General Discussion
Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsWhat Doctors Like Me Know About Americans' Health Care Anger
I rushed around the patient as he lay motionless with his eyes closed in the emergency room. He was pale and sweaty, his T-shirt stained with vomit. You didnt have to be a health-care worker to know that he was in a dire state. The beeps on the monitor told me his heart rate was dangerously slow. I told the man that he was going to be admitted to the hospital overnight.
After a pause, he beckoned me closer. His forehead furrowed with concern. I thought he would ask if he was going to be OK or if he needed surgery questions Im comfortable fielding. But instead he asked, Will my insurance cover my stay?
This is a question I cant answer with certainty. Patients often believe that since Im part of the health-care system, I would know. But I dont, not as a doctor and not even when Im a patient myself. In the United States, health insurance is so extraordinarily complicated, with different insurers offering different plans, covering certain things and denying others (sometimes in spite of what they say initially they cover). I could never guarantee anything.
I didnt say all this to the man, though, because I needed him to stay in the hospital and accept inpatient treatment. So instead I hedged. Youre very sick, I told him. You shouldnt worry about your insurance right now. I should have been able to give him a better answer, under a better system.
https://www.nytimes.com/2024/12/08/opinion/health-care-anger.html
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Medicare for all!!!
XanaDUer2
(14,602 posts)erronis
(17,176 posts)I doubt they could have designed it to be more evil if they tried.
kerry-is-my-prez
(9,409 posts)your late 4Os or 50s. If you want to live in a nice assisted living apt. (Which are tiny studios if you want to spend a reasonable amount, a one bedroom if you have extra money to spend) in my expensive town its going to cost $3,000-$4,500) a month in rent and $2,000-5,000 in entrance fees. Surprise! Medicare pays NOTHING towards long care. The rent goes up every year in these places and if you cant pay - you are evicted. If you need more care than that - you have to go to a nursing home - which is a lot more. Unless youre a multimillionaire, you will probably have to spend down your income and then go on Medicaid (if its still going be around). If things stay the way they are, you will see a lot of middle, working and lower class homeless elders or, they will put them in nightmare nursing facilities where they will get very little care. If they do get rid of Medicaid, (currently most average people will end up on it) it will be a mess - only the wealthy will be ok - the rest will be homeless. Im a social worker and know whats really going on.
allegorical oracle
(3,393 posts)To be eligible to secure an apartment, you must have $400,000 in worth (up $100,000 from last year). Depending on which of four apt. floorplans you choose, the monthly rent ranges from $6,000 to $9,000.
Then, if/when you become decrepit, the $400,000 will cover your full care. Of course, it has many amenities -- transportation, plenty of activities, etc. But it goes to your point that the average "senior" will likely end up in a much less luxurious place or be homeless. It's a frightening prospect.
kerry-is-my-prez
(9,409 posts)Which is still not paid off for several years and if we can afford the insurance and the condo fees that keep going up. He works straight commission in sales so its a bit scary. I got terminated from the only mental health org in town so I would have an hour commute and would have to get a new car. I have a 2011 with almost 100,000 miles on it. Both my parents had dementia so I worry about getting that too. I told him to just lock me in the condo when I start to wander and get lost.
onecaliberal
(36,318 posts)They have killed everything they
Touched.
wolfie001
(3,844 posts)These are the people responsible for the state of things today. Obsession/hatred with Trans Rights, racism, neglect of the environment. That's why we're here. Ignorant assholes every one.
Irish_Dem
(59,695 posts)You don't know if it will be covered or not.
allegorical oracle
(3,393 posts)stopped covering the one prescription I take. The next year, I selected a different advantage plan. A few months later, it stopped covering eye exams by ophthalmologists (I had begun to get cataracts). So I switched to original Medicare the third year.
Don't know how those advantage plans are permitted to change their one-year "contracts". Not a lawyer, but was always under the impression that valid contracts hold both parties to the agreed-upon terms for the duration of the contract. Advantage plans hold only the payer responsible to uphold the contract.
