8 ms·

The absurdity of the American health care and insurance system will never not amaze me. It's just sad and weird, and even weirder that you will always find a bu

by fab1an 6y ago

The absurdity of the American health care and insurance system will never not amaze me. It's just sad and weird, and even weirder that you will always find a bunch of intelligent folks to defend it. Wishing the author, who btw is a better writer than most writers, a speedy and complete recovery.

NortySpock 6y ago
We're not done yet, we can still improve it, we just need to keep leaning on our congress-people to fix it.
- niels2 6y ago
  Can't tell if this is irony.
brigandish 6y ago
There’s plenty about it that’s defensible, the part that seems indefensible to me is the regulatory capture that leads to situations covered in the blog where insurance won’t cover cutting edge treatments. There’s a good argument to be made that deregulation would encourage innovation and lead to dropping prices and greater supply - why capitalism should stop working its usual magic when it comes to medicine is a mystery. Edit: no blood, please!
- refurb 6y ago
  Plenty of single payer systems (like where I live in Canada) don't cover this stuff either. The difference is is in the US it's an insurance company saying "no" and in Canada it's the gov't saying "no". And actually, since it's one system, the doctors already know it's not covered so it never comes up.
- shakezula 6y ago
  Capitalism can't work its magic because healthcare is not a free market. It has a unique set of constraints that capitalism is particularly weak at dealing with: lack of choice (you don't get to choose which hospital you go to in a lot of circumstances), high barrier to entry, constantly changing regulatory environment, etc... The reason single payer systems work is because they're at a specific advantage for all of the constraints that healthcare systems face, including a better overall incentive alignment.
  - brigandish 6y ago
    > Capitalism can't work its magic because healthcare is not a free market. That's exactly my argument, regulatory capture precludes a market from being free. > It has a unique set of constraints I fail to see how the points you list make it unique. > lack of choice (you don't get to choose which hospital you go to in a lot of circumstances) Then make that possible. I live in Japan, I choose the hospital/clinic/doctor that I see, for everything. > high barrier to entry For whom at with what? > constantly changing regulatory environment Yes, so deregulate and move towards a freer market. > The reason single payer systems work Do they? If you have a heart attack in the US vs one in the UK then you are more likely to survive in the US. Blanket statements about what "works" are meaningless when talking about complex systems with multiple outcomes across large populations. The US outranks many countries that aren't using its system in many health outcomes, and if you have insurance then you will get a very high standard of care. Poor health outcomes for those at the bottom are bad but that's only one way to measure efficacy. Japan has a single payer insurance system but I can also point to many negatives, as well as many positives. None of these provide any refutation to a free(r) market providing the benefits that other markets receive.
    - shakezula 6y ago
      > regulatory capture precludes a market from being free. Yes, and healthcare is a good thing to regulate, you know, cause of all those pesky ethics and morals that get involved with human life. brigandish 2 days ago | parent | on: Notes on My Chemotherapy > Capitalism can't work its magic because healthcare is not a free market. That's exactly my argument, regulatory capture precludes a market from being free. > It has a unique set of constraints >> I fail to see how the points you list make it unique. If you can't seen why healthcare a specifically constrained market, you're being either intentionally obtuse or incredibly naive. > I live in Japan, I choose the hospital/clinic/doctor that I see, for everything. Yeah, I choose my dentist, too dawg, doesn't mean that I can choose what E.R. I get dropped off at when I get in a car wreck. I can't shop around for prices on concussion doctors when I'm unconscious in a gurney. Don't be obtuse. Sure, emergency services are only a small part of the pie, but they're the ones that bankrupt