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if the government directly subsidized healthcare instead of relying on the insurance middlemen to perform its duties, this wouldn't be an issue.

JumpCrisscross 2y ago
> if the government directly subsidized healthcare instead of relying on the insurance middlemen to perform its duties, this wouldn't be an issue Most psychiatrists I know refuse to take Medicare because it has the same paperwork and pricing issues.
- CPLX 2y ago
  Medicare is not direct. Direct would be if the therapist worked, on salary, as a therapist, and received a paycheck from the government.
  - lolinder 2y ago
    That isn't what "directly subsidized" means, though, that's "directly run". A subsidy is a strictly monetary arrangement, not one where the government actually becomes the employer.
  - jerkstate 2y ago
    Tricare is perhaps the closest thing we have to direct government healthcare, it handles healthcare for active duty military, it is part of the DoD and contracts out to providers directly (including therapists) and compared to other private insurers they are among the most difficult to work with. My partner is an independent psychotherapist and contracts with various healthcare providers and Tricare has by far the highest rate of spurious rejections, short paychecks, heavy audit requirements, etc and their resolution department is the hardest to work with. So we already have evidence of how it goes when the government manages it directly and it’s worse than private industry.
nradov 2y ago
It would still be an issue. Even countries with socialized or heavily subsidized healthcare systems tend to have long waiting lists for therapists and strict limits on the number of sessions. Services are rationed everywhere.
nanoxide 2y ago
The issue is similar in Germany, where the vast majority has mandatory insurance: Too few therapists for too many people. Even in large cities you might wait months, if they even have waiting lists. It's much easier if you pay by yourself.
- jononor 2y ago
  Same in Norway, which has a directly subsidized phealthcare system for all.
- ransom1538 2y ago
  Canada: Sure you will never see a doctor, but, when you do it is free!
  - suzumer 2y ago
    Do you live in Canada?
    - Suppafly 2y ago
      >Do you live in Canada? I'm guessing they don't. As a US person we hear a lot of, presumably insurance company sponsored, anti-Canadian-healthcare propaganda and then dumb people repeat it online.
  - HeatrayEnjoyer 2y ago
    Better than never seeing one at all because you can't afford it.
  - dghlsakjg 2y ago
    Canada’s healthcare is managed at the provincial level. So you’re comment is pretty reductive and unrepresentative of many places. This is my experience in BC as an American immigrant. It doesn’t apply to Toronto or Ontario. Counselors are very easy to find. I had my pick and the wait was about a week. The province didn’t cover it in my case but my extended benefits did. Most of the ones I talked to offer pay scales based on extended insurance coverage, and many will provide pro bono care. Some counselors are covered by the province if you get a referral from a doctor. The longest I’ve personally waited to see a general doctor is 6 hours at an ER on a weekend night, typically the wait is about an hour if you go to a clinic in the morning without an appointment. For specialists, appointments are done on a triage system with a referral. If your case is urgent, or worsening you typically get seen asap. I’ve seen MRIs get done same day, or take as long as six months for non-urgent needs. What I’ve never seen is someone wait a day with a broken arm to make sure they actually need to see a doctor because they can’t afford it. That’s something I saw twice in college in the states. I’ve also seen people get referred to a specialist and never get seen because their insurance wouldn’t cover it. Also seen people declare bankruptcy over medical debts in the states despite having insurance. Canada’s healthcare system could be improved, but if you have ever dealt with low end insurance or uninsured healthcare in the states, you would understand how much better the system is here.
lolinder 2y ago
I take it you haven't ever interacted with the IRS beyond filing the standard deduction? Or interacted with Medicare/Medicaid? The only issue raised by OP that would go away if it were managed by a US government bureaucracy instead of a private company would be people running out of coverage, and that only if healthcare were subsidized universally. And to preempt the comments saying it doesn't have to be this way: it doesn't matter what if US government bureaucracies are incompetent by the design of politicians or by necessity, the point is that they are, and the idea that this case would be the exception is just wishful thinking.
- wbl 2y ago
  I fucked up my taxes one year. I filled out the form letting them know I had made a mistake and paying the amount and that was the end of that.
  - lolinder 2y ago
    I messed up an insurance deadline one year. I called in and they sorted it out. I didn't say the IRS was worse, I just said it wasn't any better.
    - glenstein 2y ago
      Right but I think the point is that it is better at the end of the day. Since we're all sharing our anecdotes, I am familiar with someone who works in a municipality where their entire job revolves around billing and claims for EMS. The amount of extreme cases of stonewalling, long holds, call transfers, inconsistent interpretations of policy, requests for faxes that get lost, requests for new paperwork, and general lack of urgency, across numerous companies in numerous states, is mind boggling, and easily an order of magnitude more extreme the IRS experiences I've seen shared here.
- beedeebeedee 2y ago
  Government support should start a few steps before payment and filing taxes. The solutions that would fix this problem are analogous with having free education instead of student loans
mnky9800n 2y ago
No this doesn't work. In Norway there is typically a minimum 6 month wait. Or you can see a private person who takes money today. Same in Germany, and the Netherlands, and basically everywhere else I lived that has subsidized healthcare. It's one of the things that falls through the cracks in my experience.
- mewpmewp2 2y ago
  Yeah or even something like mental health it is impossible to get anything. I also pay for everything mental health related despite having universal health care.
- krageon 2y ago
  Yes, but then if you have the kind of systemic issues that need mental health care an extra six months isn't going to break the bank. It's unpleasant and a long time, but it's a pretty far cry from the US nightmare scenario
- notepad0x90 2y ago
  a) we're rich in the US compared to even Norway b) it's better than what we have, private options will always be there, they just won't be the only options with government competition.
  - PretzelJudge 2y ago
    No we are not. The US has a much higher GDP per capita than most of Europe, but not Norway.
    - notepad0x90 2y ago
      But a higher overall GDP (per-capita aside) than even Norway right? We're already spending more than any other country on the planet on healthcare. Look at the table here: https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... The US is spending 50% more per-capita than Norway already and we are worse off. This doesn't include private insurance money which is insane amounts already.
victorbjorklund 2y ago
in sweden it is almost impossible to find a psycologist. Many years of waiting and that is only if you are an extreme case. If you are just average depressed you can just dream about getting one in your lifetime.