Irish_Dem
(59,695 posts)I have worked in healthcare my entire adult working life and do not trust managed care plans.
I am very happy with regular medicare.
Yes of course, the contracts we sign with Managed Care companies only bind and control the patients
and providers. The Managed Care companies do whatever they like with impunity.
travelingthrulife
(943 posts)Last year my blood pressure med was the one I had to pay $$$ out of pocket, this year that one is cheap and different prescription is $$$ that was cheap last year.
Johnny2X2X
(21,881 posts)Michael Moore's documentary was for people who have insurance, not for those that don't.
People who think they have coverage don't, and then there's loophole after loophole. You really don't know how good your insurance really is until you have to use it for something big.
The Wizard
(12,938 posts)Is to deny claims if Is are not dotted and Ts not properly crossed.
Tell them you'd like the charges reconciled with neither rancor nor litigation. Litigation will in many cases cost more than the medical fees. They'd rather pay one than both.
GB_RN
(3,217 posts)You are correct (Im a nurse, so like the author, I get to experience all sides of the morass). My mom had a rare form of melanoma, called non-pigmented or amelanotic melanoma. Its just what it sounds like. Like regular melanoma, it can have a decent five year survival rate. But like its darker sibling, its often found late - and for one big, glaringly obvious reason. Hers was found late. A few years ago, her doctor - a physician at Duke who is specialist* in her type of cancer - ordered a PET scan. Ironically, it was United Healthcare who had the state retirees insurance contract. A desk-goon, with absolutely no medical experience, denied the pre-clearance claim. Her doctor called to argue (which happens more than you might expect). For more than two hours, he fought this clown, but he wouldnt budge. His reasoning was that 1) Mom had a PET scan earlier in the year and 2) she had
get this
melanoma (wow, that was a big fucking shock to us to hear that bit of breaking news🤦?♂️🙄 ). In support of statement 2, he said, Melanoma is a skin cancer, thus, no need for another scan. This assclown had NO goddamned clue. Skin cancer. How the fuck he thought skin cancer would be fatal - assuming he even thought it was often fatal - I seriously have not one goddamned clue.
These are the people making decisions about what treatment you can/cannot have, regardless of what your doctor says.
*Moms physician is an MD and PhD who does research into immunotherapy for cancers. Especially those that are or become non responsive to treatment. Why not chemo you ask? Chemo for melanoma, is worse than the disease on patients over the age of 70. So, its just not done. Immunotherapy offers the only hope for that patient population. And its expensive. Which means that unless you have a good insurance plan, good fucking luck. Better start your GoFundMe account now.
Sadly, Mom passed away a year ago, not quite three days after Thanksgiving (339 am, 11/26/23). But thanks to her doctor at Duke, we had 7 more years with her. I am NOT asking for donations, so please dont think what Im about to say next is begging for money. In honor of Mom, and as a way to thank her doctor, we set up an account with Duke, that would funnel donations directly to his research (researchers spend inordinate amounts of time trying to keep their funding up, applying for grants, etc.). We asked that in lieu of flowers or food, people make a donation to her memorial fund. Should anyone be interested in hearing about her doctor and his research, please feel free to contact me.
The Wizard
(12,938 posts)We need universal healthcare to be aligned with the rest of the civilized world. To arbitrarily deny medical treatment is tantamount to willful negligence and reckless disregard of human life.
When faced with prison, insurance actuaries will eschew their profit driven positions and rejoin humanity.
"Money doesn't talk it swears."
(Bob Dylan, "It's Alright Ma, I'm Only Bleeding"
IrishBubbaLiberal
(73 posts)Medical care in the USA is fantastic for those with MONEY LOTS OF MONEY.
Medical care is Great for only those who have a job that pays nearly all the cost of coverage.
Medicare care in USA is a GIGANTIC PROFIT MAKING SYSTEM for corporations.