people. No one went bankrupt getting their contacts done, and dental and vision are frequently separated _for the exact reason_ that they're not ever medical emergencies, and when they are, they send you to a specialist anyway. > high barrier to entry >> For whom at with what? This is starting to border on bad-faith. I'm not going to spell out every piece of my argument here. If you can't accept the premise that healthcare is a high barrier to entry market, then you're not familiar with the problem. > constantly changing regulatory environment >> Yes, so deregulate and move towards a freer market. You can't just deregulate things and hope it'll fix it. de-regulate _what_? You haven't even proposed a solution here, you've just yelled "Free market!" and "Deregulate healthcare!" But all that will do is worsen the quality that we see and encourage a bunch of snake oil companies to become even more common. > The reason single payer systems work >> Do they? Yes, the evidence says a resounding yes in basically every country, including the U.K., even when the NHS is underfunded. Like another poster pointed out, basically any base-line metric puts the U.S. in ranks with most third-world countries. It's embarrassing.
tehwebguy 6y ago
It's so cruel that it's hard for me to call it absurd. For instance this part from the article: Instead, insurance wants to make sure that you really-super-duper-need whatever it is they're going to give you, to the point where there's basically no way they can say no. is directly connected to this part: And, then, when my company switched insurance providers at the beginning of 2021, this nurse service stopped abruptly. Insurance companies are financially incentivized to not only say "no" to covering treatment but also just to kick the can down the road a bit. The later in the year that they reject an approval the higher the chance that you'll: 1. have to cover part of it in January when your deductible resets, 2. have to pay more toward it than you would when your plan invariably gets more expensive in January, 3. it will be some other insurer's responsibility by then, 4. you die before you incur any more treatment costs. Truly sick stuff!
- johnyzee 6y ago
  I suspect that 'nurse service' was basically the insurance company checking that they weren't paying for more than was needed.
  - spopejoy 6y ago
    It's actually worse than that. > The insurance company even assigned me a nurse to "check in on me" as a resource back in November and December, which sadly was more of a nuisance than anything else. Sadly but at least that's all it was. These nurses will try to FUD you out of critical treatments, or "suggest you ask your doctor" if they're sure something is really covered. I nearly had a major treatment go seriously off the rails where I'd need to go to another hospital, before my doc's hospital was like, "wait, no, there's no problem, that's totally covered." They spam you constantly on the phone too even once you're hip to their game. Stay away.
- wholinator2 6y ago
  It happened with my mother and her chemo for stage 4 colon cancer. She hadn't worked in years due to being laid off, not having a degree, having an extremely sick child (me) to care for. So she's temporarily working for my father, enough hours to get insurance. But dads company just switched insurances specifically because of the cost of her treatments and now they're drrrraaaaaaaagggggging out the process of getting much needed new chemo as it has grown back. It's easy to look at the situation and assume they're honestly just trying to kill her before they pay. As well it's a drug that would cost over $100,000 for a single course if she were to acquire it with no insurance. Another point is that our insurance systems are so needlessly complex that there is no single person or pair of people that understand what's actually going on. If the insurance is denying you get trapped in a continuous loop of appeals, approves, offices, pharmacies, prescribers, etc. and no one is able to tell you 1. Why they're denying you 2. What exactly you need to do to not fucking die. Im sorry but the system had become both absurd and cruel. I keep trying to remind myself that 80 years ago they wouldn't have been able to save her if they tried. It's still better. But to see this carrot perpetually yanked further and further away from you as you slowly lose your ability to keep up or keep going. And then, as the last light dims from your eyes, to see someone sprinting the carrot back to you and attempting to help you as best they can even though you're nearly past the brink. That is the story I've learned. Our system does have success stories. It is better than nothing. But any system that has the capacity for such inhumane cruelty in the face (in spite) of genuine humans trying to help sets a dangerous precedent for the future of its society.