JumpCrisscross 2y ago

> if the government directly subsidized healthcare instead of relying on the insurance middlemen to perform its duties, this wouldn't be an issue Most psychiatrists I know refuse to take Medicare because it has the same paperwork and pricing issues.

CPLX 2y ago
Medicare is not direct. Direct would be if the therapist worked, on salary, as a therapist, and received a paycheck from the government.
- lolinder 2y ago
  That isn't what "directly subsidized" means, though, that's "directly run". A subsidy is a strictly monetary arrangement, not one where the government actually becomes the employer.
- jerkstate 2y ago
  Tricare is perhaps the closest thing we have to direct government healthcare, it handles healthcare for active duty military, it is part of the DoD and contracts out to providers directly (including therapists) and compared to other private insurers they are among the most difficult to work with. My partner is an independent psychotherapist and contracts with various healthcare providers and Tricare has by far the highest rate of spurious rejections, short paychecks, heavy audit requirements, etc and their resolution department is the hardest to work with. So we already have evidence of how it goes when the government manages it directly and it’s worse than private industry.

nradov 2y ago

It would still be an issue. Even countries with socialized or heavily subsidized healthcare systems tend to have long waiting lists for therapists and strict limits on the number of sessions. Services are rationed everywhere.

nanoxide 2y ago

The issue is similar in Germany, where the vast majority has mandatory insurance: Too few therapists for too many people. Even in large cities you might wait months, if they even have waiting lists. It's much easier if you pay by yourself.