Medical insurance companies make money denying giving or deny paying for medical treatments
Medical insurance companies involved in providing MEDICARE are there ONLY to MAKE LOTS AND LOTS OF MONEY to insurers.
Denying you care is what insurance need to keep investors happy.
Denying you prescription coverage, and/or denying you a quick response to see EVEN IF YOU ARE covered is in fact THE PLAN of insurance companies.
DENY
DELAY
AND IGNORE
THAT IS WHATAND HOW MEDICAL INSURANCE COMPANIES POCKETED 100s of MILLION$$$
CEOs that are paid 10s of MILLIONS in yearly compensation
ALL PAID BY POLICY HOLDERS.
CEOs get multi-million dollar houses, 2nd and 3rd houses vacation homes,
A yacht or two. Private jets. Luxury lifestyle.
And their sick policy holders get the crumbs, or bankruptcy or death
BattleRow
(1,256 posts)calimary
(84,606 posts)DENVERPOPS
(10,147 posts)outright corruption and theft of medicare funds on top of everything else you mentioned.
ie: A Senator in Florida, who as CEO of a Health Corporation bilked the American Taxpayers out of 1.4 Billion of Medicare funds..........
Evolve Dammit
(19,056 posts)DENVERPOPS
(10,147 posts)are going to replace the Mafia in America.........
Evolve Dammit
(19,056 posts)hunter
(39,056 posts)Often they demand, or are sold, expensive, inappropriate, and possibly dangerous medical treatments.
A lot of wealthy people like to surround themselves with "yes men," which is not a good trait in a doctor but can pay very well.
Aristus
(68,617 posts)because she was rich, and bought into a lot of 'holistic medical treatment for rich idiots' hooey. She went to a resort in Mexico to get coffee enemas and shit like that, instead of going to trained medical professionals for proper treatment. She was another casualty of the paralyzingly stupid trend in this country in which right-wing media outlets sow mistrust and suspicion for professional experts.
allegorical oracle
(3,393 posts)cosmetic surgery. It's often unnecessary, it's expensive, and so often the outcomes are downright pitiful. Meanwhile, ordinary middle-class people do without necessary medical care. Forget about poor folks.
allegorical oracle
(3,393 posts)there would be a three month wait. He flew home to England and had his surgery within one week -- performed by a specialist -- and it cost him only the plane fare and the hotel room.
Old Crank
(4,889 posts)I went to our local ER. They took my insurance card and that was that.
Tests done, CT scan done, overnight stay and gall stones removed in the morning.
Never heard about money. A week later got a bill for 40 Euro, 10 for each night in the hospital with a note that said if that was a hardship I could apply to pay less.
Thank you german health system.
orleans
(35,249 posts)eppur_se_muova
(37,662 posts)A year or so ago my husband was taken to ER in Prague. We were there about 1.5 hours. Had forehead stitched from fall on sidewalk, X-rays, cast for a broken arm and saw 3 different doctors. Afterwards the receptionist said that will be $150 American dollars. OK, here you go! Thank you!
Doodles
(44 posts)Czech Republic!
Old Crank
(4,889 posts)A few days in the hospital and virtually no expenses charged to them for the stay.
Civilized countries.
bamagal62
(3,688 posts)Cost me nothing.
bucolic_frolic
(47,578 posts)I had a conversation with someone just last week, same subject.
patphil
(7,111 posts)I say we can't afford not to have it.
All of Europe has it. Japan has it. Australia has it. Canada has it. A huge number of countries have it.
What do they do differently than the US?
Simple. These countries emphasize health and care. We emphasize profit.
The US health care insurance system is short on health, and woefully short on care.
But healthy, carefully maintained profits are never rejected, and never out of plan.
Even Russia has universal healthcare in it's constitution.
ECL213
(319 posts)These idiot piss me off the most.
