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Anyone trying to picture a US “universal healthcare”, I want you to think back to your last trip to the DMV. The experience dealing with almost any aspect of ou

Anyone trying to picture a US “universal healthcare”, I want you to think back to your last trip to the DMV. The experience dealing with almost any aspect of our government is fraught with paperwork, delays, forms to fill out, “oh you want this other department” circular loops. You can put up with this torture for the “privilege” to drive a car, but you don’t get to force me to deal with this so I can get healthcare when/how I want to. A while ago I went to an endoscopy clinic, and there was a woman crying and pleading with the secretary because her husband has cancer and couldn’t get treated on the day of his appointment because some medicaid paperwork didn’t go through regarding his diagnosis and thus medicaid wouldn’t approve the procedure yet.

andrewjf 5y ago
Sounds like dealing with private insurance, as well. With the added benefit of getting bankrupted, even if insured.
csnover 5y ago
Instead of telling people to make dishonest comparisons to unrelated bureaucracies, I’d recommend that they instead find someone who has actually used Original Medicare[0] (not Medicaid, which is a different thing) if they want to know what it is like to use Original Medicare. The amount of bureaucracy on the patient side is basically zero. My personal experience with Original Medicare + Medigap has essentially been this: Step 1. Need some health service. Step 2. Go get the health service. Step 3. There is no step 3, unless the provider fucks up and tries to bill the Medigap insurer as the primary insurer—which is a problem caused by the existence of private primary insurers, not Medicare. And with private insurers, this: Step 1. Need some health service. Step 2. Check if the provider is in-network. Step 3. Check if the facility is in-network. Step 4. Check if the service is covered by the insurance. Step 5. Submit a prior authorisation or else the insurer won’t pay anything at all. Step 6. Get denied for some asinine technicality. Step 7. Appeal and submit more documentation until they finally capitulate. (Also, you’re doing this while very sick.) Step 8. Triple-check with the facility that they are only going to use in-network doctors for things like anaesthesiology. Step 9. Go get the health service. Step 10. Get a half-dozen gigantic bills in the mail. There are certainly issues with Medicare, but I can’t think of any that aren’t the result of for-profit insurers or government abolitionists doing everything in their power to make the system intentionally terrible. [0] As mentioned in the article, Original Medicare is parts A & B. Part C—Medicare “Advantage”—is the government hand-out to private insurers.
- fallingknife 5y ago
  I'm no fan of our current healthcare system, but your description of dealing with private insurance is very much at odds with my experience. It has always been very simple and easy for me. (Doctors are a another story)
  - csnover 5y ago
    There are a lot of factors that determine how hard private insurers are to deal with—the kind of plan you have, the type and intensity of care you need, and the quality of the providers in your area/network—so experiences will vary significantly. I am genuinely glad it has not been so bad for you, and I’d love to say my experience with private insurers is the outlier, but unfortunately I suspect it is the other way around. Every US-based friend or family member of mine has at least one horror story about a surprise bill, a Kafkaesque nightmare of denials and prior auths, being unable to afford their medications or doctor visits, unrealistically low annual visit limits (Depressed? No more than 12 visits per year to a therapist should cure that!), “copay accumulators”, and on and on. The podcast An Arm And A Leg[0] offers a disturbingly wide variety of stories of this bullshit and all the things you have to learn just to protect yourself from getting completely screwed in America’s privatised health care system. It’s endless, and it’s exhausting, and it’s even more exhausting when folks like the OP show up to make baseless claims that government-run care is somehow going to be like going to the DMV because they’ve swallowed this “government is the problem” bullshit. I’m not going to sit here and say governments are infallible, or that Medicare is perfect, because they aren’t and it isn’t. But do you know which insurance plans in the US have the highest patient satisfaction ratings? The government-run ones[1]! [0] https://armandalegshow.com/ https://armandalegshow.com/ [1] https://www.insure.com/health-insurance/health-insurance-satisfaction-index/ https://www.insure.com/health-insurance/health-insurance-sat...
  - WarChortle18 5y ago
    I never had a problem either until you try to anything outside of the ordinary. My wife needed some special treatment it was a nightmare to get approved I wasted hours on the phone to be told that the procedure was through another insurance company my company hired for this special procedure. They made so many mistakes I had to call once a week. At one point I had a 4 way conference call between both companies and a special hr person from my company to get this shit sorted out. That is what pushed me to socialized healthcare private insurers can get fucked.
adamredwoods 5y ago
>> I want you to think back to your last trip to the DMV. I made an appointment and it was quick and easy, but I do agree some government services are painful and slow. >> because some medicaid paperwork didn’t go through regarding his diagnosis Medicaid budgets are almost always in flux, which creates service disruptions. From 2020: https://www.salon.com/2020/05/16/as-millions-lose-insurance-states-cut-medicaid-in-response-to-the-coronavirus-crisis/ https://www.salon.com/2020/05/16/as-millions-lose-insurance-...
nickd2001 5y ago
"Anyone trying to picture a US “universal healthcare”, I want you to think back to your last trip to the DMV. " - I think the truth in this, is the USA needs to solve the meta problem of having well-run government systems, before it can attempt universal healthcare. For various reasons, while the USA is excellent at many things, its poor compared to other countries, at running public services. It seems like a self-fulfilling prophecy to me. Americans don't believe gov't can run things well, therefore they don't even try, therefore it doesn't happen. When Ronald Reagan famously said the 9 scariest words were "I'm from the gov't and I'm here to help" , that message would have landed flat and made no sense to Europeans and Canadians, but in the USA that fits with people's experience. One big thing is the lack of an independent civil service in the USA. If I understand correctly, in the US when a new administration comes in they effectively fire all the managers and put their own people in charge. Whereas in the UK for example, there's an independent civil service who operate by a code of unbiasedly serving whatever administration is in and implementing their policies. While this means that sometimes there same people in their career implement one thing, then roll it back, then re-implement it, as governments change, and this may sound inefficient, in practice this means the public services carry on running reasonably well despite the wins and crazinesses of certain politicians that come and go.