eterm 6y ago
It makes me so glad to be under the care of the NHS. It isn't even about the money, I could afford the $3k out of pocket too, it's more about not having to be a "customer" who has to frequently make choices or shop around. It's also a relief not having to think about the money or insurers. I don't need to collect receipts or bills or phone insurers or providers, I can focus 100% on getting through my chemo. I haven't had to fill in a single form except the occassional consent form since diagnosis, and to me that's worth every penny of tax I've ever spent.
- abraae 6y ago
  We have a public health system in NZ, i.e. free healthcare. We also have private health insurance, 30-40 percent of the population take that up. When you go public you will need to wait in a longer line, you won't get the flowers next to your bed and you might need to ring for a bit longer for a nurse to come, but you'll often be seeing the same doctor you would have seen going private. Last time I was in hospital the only paperwork was the admission form, and then telling the desk people my insurance number as I left.
- bb123 6y ago
  I know that love of the NHS in the U.K. is a religion but the truth is the quality of cancer care you will receive is lower, there’s less preventative testing, and longer wait times. All of that means you’re way more likely to die of cancer under the care of the NHS than the American healthcare system.
  - DanBC 6y ago
    And yet all the things you mention are only important for 5 year survival rates. They don't seem to make much difference to all cause mortality. This means Americans are paying lots of money for treatment that lowers quality of life, can have serious side effects and unintended consequences, and which is mostly not allowing them to live longer. I know which I prefer.
  - eterm 6y ago
    There's less diagnosis for sure, but wait times for actual treatment has been absolutely amazing in my experience. The diagnosis took way longer, in the US I'd have likely been diagnosed months earlier. However, I was diagnosed on a Thursday, started steroid treatments by Monday in preparation for starting full treatment a few days later, and also went from an PET/CT scan to having radiotherapy just 3 days later. I'd be wary of looking too deeply into survival statistics, especially since the much greater emphasis on diagnosis means that a lot of the cancers treated in the US are an earlier stage which is reflected in the survival statistics. It's also important to consider that there aren't people made homeless through medical debt in the UK. There aren't people who avoid going to the doctor because they feel they can't afford it (regardless or whether they could with the appropriate allowances etc). It's not a "religion", it's just experience of 70 years of fully public healthcare which is reflected in things like our vaccine rollout which when compared to our neighbours we have been miles ahead. Even those countries with socialised healthcare but private provision (public insurance + private provision) have massively lagged behind because having a single provider of healthcare has been monumental in coordinating a massive vaccination effort, and as a result the UK is almost top of the per capita vaccination rate with only the much smaller Israel and Bahrain above it. But again, I can't stress how good it is that I don't have to worry about my wallet when getting treated. I was able to change jobs even while undergoing treatment because I didn't have to worry about losing access to health insurance. I may be wrong but if I were working the US I'd feel trapped in my previous job because I'd have been worried about not being covered for a time. The TLDR is that I value living in a society where the poorest and the middle class both have access to the same healthcare. (And yes, like other countries we also do have a private healthcare industry, which is popular especially for elective stuff.)