If you have health insurance, now, you probably don't get to choose your own doctor. You choose from the doctors who have been approved by your insurer, and if they aren't in-plan, you pay more to choose them.
Don't they understand that if we have Universal Healthcare EVERY doctor will accept it if they want to stay in business.
Mariana
(15,194 posts)He's really good and so are all of the specialists I've seen in that system, so I've had to find another insurance plan. What a huge PITA, and this isn't the first time either. My husband doesn't have this problem with Medicare.
ShazzieB
(18,925 posts)In many countries, it is. In the U.S., not so much.
patphil
(7,111 posts)Healthy people are happier, and more productive.
Happy people don't look for ways to make other people pay for their unhappiness.
Happy people find it easier to move into joy and express love.
Love is what can actually Make America Great; actually greater because we are already a great people in a great nation.
The unhappiness that so many Trump supporters feel is a contracting energy that denies greatness to the whole nation and it's people by insisting you have to be like them for the nation to be great.
What they don't see is that unhappiness fosters hate, and hate never made anything great.
Mr. Mustard 2023
(257 posts)in the system is enough, it's just used horribly. Probably 40% of annual health care costs are used for exorbitant pay, bonuses, marketing, fraud and legal protections. We're being screwed.
Aviation Pro
(13,569 posts)Motherfucks a national healthcare system that works.
(Motherfucks is my substitute for trump).
2naSalit
(93,443 posts)It seems we have thrown the baby out with the bathwater.
Hekate
(95,286 posts)Its bad.
bluesbassman
(19,902 posts)Theres absolutely no reason for this. Its a malignant evolution of the infamous fine print inserted in so many contracts of various types and applications over the years, all designed to obfuscate the true nature of the product or service being offered.
DinahMoeHum
(22,518 posts)And the medical profession is not at home with business values.
Beck23
(244 posts)People like Dr. Oz will say Medicare Advantage is more effcient that original Medicare. But that depends on the purpose of the organization. If the purpose is to make as much money as possible for stockholders, then Medicare Advantage is more efficient. If the purpose is to offer affordable healthcare to the public, Medicare Advantage is not more efficient. It should be noted that Oz owns 550k worth of United Healthcare stock.
The idea that all government services should be privatized because that makes them more efficient is an old canard used by Republicans to turn every public service over to private companies with the purpose of siphoning money from the public to their rich friends.
valleyrogue
(1,191 posts)And that is above your Part B. As I have said, I have had no problem with Medicare Advantage, and I will not pay an outrageous premium that is typical of Medicare Supp (aka Medigap).
kerry-is-my-prez
(9,409 posts)Its pretty much way offset by my social security. Went to the ER with a stomach ache thinking I had a bowel obstruction. Turned out my appendix had burst about 4-5 days before I felt any pain. (I have a pretty strong tolerance for pain). I ended up being in the hospital for 5 days hooked up to a IV with antibiotics waiting until my blood cell count got better. The only thing I had to pay was about $250 because my surgeon went over the recommended Medicare amount so I had to pay the excess charges.
misanthrope
(8,295 posts)As one digs deeper into the national character of the Americans, one sees that they have sought the value of everything in this world only in the answer to this single question: how much money will it bring in?
-Alexis de Tocqueville, Letter to Ernest de Chabrol, June 9, 1831
I first encountered this quote 40 years ago and it resounds every day of my life.
mitch96
(14,767 posts)IronLionZion
(47,117 posts)we are living in an idiocracy. Then there are the many people who don't want treatment or to even go to the hospital because they don't want to be burdened with gigantic bills they can't pay.
You can go on Freeperville to see people defend the idiocy. How it's important for the wealthy to get good quality care while others die quickly. If those who can't afford care die quickly, then shorter waits for those who can afford it.
Beck23
(244 posts)Be prepared as you grow older. If you can, buy long term care insurance while you are young, or as soon as you can.