andrewjf 5y ago

Sounds like dealing with private insurance, as well. With the added benefit of getting bankrupted, even if insured.

csnover 5y ago

Instead of telling people to make dishonest comparisons to unrelated bureaucracies, I’d recommend that they instead find someone who has actually used Original Medicare[0] (not Medicaid, which is a different thing) if they want to know what it is like to use Original Medicare. The amount of bureaucracy on the patient side is basically zero. My personal experience with Original Medicare + Medigap has essentially been this: Step 1. Need some health service. Step 2. Go get the health service. Step 3. There is no step 3, unless the provider fucks up and tries to bill the Medigap insurer as the primary insurer—which is a problem caused by the existence of private primary insurers, not Medicare. And with private insurers, this: Step 1. Need some health service. Step 2. Check if the provider is in-network. Step 3. Check if the facility is in-network. Step 4. Check if the service is covered by the insurance. Step 5. Submit a prior authorisation or else the insurer won’t pay anything at all. Step 6. Get denied for some asinine technicality. Step 7. Appeal and submit more documentation until they finally capitulate. (Also, you’re doing this while very sick.) Step 8. Triple-check with the facility that they are only going to use in-network doctors for things like anaesthesiology. Step 9. Go get the health service. Step 10. Get a half-dozen gigantic bills in the mail. There are certainly issues with Medicare, but I can’t think of any that aren’t the result of for-profit insurers or government abolitionists doing everything in their power to make the system intentionally terrible. [0] As mentioned in the article, Original Medicare is parts A & B. Part C—Medicare “Advantage”—is the government hand-out to private insurers.

fallingknife 5y ago
I'm no fan of our current healthcare system, but your description of dealing with private insurance is very much at odds with my experience. It has always been very simple and easy for me. (Doctors are a another story)
- csnover 5y ago
  There are a lot of factors that determine how hard private insurers are to deal with—the kind of plan you have, the type and intensity of care you need, and the quality of the providers in your area/network—so experiences will vary significantly. I am genuinely glad it has not been so bad for you, and I’d love to say my experience with private insurers is the outlier, but unfortunately I suspect it is the other way around. Every US-based friend or family member of mine has at least one horror story about a surprise bill, a Kafkaesque nightmare of denials and prior auths, being unable to afford their medications or doctor visits, unrealistically low annual visit limits (Depressed? No more than 12 visits per year to a therapist should cure that!), “copay accumulators”, and on and on. The podcast An Arm And A Leg[0] offers a disturbingly wide variety of stories of this bullshit and all the things you have to learn just to protect yourself from getting completely screwed in America’s privatised health care system. It’s endless, and it’s exhausting, and it’s even more exhausting when folks like the OP show up to make baseless claims that government-run care is somehow going to be like going to the DMV because they’ve swallowed this “government is the problem” bullshit. I’m not going to sit here and say governments are infallible, or that Medicare is perfect, because they aren’t and it isn’t. But do you know which insurance plans in the US have the highest patient satisfaction ratings? The government-run ones[1]! [0] https://armandalegshow.com/ https://armandalegshow.com/ [1] https://www.insure.com/health-insurance/health-insurance-satisfaction-index/ https://www.insure.com/health-insurance/health-insurance-sat...
- WarChortle18 5y ago
  I never had a problem either until you try to anything outside of the ordinary. My wife needed some special treatment it was a nightmare to get approved I wasted hours on the phone to be told that the procedure was through another insurance company my company hired for this special procedure. They made so many mistakes I had to call once a week. At one point I had a 4 way conference call between both companies and a special hr person from my company to get this shit sorted out. That is what pushed me to socialized healthcare private insurers can get fucked.

adamredwoods 5y ago

>> I want you to think back to your last trip to the DMV. I made an appointment and it was quick and easy, but I do agree some government services are painful and slow. >> because some medicaid paperwork didn’t go through regarding his diagnosis Medicaid budgets are almost always in flux, which creates service disruptions. From 2020: https://www.salon.com/2020/05/16/as-millions-lose-insurance-states-cut-medicaid-in-response-to-the-coronavirus-crisis/ https://www.salon.com/2020/05/16/as-millions-lose-insurance-...

nickd2001 5y ago

"Anyone trying to picture a US “universal healthcare”, I want you to think back to your last trip to the DMV. " - I think the truth in this, is the USA needs to solve the meta problem of having well-run government systems, before it can attempt universal healthcare. For various reasons, while the USA is excellent at many things, its poor compared to other countries, at running public services. It seems like a self-fulfilling prophecy to me. Americans don't believe gov't can run things well, therefore they don't even try, therefore it doesn't happen. When Ronald Reagan famously said the 9 scariest words were "I'm from the gov't and I'm here to help" , that message would have landed flat and made no sense to Europeans and Canadians, but in the USA that fits with people's experience. One big thing is the lack of an independent civil service in the USA. If I understand correctly, in the US when a new administration comes in they effectively fire all the managers and put their own people in charge. Whereas in the UK for example, there's an independent civil service who operate by a code of unbiasedly serving whatever administration is in and implementing their policies. While this means that sometimes there same people in their career implement one thing, then roll it back, then re-implement it, as governments change, and this may sound inefficient, in practice this means the public services carry on running reasonably well despite the wins and crazinesses of certain politicians that come and go.