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I write about America’s health care system, and I got caught up in it
- jeffrallen 5y agoDude should have called 911 when he was at 12 hours of insulin left and let the hospital and the insurance company fight it out. That's seriously f'ed up.
- civilized 5y agoHave you ever gotten an ER bill for something you didn't absolutely have to get an ER bill for, in retrospect? It's a few thousand dollars worth of regret.
- HarryHirsch 5y agoYeah, that's what the mandatory price lists in hospitals are designed to do. Instead of going to the hospital to get treated for cancer and get stunned by the huge bill after you now conclude that you can't afford lifesaving treatment and stay home. If you don't believe that's the purpose of the new regulation you are insufficiently cynical. Where's the revolution?
- Sinidir 5y agoOr you start cooking meth.
- civilized 5y agoI hear that hijinks ensue when you do that.
- tsol 5y agoBest case scenario, though, you win an Emmy
- ______-_-______ 5y agoThen you sell the Emmy, and you'll have enough money for one month worth of insulin.
- throw8932894 5y ago> The price of my prescription without insurance was $339 per vial of insulin In most countries insulin price is around $30. I remember it was cheap in US too. Seems like another problem created by US kleptocracy. Make something prohibitively expensive, and "solve" problem by providing handouts to cover costs.
- lawn 5y agoFor reference, in Sweden we have a ceiling for hospital + medicin costs per year at less than half of the cost of that one insulin vial.
- kwhitefoot 5y agoAlmost the same here in Norway, the ceiling is a little higher.but still less than that one vial.
- nceqs3 5y agoYou are comparing an insured price to a cash list price (most of which does not go to the pharma co and a price which effectively nobody pays). As an insured American, I would pay 0$ for insulin.
- throw8932894 5y agoNo, cash list price of insulin in most countries is around $30. As uninsured person you can still buy insulin for this price in Mexico or order it from India.
- chousuke 5y agoThat's not really a good counterpoint if the non-insured prices are patently insane. How on Earth is it justifiable for insulin to cost 300 dollars? Here it seems to be around 20-40 euros before the deduction you will get from our national health bureau (which can vary from 0% to 100% depending on your diagnosis and the medication you need.) On top of the national mandatory health insurance, there's also optional private health insurance and private hospitals and such, but even for those the prices are nowhere near the insane numbers I see whenever US healthcare is discussed, and I frankly can't understand how people aren't revolting over there.
- civilized 5y agoAside from someone being denied life-saving medication, the most awful thing for me in these stories is the relentless Kafkaesque quality. We never get any answers to our basic sense-making questions about the bureaucratic process: - What did the insurer expect to happen, in order for this person to keep getting their medicine? - Why did those things not happen? - Whose job was it to make sure those things happened? - Did that person know it was their job? - ...etc. I get that it was about prior authorization, but whose job was it to make sure the prior authorization happened? Why didn't that person do it in a timely fashion? Why isn't there an understanding within the insurer's system that Type 1 Diabetes is a life-long condition and not something that will just go away when the insulin runs out? Was there a "happy path" here or does a scenario like this invariably degenerate into a scramble involving dozens of calls and day-destroying last-minute errands?
- lotsofpulp 5y agoI find the article written in a circuitous way, that does not clearly lay out the timeline. This statement about what a prior authorization is is also incorrect: > They’re essentially requirements that a physician get approval from an insurance company before prescribing a treatment. Doctors need no approval from anyone to prescribe. A prior authorization is approval from the insurance company that they agree with the treatment option and will pay for it (subject to deductible/copay/oop max). The theory here is that the end user has no idea what they are getting since they are not knowledgeable about medicine. Doctors could be prescribing unnecessarily expensive medicine or treatment, so the managed care organization (MCO, or insurance company) “manages” the healthcare for the uninformed buyer by having the healthcare professionals employed by the MCO double check things. In this specific person’s case, it looks like the biggest delay was in getting a doctor’s appointment when he needed both a new MCO and a new doctor. Technically, you can pin this on undersupply of doctors, MCOs tied to employer, MCOs not hiring good people and causing unnecessary delays, incompatible electronic documentation systems that do not talk to each other, and I could go on and on. Ideally the doctor should be able to see what medications the MCO will cover on their computer while the doctor is seeing the patient so before they even leave the doctor’s office. Another concern in the long list of concerns is the MCO is not necessarily the one deciding the rules for what treatment/medications to pay for or not. Many, many times it is state government (e.g. Medicaid), federal government (e.g. Medicare/Tricare), or other entity that is actually paying for the healthcare who will hire the MCO and give them the rubric on how much to pay for people’s healthcare/what treatment courses or brands of medications will be covered. This is how poor people (Medicaid) can be restricted access to healthcare by limiting the reimbursement for their healthcare so fewer doctors accept it while older people or members of military get access to better healthcare because their healthcare gets reimbursed at higher prices (Medicare/Tricare). The system allows for a lot of opacity to allow for a lot of price segmentation while also providing political cover for such decisions due to the complexity of understanding it.