In the long run it is better to get original Medicare and Medigap in the beginning. I believe that is at age 65. Remember, original Medicare is run by the CMS (government). Medicare Advantage is a private company. Don't be fooled by all the Medicare Advantage freebies. If you get cancer, they will start refusing to pay.
Concentrate on staying healthy.
HappyLarge
(22 posts)Ive been an RN for 30 odd years and 9 times out of 10, LTC insurance never pays a dime. Because by the time you need it, they have a 90 day waiting period to start paying and most patients die before then.
And you wont find a LTC insurance plan that it anything like affordable at any age. The premiums are adjustable and they never go down
.
It's basically like turning tables in a restaurant to maximize profit....
Docreed2003
(17,880 posts)Damn near any time we have a patient who is in a complex or critical situation they ask this very same question. It's appalling.
Evolve Dammit
(19,056 posts)change, one way or another. The grip of these corporations on the Congress is another "uniquely American" problem, just like gun violence.
Beck23
(244 posts)Evolve Dammit
(19,056 posts)evolves
(5,597 posts)and this is absolutely true.
The system is Byzantine for a reason: to obfuscate and confuse in the service of PROFIT.
If I had known in 1988 what I was getting into, I would never have pursued this career.
Evolve Dammit
(19,056 posts)LogDog75
(164 posts)If military healthcare, which is in fact socialized medicine, is good enough for our military then it should be good enough for the rest of the country. Being retired military, I often get into discussions with my fellow retirees who don't want the U.S. to have socialized medicine. When I asked them what socialized medicine is and they tell me, I say that's what military medicine (Tricare) is; socialized medicine. Both active duty and retirees using Tricare and Medicare plus Tricare for Life (for retirees) are getting their healthcare from the government who owns the medical facilities, employ the doctors/nurses/medical staff, owns the medical equipment and medical supplies, provides prescription drugs at no cost or super low cost. The expression on their faces is priceless. Once they get over their shock that they're receiving socialized medicine their response is "Well, I earned it." LOL.
ShazzieB
(18,925 posts)Add to that the fact that the employers then get to decide what care to actually provide and how much (If any) of the premiums to subsidize and you have nothing but a patchwork of inequalities and insufficiencies.
The first job I had after college, in 1975, was working for a state university as a lowly library clerk. The pay was chickenfeed, but my health insurance didn't cost me a dime. It was good coverage, too.
Since then, the costs of health care in the U.S. have gone up, up, up, up, which means that insurance costs have gone up, up, up, up. And THAT means it's gotten more and more expensive for employers to provide decent coverage to their employees. Throughout my life, working for a variety of employers, I saw the following:
Health insurance premiums: UP
Co-pays: UP
Deductibles: UP
Portion of costs subsidized by employers: DOWN
I'm not even going to get into the rules regarding what's covered and what isn't, or what hoops have to be jumped through to get certain things covered, because that stuff is ALL OVER the place.
This has caused problems for employers, because the amount of their HR budget that goes into covering health insurance has increased so much. You'd think larger employers would welcome a national health care plan that would allow them to wash their hands of the whole thing. But for whatever reason, they aren't.
You'd think less rich employers would be happy not to have to complete for good employees against richer employers that can afford to offer more lavish health care benefits. You'd think the really small employers, who can't offer those benefits at all (and aren't required by law to do so) would welcome a program that would give them a more level playing field for attracting good employees, instead of having to compete with employers that can afford to offer health care benefits. But as far as I know, none of them are in favor of a national plan like Medicare for all, at least not in impactful numbers.
The only thing I can figure is that the bigger, richer employers (who have the most impact) don't want to give up the power this system gives them over employees. How many of us have stayed in a job we weren't happy with longer than we wanted to, because we couldn't afford to take a chance on being without health insurance (or known someone who did that)? I'm guessing a high percentage, because losing one's health insurance coverage is one of the scariest things that can happen to an American worker.
