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I don't have any experience with US healthcare, but presumably having insurance and whatever conditions they enforce is basically a form of socialized healthcar

I don't have any experience with US healthcare, but presumably having insurance and whatever conditions they enforce is basically a form of socialized healthcare, no? If one wanted to, couldn't they find a provider they could pay to deal with whatever issue immediately?

aidenn0 4y ago
There are three main types of insurance in the US: HMO, PPO, and EPO. HMO works a lot like my understanding of the UK system (except the government doesn't pay for it); if you want to see a specialist, you need to get permission from the insurance provider, either directly, or (more typically) by having your GP (a.k.a "primary care provider) write you a referral. PPO and EPO do not require referrals. A PPO typically has high deductibles for doctors that are not contracted with the PPO, and an EPO does not provide any coverage for doctors that aare not contracted with it (the P vs E is "preferred" vs "exclusive"). PPOs tend to have the highest premiums. Anecdotally, HMOs used to be a pretty good deal. From my earliest memories of how health-care worked HMOs didn't add too large of a delay. However, more recently it has been harder to get a referral, and once I get the referral, there are so few local places that accept the HMO (perhaps because of below-market rates paid out?) that a 6+ month wait list to see a specialist is not uncommon (some things like physical therapy having such a long wait-list that it's hardly worth it; I was quoted an 8 month wait list for PT for a shoulder injury, at which point I just googled for exercises I could do). Also twice now I have been hit by the HMO refusing to pay for emergency care because even though the ER I took my kid to was "in-network" one of the doctors who saw the kid at the ER was an independent contractor which isn't covered by the HMO. Over $1k out-of-pocket each time.
- arghnoname 4y ago
  This is a good summary. What's interesting to me to observe here is your PT story is the system working as designed. This intention is not hidden. If one could just google the solution to their problem instead of using scarce resources, as the common phrase goes, that's a good thing actually. We do an awful lot of rationing in these sorts of ways. It's maddening to me that I pay the astronomical premiums I pay and yet, end up having to play mini-doctor by asking the internet for answers. I do not have any illusions that I'm able to provide sound medical advice to myself or others, but just due to these sorts of issues and also doctors visits that are practically conducted via drive-through, Google MD is often my doctor / PT person / etc of first resort.
  - aidenn0 4y ago
    If you substitute "google the problem" for "get a printout from my doctor that isn't from a possibly sketchy internet source" I would be a lot happier.
aidenn0 4y ago
> If one wanted to, couldn't they find a provider they could pay to deal with whatever issue immediately? If you live in or near a large town, yes, but the price will likely be 4-8x what your insurance company would pay for the same services, and you can't get a quote in advance.

aidenn0 4y ago

There are three main types of insurance in the US: HMO, PPO, and EPO. HMO works a lot like my understanding of the UK system (except the government doesn't pay for it); if you want to see a specialist, you need to get permission from the insurance provider, either directly, or (more typically) by having your GP (a.k.a "primary care provider) write you a referral. PPO and EPO do not require referrals. A PPO typically has high deductibles for doctors that are not contracted with the PPO, and an EPO does not provide any coverage for doctors that aare not contracted with it (the P vs E is "preferred" vs "exclusive"). PPOs tend to have the highest premiums. Anecdotally, HMOs used to be a pretty good deal. From my earliest memories of how health-care worked HMOs didn't add too large of a delay. However, more recently it has been harder to get a referral, and once I get the referral, there are so few local places that accept the HMO (perhaps because of below-market rates paid out?) that a 6+ month wait list to see a specialist is not uncommon (some things like physical therapy having such a long wait-list that it's hardly worth it; I was quoted an 8 month wait list for PT for a shoulder injury, at which point I just googled for exercises I could do). Also twice now I have been hit by the HMO refusing to pay for emergency care because even though the ER I took my kid to was "in-network" one of the doctors who saw the kid at the ER was an independent contractor which isn't covered by the HMO. Over $1k out-of-pocket each time.

arghnoname 4y ago
This is a good summary. What's interesting to me to observe here is your PT story is the system working as designed. This intention is not hidden. If one could just google the solution to their problem instead of using scarce resources, as the common phrase goes, that's a good thing actually. We do an awful lot of rationing in these sorts of ways. It's maddening to me that I pay the astronomical premiums I pay and yet, end up having to play mini-doctor by asking the internet for answers. I do not have any illusions that I'm able to provide sound medical advice to myself or others, but just due to these sorts of issues and also doctors visits that are practically conducted via drive-through, Google MD is often my doctor / PT person / etc of first resort.
- aidenn0 4y ago
  If you substitute "google the problem" for "get a printout from my doctor that isn't from a possibly sketchy internet source" I would be a lot happier.

aidenn0 4y ago

> If one wanted to, couldn't they find a provider they could pay to deal with whatever issue immediately? If you live in or near a large town, yes, but the price will likely be 4-8x what your insurance company would pay for the same services, and you can't get a quote in advance.