jononor 2y ago
Same in Norway, which has a directly subsidized phealthcare system for all.
ransom1538 2y ago
Canada: Sure you will never see a doctor, but, when you do it is free!
- suzumer 2y ago
  Do you live in Canada?
  - Suppafly 2y ago
    >Do you live in Canada? I'm guessing they don't. As a US person we hear a lot of, presumably insurance company sponsored, anti-Canadian-healthcare propaganda and then dumb people repeat it online.
- HeatrayEnjoyer 2y ago
  Better than never seeing one at all because you can't afford it.
- dghlsakjg 2y ago
  Canada’s healthcare is managed at the provincial level. So you’re comment is pretty reductive and unrepresentative of many places. This is my experience in BC as an American immigrant. It doesn’t apply to Toronto or Ontario. Counselors are very easy to find. I had my pick and the wait was about a week. The province didn’t cover it in my case but my extended benefits did. Most of the ones I talked to offer pay scales based on extended insurance coverage, and many will provide pro bono care. Some counselors are covered by the province if you get a referral from a doctor. The longest I’ve personally waited to see a general doctor is 6 hours at an ER on a weekend night, typically the wait is about an hour if you go to a clinic in the morning without an appointment. For specialists, appointments are done on a triage system with a referral. If your case is urgent, or worsening you typically get seen asap. I’ve seen MRIs get done same day, or take as long as six months for non-urgent needs. What I’ve never seen is someone wait a day with a broken arm to make sure they actually need to see a doctor because they can’t afford it. That’s something I saw twice in college in the states. I’ve also seen people get referred to a specialist and never get seen because their insurance wouldn’t cover it. Also seen people declare bankruptcy over medical debts in the states despite having insurance. Canada’s healthcare system could be improved, but if you have ever dealt with low end insurance or uninsured healthcare in the states, you would understand how much better the system is here.

lolinder 2y ago

I take it you haven't ever interacted with the IRS beyond filing the standard deduction? Or interacted with Medicare/Medicaid? The only issue raised by OP that would go away if it were managed by a US government bureaucracy instead of a private company would be people running out of coverage, and that only if healthcare were subsidized universally. And to preempt the comments saying it doesn't have to be this way: it doesn't matter what if US government bureaucracies are incompetent by the design of politicians or by necessity, the point is that they are, and the idea that this case would be the exception is just wishful thinking.

wbl 2y ago
I fucked up my taxes one year. I filled out the form letting them know I had made a mistake and paying the amount and that was the end of that.
- lolinder 2y ago
  I messed up an insurance deadline one year. I called in and they sorted it out. I didn't say the IRS was worse, I just said it wasn't any better.
  - glenstein 2y ago
    Right but I think the point is that it is better at the end of the day. Since we're all sharing our anecdotes, I am familiar with someone who works in a municipality where their entire job revolves around billing and claims for EMS. The amount of extreme cases of stonewalling, long holds, call transfers, inconsistent interpretations of policy, requests for faxes that get lost, requests for new paperwork, and general lack of urgency, across numerous companies in numerous states, is mind boggling, and easily an order of magnitude more extreme the IRS experiences I've seen shared here.
beedeebeedee 2y ago
Government support should start a few steps before payment and filing taxes. The solutions that would fix this problem are analogous with having free education instead of student loans

mnky9800n 2y ago

No this doesn't work. In Norway there is typically a minimum 6 month wait. Or you can see a private person who takes money today. Same in Germany, and the Netherlands, and basically everywhere else I lived that has subsidized healthcare. It's one of the things that falls through the cracks in my experience.

mewpmewp2 2y ago
Yeah or even something like mental health it is impossible to get anything. I also pay for everything mental health related despite having universal health care.
krageon 2y ago
Yes, but then if you have the kind of systemic issues that need mental health care an extra six months isn't going to break the bank. It's unpleasant and a long time, but it's a pretty far cry from the US nightmare scenario
notepad0x90 2y ago
a) we're rich in the US compared to even Norway b) it's better than what we have, private options will always be there, they just won't be the only options with government competition.
- PretzelJudge 2y ago
  No we are not. The US has a much higher GDP per capita than most of Europe, but not Norway.
  - notepad0x90 2y ago
    But a higher overall GDP (per-capita aside) than even Norway right? We're already spending more than any other country on the planet on healthcare. Look at the table here: https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... The US is spending 50% more per-capita than Norway already and we are worse off. This doesn't include private insurance money which is insane amounts already.

victorbjorklund 2y ago

in sweden it is almost impossible to find a psycologist. Many years of waiting and that is only if you are an extreme case. If you are just average depressed you can just dream about getting one in your lifetime.