by fab1an 6y ago

NortySpock 6y ago

We're not done yet, we can still improve it, we just need to keep leaning on our congress-people to fix it.

niels2 6y ago
Can't tell if this is irony.

brigandish 6y ago

There’s plenty about it that’s defensible, the part that seems indefensible to me is the regulatory capture that leads to situations covered in the blog where insurance won’t cover cutting edge treatments. There’s a good argument to be made that deregulation would encourage innovation and lead to dropping prices and greater supply - why capitalism should stop working its usual magic when it comes to medicine is a mystery. Edit: no blood, please!

refurb 6y ago
Plenty of single payer systems (like where I live in Canada) don't cover this stuff either. The difference is is in the US it's an insurance company saying "no" and in Canada it's the gov't saying "no". And actually, since it's one system, the doctors already know it's not covered so it never comes up.
shakezula 6y ago
Capitalism can't work its magic because healthcare is not a free market. It has a unique set of constraints that capitalism is particularly weak at dealing with: lack of choice (you don't get to choose which hospital you go to in a lot of circumstances), high barrier to entry, constantly changing regulatory environment, etc... The reason single payer systems work is because they're at a specific advantage for all of the constraints that healthcare systems face, including a better overall incentive alignment.
- brigandish 6y ago
  > Capitalism can't work its magic because healthcare is not a free market. That's exactly my argument, regulatory capture precludes a market from being free. > It has a unique set of constraints I fail to see how the points you list make it unique. > lack of choice (you don't get to choose which hospital you go to in a lot of circumstances) Then make that possible. I live in Japan, I choose the hospital/clinic/doctor that I see, for everything. > high barrier to entry For whom at with what? > constantly changing regulatory environment Yes, so deregulate and move towards a freer market. > The reason single payer systems work Do they? If you have a heart attack in the US vs one in the UK then you are more likely to survive in the US. Blanket statements about what "works" are meaningless when talking about complex systems with multiple outcomes across large populations. The US outranks many countries that aren't using its system in many health outcomes, and if you have insurance then you will get a very high standard of care. Poor health outcomes for those at the bottom are bad but that's only one way to measure efficacy. Japan has a single payer insurance system but I can also point to many negatives, as well as many positives. None of these provide any refutation to a free(r) market providing the benefits that other markets receive.
  - shakezula 6y ago
    > regulatory capture precludes a market from being free. Yes, and healthcare is a good thing to regulate, you know, cause of all those pesky ethics and morals that get involved with human life. brigandish 2 days ago | parent | on: Notes on My Chemotherapy > Capitalism can't work its magic because healthcare is not a free market. That's exactly my argument, regulatory capture precludes a market from being free. > It has a unique set of constraints >> I fail to see how the points you list make it unique. If you can't seen why healthcare a specifically constrained market, you're being either intentionally obtuse or incredibly naive. > I live in Japan, I choose the hospital/clinic/doctor that I see, for everything. Yeah, I choose my dentist, too dawg, doesn't mean that I can choose what E.R. I get dropped off at when I get in a car wreck. I can't shop around for prices on concussion doctors when I'm unconscious in a gurney. Don't be obtuse. Sure, emergency services are only a small part of the pie, but they're the ones that bankrupt people. No one went bankrupt getting their contacts done, and dental and vision are frequently separated _for the exact reason_ that they're not ever medical emergencies, and when they are, they send you to a specialist anyway. > high barrier to entry >> For whom at with what? This is starting to border on bad-faith. I'm not going to spell out every piece of my argument here. If you can't accept the premise that healthcare is a high barrier to entry market, then you're not familiar with the problem. > constantly changing regulatory environment >> Yes, so deregulate and move towards a freer market. You can't just deregulate things and hope it'll fix it. de-regulate _what_? You haven't even proposed a solution here, you've just yelled "Free market!" and "Deregulate healthcare!" But all that will do is worsen the quality that we see and encourage a bunch of snake oil companies to become even more common. > The reason single payer systems work >> Do they? Yes, the evidence says a resounding yes in basically every country, including the U.K., even when the NHS is underfunded. Like another poster pointed out, basically any base-line metric puts the U.S. in ranks with most third-world countries. It's embarrassing.

tehwebguy 6y ago

It's so cruel that it's hard for me to call it absurd. For instance this part from the article: Instead, insurance wants to make sure that you really-super-duper-need whatever it is they're going to give you, to the point where there's basically no way they can say no. is directly connected to this part: And, then, when my company switched insurance providers at the beginning of 2021, this nurse service stopped abruptly. Insurance companies are financially incentivized to not only say "no" to covering treatment but also just to kick the can down the road a bit. The later in the year that they reject an approval the higher the chance that you'll: 1. have to cover part of it in January when your deductible resets, 2. have to pay more toward it than you would when your plan invariably gets more expensive in January, 3. it will be some other insurer's responsibility by then, 4. you die before you incur any more treatment costs. Truly sick stuff!

