for.

[Bartimaeus]

1 hour ago, ShadySands said:

My dad and stepmom are finally recovering after a little over two weeks of being sick from this. My dad had it the worst and there were a couple of days where it got pretty close for him (he stopped breathing one of those nights) but since the hospitals in AZ are overfilled he didn't really have many options other than toughing it out and hoping to either pull tough or pass quickly. Of course I didn't know about any of this until a day or so ago once he was feeling better.

That sounds like a classic dad move to me. Glad to hear he made it.

[Gromnir]

6 minutes ago, Bartimaeus said:

That sounds like a classic dad move to me. Glad to hear he made it.

am also glad to hear shady's dad recovers, but am thinking we is kinda simpatico on not wanting to go to a hospital if we get covid-19, particular if we feel we require breathing assistance. we do not wanna go thorough interminable er triage only to discover there is little the med folks may do for us save make us feel more comfortable, which is actual impractical given a few o' our medication issues. am having a hard time seeing our self consent to a ventilator. so...

hospitals is not too strained here in norcal at the moment, but if they become such, am certain gonna be less likely to go to hospital even for potential life saving measures. 

given a few o' our health issues, we has had a pretty good run. all things considered, am less afraid o' death than am o' dying in a hospital. will opt for the "dad move" if such a situation arises. 

HA! Good Fun!

 

[Amentep]

5 hours ago, Skarpen said:

Well, insurance companies have to show profit all over the world and so is private healthcare. Yet I didn't heard of some ridiculous deductibles or astronomical bills for simple procedures outside the US. So I don't think we can blame universal economic factors for something that occured in one country.

As for the research costs. Unless you claim that US still pays Flemming tantiems then I think it doesn't hold water. First of all other countries also use the new medicine, even the same medicine and they have much lower prices. Also in US the price for long established basic medicine and procedures are higher then everywhere else and research cost for those are I think long paid for.

The difference is that the US business class believes that if your profit isn't growing, you are doing things wrong. Despite the fact that unlimited growth is an impossibility, the need to show stockholders a profit means that they'll charge what they think they can get away with. This is the background to all those things I mentioned. 

Other countries regulated health care, placed limits on costs, or introduced other measures to keep costs down.

[Skarpen]

1 hour ago, Amentep said:

Despite the fact that unlimited growth is an impossibility, the need to show stockholders a profit means that they'll charge what they think they can get away with. This is the background to all those things I mentioned. 

Yeah. That's probably it.