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I wonder how much stress over money affects the health of patients. It's just the last thing you want to worry about when your body is failing. I also think th
by purplelobster 14y ago
I wonder how much stress over money affects the health of patients. It's just the last thing you want to worry about when your body is failing.
I also think the system puts too much stress on relatives and the patient when it comes to choices and bureaucracy. Coming from Sweden, just having to choose between 7-8 different insurance plans is headache enough, but to have to choose your doctor, your hospital etc is just too much. I don't want to have to think about it. Americans seem to value choice and being able to shop around much more highly than I do. "Being a good consumer". I can intellectually understand why, but making choices all the time for everything is very taxing and energy consuming, and at some point I just want to be taken care of.
- philwelch 14y agoWhat happens in Sweden? Does the state assign a doctor to you? What happens if you don't like that doctor and want a different one? I wouldn't want to do away with the freedom of choice, convenient as it may be to have a default. Besides, once you've chosen all those things you can just stick with them for years on end.
- goodcanadian 14y agoI can't comment on Sweden, but in Canada, you essentially go to any doctor you want. It was in the US, where the insurance company more-or-less assigned a doctor, that I lacked freedom of choice.
- philwelch 14y agoThat depends on your insurance company, too. In my city it's not a big problem.
- purplelobster 14y agoI'm sure you can choose if you really really want to, but there are sensible default options. The way it should be in my opinion: 1. Go to nearest hospital, no need to worry about insurance or whether it's a "preferred" hospital for your insurance company. 2. Get assigned doctor(s) based on your needs. 3. Get treatment. No need to check what treatments are covered and if your doctor is trying to screw you over with unnecessary expensive tests. 3. Relax. No paperwork because there is a unified information system. No insurance paperwork because it's all covered. I think it's difficult to imagine how much easier it can be, when you're used to dealing with heavy bureaucracy and insurance companies. I can't explain how much less stressed I was in that system. Then again, I'm even stressed about owning a car with all that entails in terms of check-ups, oil changes, repairs, insurance, expiring licenses, parking etc. Perhaps other people are better at dealing with this crap than I am.
- philwelch 14y agoFor regular doctor's appointments, I don't go to the hospital, I just go to my doctor's office. I can imagine pretty well. When things are set up with good insurance coverage, it's hardly any different than what you described, maybe with the exception of preferred networks, but in my city I've never had any doctor fall outside of the preferred network for my insurance anyway. Everything is either covered from the insurance or you get a straightforward bill, and even then you can get an HSA to cover your out-of-pocket expenses with some insurance plans. I've never had to deal with insurance paperwork either, aside from collecting my insurance card from the mail and presenting it at the doctor's office. It can easily be much, much worse though.
- purplelobster 14y agoWell, obviously there are exceptions, but I wouldn't measure or defend a system based on the best case, but the average and standard deviation. Unfortunately, a huge amount of people are falling through the cracks. Sweden's system might be worse for rich/upper middle class people, but the average case is more than acceptable and the deviation is small. For instance, if you come in with a non life threatening condition, you will have to wait. That could mean waiting months for a specific surgery that you might get instantly in the US if you had good insurance. That kinda sucks when you have to wait and you're in pain, but is understandable unless you want to spend 50% of GDP on health care, or prioritize people based on how much they earn.
- philwelch 14y agoHistorically, rich people from countries with socialized medicine would fly to the United States for medical treatment. We could stand to improve the quality of care for the poor in the US, but there's lots of room to do that in the existing system. For people who have health insurance benefits from their work, I think having a little bit more paperwork is better than waiting for months for surgery.
- purplelobster 14y ago
- polymatter 14y agoAlso can't comment on Sweden, but in the UK its any qualified doctor you want. And its very quick and painless to change.
- _delirium 14y agoI'm an American who typically values choice and being able to shop around, but I agree that it ends up creating this sort of unpleasant situation in healthcare. Lots of reasons, but two big ones are: 1) lots of buyers who cannot say no, e.g. someone in an ambulance on a way to a hospital is not in a strong negotiating position; and 2) the insurance model doesn't work that well, because incidents are strongly correlated within an individual's lifetime (hence the notion of "preexisting conditions" and the need for employer-tied group plans to pool risk without adverse selection), not independently insurable. I live in Denmark currently, and I do find the healthcare system here a lot more sane. I have some choice; for example, I can choose a doctor. On that angle I actually have more choice: I can choose any doctor, and keep him/her, whereas in the U.S. I had to give up the doctor I liked when I was a kid, because my dad's company changed insurance plans and my doctor wasn't covered by the new one. And I don't have a huge bureaucratic mess of insurances and plans and bills to deal with, or worry about how changes in my employment will affect my coverage.
- javert 14y agoPlease realize that the current horrible insurance system is almost entirely a product of government regultory practice.
- _delirium 14y agoI disagree; government regulatory practice is mainly taking some of the worse edges off the inherently broken model of "healthcare as insurance". I'm thinking particularly of major conditions. I think regular office visits could probably be paid for out of pocket, but the real money is going towards hospitals, and that's also where free-market solutions don't work at all. In particular, I don't see how an unregulated system would solve the correlation-across-lifetime problems. A friend of mine was born with a congenital heart defect, a "preexisting condition" since birth. In a free market, it actuarially makes little sense to sell him insurance at any kind of affordable rate, because the uncertain event already happened (he lost a particular lottery at birth). And in a really free market, that would apply to many more people, because rational insurance companies would require genetic screening before allowing coverage (which they currently can't), allowing them to uncover all sorts of less obvious genetic lottery losers. Put differently, the random risk being insured is, in large part, entire lifetimes, which the insurance market cannot handle, particularly if you think individuals should have some kind of choice (vs. some kind of setup where parents have to buy their offspring's lifetime health insurance pre-conception). Risk pooling across a large corporation's employees is sort of a hack to approximate the needed across-population risk pooling, in the absence of a true socialized risk pool. That hack has let he U.S. hobble through much of the post-WW2 era, since a large percentage of Americans had employment-for-life at large companies, but it's poorly suited to a world of freelancers and job-hopping.
- javert 14y agomaking choices all the time for everything is very taxing and energy consuming, and at some point I just want to be taken care of That seems shockingly lazy to me, and possibly dangerous.
- purplelobster 14y agoLet me clarify that when I'm sick, I just want to be taken care of, I'm not saying that should apply to everything. On to choices, having many choices do not make people happier, but rather the opposite, there is plenty of research backing this up. Obviously having no ability to choose makes people unhappy as well. I don't think it's laziness realizing and acting on what makes us happy and what doesn't.