johnyzee 6y ago
I suspect that 'nurse service' was basically the insurance company checking that they weren't paying for more than was needed.
- spopejoy 6y ago
  It's actually worse than that. > The insurance company even assigned me a nurse to "check in on me" as a resource back in November and December, which sadly was more of a nuisance than anything else. Sadly but at least that's all it was. These nurses will try to FUD you out of critical treatments, or "suggest you ask your doctor" if they're sure something is really covered. I nearly had a major treatment go seriously off the rails where I'd need to go to another hospital, before my doc's hospital was like, "wait, no, there's no problem, that's totally covered." They spam you constantly on the phone too even once you're hip to their game. Stay away.
wholinator2 6y ago
It happened with my mother and her chemo for stage 4 colon cancer. She hadn't worked in years due to being laid off, not having a degree, having an extremely sick child (me) to care for. So she's temporarily working for my father, enough hours to get insurance. But dads company just switched insurances specifically because of the cost of her treatments and now they're drrrraaaaaaaagggggging out the process of getting much needed new chemo as it has grown back. It's easy to look at the situation and assume they're honestly just trying to kill her before they pay. As well it's a drug that would cost over $100,000 for a single course if she were to acquire it with no insurance. Another point is that our insurance systems are so needlessly complex that there is no single person or pair of people that understand what's actually going on. If the insurance is denying you get trapped in a continuous loop of appeals, approves, offices, pharmacies, prescribers, etc. and no one is able to tell you 1. Why they're denying you 2. What exactly you need to do to not fucking die. Im sorry but the system had become both absurd and cruel. I keep trying to remind myself that 80 years ago they wouldn't have been able to save her if they tried. It's still better. But to see this carrot perpetually yanked further and further away from you as you slowly lose your ability to keep up or keep going. And then, as the last light dims from your eyes, to see someone sprinting the carrot back to you and attempting to help you as best they can even though you're nearly past the brink. That is the story I've learned. Our system does have success stories. It is better than nothing. But any system that has the capacity for such inhumane cruelty in the face (in spite) of genuine humans trying to help sets a dangerous precedent for the future of its society.

eterm 6y ago

It makes me so glad to be under the care of the NHS. It isn't even about the money, I could afford the $3k out of pocket too, it's more about not having to be a "customer" who has to frequently make choices or shop around. It's also a relief not having to think about the money or insurers. I don't need to collect receipts or bills or phone insurers or providers, I can focus 100% on getting through my chemo. I haven't had to fill in a single form except the occassional consent form since diagnosis, and to me that's worth every penny of tax I've ever spent.

abraae 6y ago
We have a public health system in NZ, i.e. free healthcare. We also have private health insurance, 30-40 percent of the population take that up. When you go public you will need to wait in a longer line, you won't get the flowers next to your bed and you might need to ring for a bit longer for a nurse to come, but you'll often be seeing the same doctor you would have seen going private. Last time I was in hospital the only paperwork was the admission form, and then telling the desk people my insurance number as I left.
bb123 6y ago
I know that love of the NHS in the U.K. is a religion but the truth is the quality of cancer care you will receive is lower, there’s less preventative testing, and longer wait times. All of that means you’re way more likely to die of cancer under the care of the NHS than the American healthcare system.
- DanBC 6y ago
  And yet all the things you mention are only important for 5 year survival rates. They don't seem to make much difference to all cause mortality. This means Americans are paying lots of money for treatment that lowers quality of life, can have serious side effects and unintended consequences, and which is mostly not allowing them to live longer. I know which I prefer.
- eterm 6y ago
  There's less diagnosis for sure, but wait times for actual treatment has been absolutely amazing in my experience. The diagnosis took way longer, in the US I'd have likely been diagnosed months earlier. However, I was diagnosed on a Thursday, started steroid treatments by Monday in preparation for starting full treatment a few days later, and also went from an PET/CT scan to having radiotherapy just 3 days later. I'd be wary of looking too deeply into survival statistics, especially since the much greater emphasis on diagnosis means that a lot of the cancers treated in the US are an earlier stage which is reflected in the survival statistics. It's also important to consider that there aren't people made homeless through medical debt in the UK. There aren't people who avoid going to the doctor because they feel they can't afford it (regardless or whether they could with the appropriate allowances etc). It's not a "religion", it's just experience of 70 years of fully public healthcare which is reflected in things like our vaccine rollout which when compared to our neighbours we have been miles ahead. Even those countries with socialised healthcare but private provision (public insurance + private provision) have massively lagged behind because having a single provider of healthcare has been monumental in coordinating a massive vaccination effort, and as a result the UK is almost top of the per capita vaccination rate with only the much smaller Israel and Bahrain above it. But again, I can't stress how good it is that I don't have to worry about my wallet when getting treated. I was able to change jobs even while undergoing treatment because I didn't have to worry about losing access to health insurance. I may be wrong but if I were working the US I'd feel trapped in my previous job because I'd have been worried about not being covered for a time. The TLDR is that I value living in a society where the poorest and the middle class both have access to the same healthcare. (And yes, like other countries we also do have a private healthcare industry, which is popular especially for elective stuff.)