And some of the biggest, richest, and most powerful companies of all are the health insurance companies themselves, who have plenty of lobbying money to spread around, to make sure that they don't lose the stranglehold they have on the rest of us to a national plan that treats everyone equally.
gypsy11
(350 posts)Years ago. Im in my mid 50s. No insurance, but even when I had insurance, the deductible was so high, I had to pay for most care out of pocket. I recently lost my job (16 years with a major international corporation, I got too old for their taste, so they made up a bogus reason to can me, said corporation is self funded regarding their high deductible insurance too, they make $ off of it) and try not to think about if a health issue happens with me, Ill lose everything I have. My home, and all my $. Theres no guarantee that wouldnt happen even if I was insured. So I stopped going to the doctors. I dont want to know because if something really major is wrong? I couldnt afford to treat it anyway. Thankfully Im pretty healthy. So far anyway. If I get cancer, or have a massive stroke? Why would I want to be saved by the US healthcare system only to become homeless paying for the treatment? I dont see the point. So I stopped going. I think it must be nice to live in a country where you dont have to make these kind of choices.
oldmanlynn
(510 posts)You will never get Medicare for all or any serious healthcare improvements while Republicans control any branch of the government. They want to do away with any of these improvements so that they can pass along the most money possible to the rich companies and their rich CEO friend, so in order for this kind of changed to ever happen, Democrats have to be in control of all three branches. voting is the only way
Meowmee
(6,116 posts)Knows that people have to worry about going bankrupt too.
Clouds Passing
(2,697 posts)Kill for profit healthcare!
Aussie105
(6,467 posts)And in most countries, it isn't.
I guess . . .don't get sick and need a hospital or dentist if you live in America and aren't cashed up?
LeftInTX
(30,594 posts)In 2012, my dad sent me a letter from his cardiologist encouraging everyone not to re-elect Obama. (My dad has since passed away) And I know my rheumatologist also is a big gop guy.
And the Texas Medical Associate and the America Medical Association have given John Cornyn numerous awards. They also are against Democrats because the GOP supports torte reform.
I put part of the blame on providers. If they care about this, more of them will be speak up collectively. Until that happens, I see them as part of the problem.
One of my friends from a Medicare of All group told me that almost all of the doctors are against Medicare for All and most of the doctors are GOP. Her husband was one of the few physicians who supported Medicare for All.
PHOTO: Sen. Cornyn Receives TACHC Health Care Champion Award
WASHINGTON Ahead of National Community Health Center Week (August 4-10, 2024), U.S. Senator John Cornyn (R-TX) met with Texas health care leaders, including Texas Association of Community Health Centers (TACHC) CEO & Executive Director Jana Eubank, CommUnityCare CEO Jaeson Fournier, Lone Star Circle of Care CEO Jonathan Calvin, Matagorda Episcopal Health Outreach Program CEO Celeste Harrison, and Los Barrios Unidos Community Clinic CEO Leonor Marquez. During the meeting, the Senator was presented with the TACHCs Health Care Champion Award for his extensive efforts in support of federally qualified health centers throughout the state.
https://www.cornyn.senate.gov/news/photo-sen-cornyn-receives-tachc-health-care-champion-award/
(He's always receiving these freak'n awards. This is one of his most recent)
Passages
(1,430 posts)It should never be up to doctors to decide on a national healthcare system.
The greed is good crowd has a wide net in America.
LeftInTX
(30,594 posts)My friend's sister was an MD. She was hardcore MAGA. She died of cancer. She also was busy avoiding vaccines etc.
poozwah
(278 posts)no accountant should be permitted to dictate to medical professionals what care they should provide. we have the system we have because americans are ignorant. ignorance may be bliss, but it is more often deadly. anyway, i gotta run for it is time for my morning cocktail of ivermectin and raw milk.
Passages
(1,430 posts)leadership to confront the beast..... lobbyists.
Pick a side and commit, make it central to the campaign.
If we make it comfortable or "understand" why they do not take on this sizable fight, we will continue to see Americans suffer and or die needlessly.