This is like saying I "pay" thousands of dollars a year to use my credit card just because there are thousands of dollars of transactions on my credit card bill when I pay it off every month, have no interest payments, and no annual fee.

By what criteria does a hospital decide when to go after the patient for the amount insurance won't pay? Whim?

Yes this, plus the % of their ad revenues coming from "Medicare For All" advocates approaches zero while ad revenues from pharma and insurance br0s are much higher.

My local hometown "county" hospital used to just write everything under $10k off, now they are taking people to small-claims court over $500 unpaid balances.

so the koch brothers funded a pro medicare for all think tank study by mistake? man, i bet they are happy today..

A quick google says the average healthcare premium in the US is $321 per month. Times by 325 million americans and you get $104 Trillion. $32T seems like quite a bargain.

You forgot to divide by the average number of people per plan. But then also to then add all the money we pay above and beyond premiums, because lol, you think we would tolerate a system that actually covers things?

that was for a single person I think l.average family plan was 850 ish

I'm talking specifically about this new scary thing where a hospital will charge you $30k to give your baby a tylenol, because they have to assemble a "trauma team" while you're en route to the hospital.

Then insurance says - nahh that's ridiculous we're only gonna pay $10k, and the hospital goes after the patient for the rest.

I didn't even know that was a thing.

Depends on the hospital and the state. In Nevada, I believe you can get it "pled down" to medicaid rates if you can show you're not able to pay. Pretty much the only people who get totally screwed on the deal are the working poor - have a job and an income but no insurance.

As I noted above, trauma charges are something else altogether. In Nevada, they're set by the state (as are the criteria) - and I don't think they are all that negotiable because of that - the money from the trauma activation fees goes to the state to fund the trauma centers so that when Pokey shanks/shoots Leon, Leon has somewhere to go and get fixed up. Or when Drunky McWhitetrash rolls his pick up and Lucille goes thru the windshield, we can piece her face back together....

AFAIK this is all VERY state specific - might even be county specific in some states (I believe it was, at least, in Illinois 20+ years ago)

MM MD

ACA premiums are down.

Not “the rate of increase is down,” actually lower than last year.

RUN ON HEALTH CARE

I'm about done reading Matt Tiabbi's Griftopia. It has a section about Obamacare and insurance in general.

I'm sure these things are true but two things i didn't know until reading it and I'm sure have been discussed here.

1) Medicare isnt allowed to negotiate drug prices?
2) Antitrust laws dont apply to Insurance?

What THE ****?

1) is literally because Republicans (and I think a few Dems) lobbied hard on behalf of drug companies, then immediately quit and moved into cushy jobs in the drug industry. It's basically out in the open, legal grift.

2) might have something to do with insurance being highly regulated at the state level - like a tradeoff. But I'm not sure.

Honey! This idiot just raised me 32 TRILLION!!! Can you believe it?

well its a good job that middle america put a maverick with no ties to the traditional elites and monied interests into the WH, certainly this will be fixed any day now

You will NEVER guess the top two industries for spending on lobbying efforts so I will just go ahead and give it to you

https://www.investopedia.com/investi...bying-antm-so/

Meanwhile the Perdue Pharma people parade around buying museum names and getting fellated, god damn this ****ing country is such a disgrace

Beyond parody:

What the **** is the difference between that and not covering someone with a preexisting condition?

I like this new 3rd option: "Good news is you're covered. Bad news is your insurance refuses to pay $40k for an ER visit and a tylenol. So we're coming after you for the rest."

I walked into one of the best hospitals in Mexico. Got my heel x-rayed and a consult with a doctor about it - including a couple prescriptions. Total cost $100.

So it seems that the situation behind that letter is a lot more nuanced than I previously thought. This is a really informative thread:



Important points:
- The letter is from a transplant committee, not the insurer.
- The reason is because Medicare imposes significant post-transplant costs in the form of copays for required anti-rejection drugs, and it would be a waste to perform that transplant knowing that the patient could not comply with the required post-transplant treatment. The organ would simply be rejected without those drugs.


I'm not a doctor, but the author makes a compelling case and backs it up with plenty of documentation from the CMS website.

That's somehow even worse. JFC what a **** hole country we live in.

I didn't mean to imply that the story wasn't as bad as initially thought. Only that it was bad for a different reason than the common "private insurers are greedy" idea. I had no idea that someone covered by Medicare would face this issue, and I thought others might find it informative, too.

I don't know the author, but he seems like an informed guy who wants a better, universal health care system. He also seems interested in talking with AOC rather than just slamming her, so maybe something productive will come out of all this.

Agree with you 100%. I'm glad to know about this and would have had no idea otherwise.

I'm just going to dump this here, because it's health care related, I don't know where else it could go, and it illustrates how screwed up our health care system is and why I doubt it is fixable. It's long.

There's an excellent article in the most recent New Yorker that talks about the following - about 15 years ago some bright psychologists decided to try to figure out why the incidence of burned out physicians was trending upwards - it's a high prestige career, the work is interesting and the pay is good/excellent, depending on the specialty - but docs repeatedly report hating their job, advise their kids/students against a medical career, etc. After a lot of work, they decided that docs had screwed up their work/life balance (kind of blaming the victim, IMHO, but whatever) and restoring that balance would fix the problem.

So med schools jumped on board and started emphasizing the idea - workshops at national conferences, etc. etc. No change. Then the bright psychologists thought - wait, there's something wrong with our theory. The specialty with the BEST work life balance is ER docs - they just work shifts, don't have to run an office/take call - but they have higher burn out rates than pretty much any other specialty. After a lot of investigating, they decided that the primary problem was the proliferation of EMR's (computerized medical records) - since docs now spend 40-60% of their work times as data entry clerks instead of being doctors, it leads to them hating life.

Which I can confirm. As the article notes, the EMR isn't designed to help docs take better care of patients - it's designed to check off box after box after box than insures maximal billing for the health care system for whatever is going on. Any benefit to patient care is unintentional and accidental.

So the solution? Scribes; - someone who follows you around, doing a real time dictation on your interaction with patients, entering all the ancillary data for you, etc. You theoretically spend more time with the patient, less time as a data entry clerk, and you're happier (as are the patients) Problem is that almost all the scribes are premed students who do the work for 6-12 months and then move on, either to medical school or some other line of work, It's a never ending cycle of churn/training, very expensive and inefficient. (Additionally, for most docs who use scribes, the health care systems take the stand that since you're now free of doing all the useless EMR crap, you can see more patients - so it isn't like you're work load got less - it probably went up, but whatever)

Solution to the scribe issue? Mega groups are now using telemedicine to hire docs in India to be long distance scribes - a camera films the doctor/patient interaction, the Indian doc sitting in his pajamas does the transcription and the US doc signs it. They speak English, so no language barrier. They make more money being scribes for a US doc than they would taking care of people in India, so they're happy to do it.

So basically, because we've set up a horse**** computerized system that takes docs away from the bedside for reasons that have nothing to do with delivering health care, the solution is to deny health care to people in India. What the actual ****.....it's like a Kafka novel.

MM MD