- h2odragon 5y ago> Some suggested I go to Walmart for $25 insulin, an older type I have no idea how to safely use. I'm sorry but this erodes my sympathy significantly. Learn about the options that exist if your first choice treatment isnt available. Learn about mitigation when no treatment is available. This is your life, act like its your responsibility already.
- pmyteh 5y agoIt takes weeks to get comfortable using a different insulin to manage your blood sugars, and the results on older NPH insulin are going to be much worse than a more modern one. Doing that, and damaging your body, just to avoid avoidable bureaucracy is not reasonable. In fact, it's mildly tragic.
- ip26 5y agoThese threads always talk out both sides of their mouths. First people say, insulin was invented 100 years ago and the patent was gifted away to help patients, so it should be free. Then people say, it is stupid to use anything but the most modern formulations, because they are way better than the old ones. I have no love for pharma price gouging, but if insulin was free, everybody would be stuck on the 1921 formulation.
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- HarryHirsch 5y agoYou need to manage a chronic condition, either you need a spouse or a child who has a chronic condition or you need one yourself. Science can help, alloxan destroys the islets of Langerhans, it is used to create diabetic mice. Go ahead, take a dose, lead by example. The Walmart insulin comes up here on this website from time to time, and the overall conclusion is that long-acting insulins prevent blood sugar excursions.
- h2odragon 5y ago> You need to manage a chronic condition, I am. I expect to be dead before the decade is out, the doctors offer ways to make that more comfortable but shorter. I disagree with their priorities and am thus on my own for other treatment options. "I do not need to know about other options" seems inexcusable to me, and seems to be what the author assumes is the correct attitude towards their treatment.
- dannykwells 5y agoIronic that he works at Kaiser, I wonder if he has Kaiser Permanente insurance?
- DavidPeiffer 5y agoKaiser Health News and Kaiser Permanente are independent organizations, through they come from the same original funder. Here's a page going through the story. An Arm and A Leg is a really interesting podcast partially funded by Kaiser Health News that does similar stories to this one, going through the ridiculousness of the whole US Healthcare system and how people have successfully navigated it. https://armandalegshow.com/about-x/partners-and-supporters/kaiserhealthnews/ https://armandalegshow.com/about-x/partners-and-supporters/k...
- cmmeur01 5y agoUsed to do these “pre-authorizations” for Humana and wanted to kill myself after a week. Seniors write in about how they’re eating dog food to pay for their medicine, I forward the letter to insurance doctors, who deny it because they “have to try these 3 drugs before you can get what works”. Made me realize this whole country is broken and those at the top are morally bankrupt.
- Abishek_Muthian 5y agoNot just your country, Nothing throws spotlight on how wonderful capitalism has become(/s) like checking out health insurance industry in almost every country without a socialized health-care. Okay may be private-prisons would come close second. I get denied health insurance policy itself due to my physical disabilities against the local laws and regulations in my country[1]. That includes major International brands. How can I put this gently, capitalism thinks I'm not worth living or saving. [1] https://abishekmuthian.com/insurers-are-putting-the-lives-of-sick-and-disabled-at-risk-during-covid-19-pandemic/ https://abishekmuthian.com/insurers-are-putting-the-lives-of...
- refurb 5y agoWhy is that broken? Even systems with universal healthcare have rules like this. Why use a $1000 per month branded drug unless you know the $5 per month generic drug doesn’t work?
- peteradio 5y agoIf you have a past knowledge that the generic doesn't work and you also save money by withholding the real treatment, then that seems perverse.
- kemiller2002 5y agoIt's because a lot of times the doctors know it isn't going to work on the outset. A number of generics don't work exactly the same. You're punishing the patient and questioning the expert simply for the fact that the insurance company (or the government in the case of geriatrics) might save a few dollars.
- nine_zeros 5y agoPrice aside, the biggest problem with American health care system is the administrative black hole at every stage. Wife was on some serious (and expensive) medical treatment. After many months, the medical provider was at the final stages of the treatment. As usual, the provider needs insurance approval for arcane codes that constitute that segment of the treatment. Get this, the medical provider applies for approval using a FAX. There is no acknowledgement or online tracking. And the authorization is received back using FAX. What a joke! My wife didn't hear about the treatment for 3 weeks. Under pressure, she called her insurance. Insurance says, they didn't receive any request for authorization. Why the fuck didn't the medical provider follow up? Exact question asked by my wife. Medical provider's explanation was that they faxed and were just waiting on insurance. They just sat on their fat bums while the time was running out. So, wife patiently asked medical provider to apply for authorization again. The provider said they sent another request right away. Another week later, wife had to call insurance again to find out that they STILL DID NOT receive any request. Distraught wife asked insurance rep to call the medical provider immediately. Of course the call went to voice mail. Wife then called the medical provider and left a scathing voicemail, threatening to sue. Only then this system worked miraculously. It still took a day for the medical provider to figure out what was wrong with their fax system. It still required my wife to follow up with insurance asking if they received the authorization request. Then 3 days later, the insurance provider approved the authorization and my wife had to call the medical provider again to confirm that the authorization was received. All good now? Ohhh Noooo. Now the medical provider placed an order for medication that needs to be shipped from a pharmacy in another state. And they do place it. Now my wife gets a call from the shipping pharmacy to schedule a delivery. The delivery happens after 3 days. Wife checks the delivery. Oops, it is missing a few items required for treatment. Guess what she needs to do to get the missing items delivered? You guessed it. Have the medical provider do the authorization process ALL OVER AGAIN. Oh, and every call to the medical provider goes to a voicemail to which they take a minimum of 8 hours to reply and every call to insurance has a 30 min elevator music. Imagine all this 10 times in 3 weeks and that was just one round of shipping and nervousness. Fuck American Healthcare.
- agumonkey 5y agoSome countries have been jumping so far ahead. IIRC Slovakia, Iceland have ultra lean administrative processes in lots of places. Minutes instead of days or more, and non hassle. UK has some of that too. France is starting. Someone in the US should get funding for this. It's a 300M people's "market".
- lil_dispaches 5y agoHealth Insurance is a political scam of epic proportions. There is no indemnity involved. It is not real insurance. You don't use insurance to pay a monthly bill, you have it for black swan events. Nor should insulin be 1000/mo, on paper or otherwise. The whole thing is performance politics to distract from the "insurance" companies running everything from medicine regulations to your kids playgrounds (so they don't hurt themselves and need care).
- lotsofpulp 5y agoHealth insurance in the US has an in network out of pocket maximum of $8,700 for individual and $17,400 for families: https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/ https://www.healthcare.gov/glossary/out-of-pocket-maximum-li... With the recent laws regarding mandatory coverage of emergencies while out of network, it seems to qualify for the definition of “insurance”, as you are protected from expenses above $17.4k per calendar year per family. The fact that most Americans probably cannot afford this is a separate matter, but it is more insurance than it has ever been in the US.
- cascom 5y agoTo your last point I wonder what the effect of not allowing a provider to charge a different price for the same service/product would be.
- hallway_monitor 5y agoThis is a really interesting idea. Seems like it would kind of level the playing field and might help guide us toward what I think is the ideal situation - no one needs health insurance other than for a catastrophic event because prices are known and reasonable and you just pay them, like literally every other service we need and consume.
- lotsofpulp 5y agoThat is supposedly the goal of high deductible health plans and HSAs.
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- cascom 5y agoWe (Americans) are in this situation simply because we have avoided making hard decisions in our healthcare system, and in many cases created actually done things that break the system further (limited to no healthcare rationing in Medicare, mandatory acceptance of pre existing conditions, attaching private insurance to one’s employer rather than the individual, etc.) In short we haven’t come to a consensus as to derivation of the engineering axiom, you can have 1) broader access 2) quantity/quality 3) affordability —-pick two
- deleted 5y ago[deleted]