I'm 55 years old living in NH, and my Anthem premium for my Bronze, high deductible plan is dropping next month from $650 to $525.

What do you know - high deductibles + getting over the first few years of people finally getting insurance who had neglected their health - might be working as planned. Just in time for Republicans to kill it off. Awesome.

I was loving this doc's extended Vegas TR, then he went and made this post. JFC.

tldr:
we have the worst health and worst health care of any developed nation, but making our healthcare system more like every other system by socialising healthcare is obviously doomed to fail

That is an amazing post.

I really think it comes down to hating poors.

Yeah, that was an unfortunate post. Although I agree with his third, and mostly with the last half of the last paragraph. Might be that he just had a horrible day at the office (I don't know what his specialty is) - after some shifts I'm ready to quit, and after others I feel pretty good about what I do. There are times where I kind of feel like the boat is sinking and no one is paying attention....

MM MD

"However, the main issue with the American health care system is we want the best, we want it now, and we want it for free"

that's not true at all. the main issue is that healthcare is being held ransom by a bunch of profiteers who are ****ing everybody.

Pretty much any post that begins with “I’m a Libertarian” is a lock to get here eventually.

So this PAYGO vote upcoming is gonna be another example on how the Democratic Party is merely pretending to be opposed to the GOP but really wants most of what they do.

It'll likely be the death knell of UHC in the coming future.

Backroom deals will happen to make sure Obamacare sticks around and we creep toward UHC.

Because nobody wants to commit political suicide.

Insurance companies a top 3 Democratic Party donor, duh.

Abolish health insurance companies and we instantly have affordable health care.

Feel free to quit any time, no one is stopping you.

Well, that escalated quickly. Sorry you're having a bad day. Just put me on ignore if it helps. That's what I did with you.

MM MD

Yeah that was kind of a dickish post.

It still outpaced inflation.

Deductibles don't actually matter that much in most plans except WRT to ER, urgent care, and anything that keeps you in hospital, the most expensive stuff that insurance companies want to deter you from. If you're sick enough to REQUIRE these types of services, doctors will make you sign a form basically saying you're leaving "against medical advice." Slower growth here is working as intended as you say.

For day to day stuff, including most lab tests, it's typically some kind of co-pay that doesn't go toward deductibles.

The bigger part of the slow down may or may not be sustainable. Essentially in the past couple years we had the fortune of some blockbuster drugs going off patent and the dramatical increase of use of generics drove costs down. That and the insurance companies have been much more aggressive in negotiating prices and credibly threatening to move drugs off their formularies (mostly due to the best sellers nowadays having more "therapeutic equivalents" than even 10 years ago.)

I don't disagree with what you're saying for the most part, but the ONLY reason you get asked to sign out against medical advice is for med/mal issues. (Maybe for PR issues, if your doc thinks you're a complete dick who's going to complain - but I've never done it) I probably sign out someone AMA once a month or so. Docs don't like doing it - the paperwork is a pain in the ass, and on some level you often feel like you failed in your job.

In my group, I can't even SEE the patients insurance status without jumping through about 15 computer screens, and for the most part I deeply don't care. If you come thru the Emergency department for an emergent condition, the on call docs for the most part dont care either, if you're admitted - they (by medical staff bylaws) obligated to consult on you no matter what your insurance status is. Of course, this all changes if you need to follow up in the outpatient world.

Costs for emergent/critical care are so high that you're likely going to blow thru your deductible no matter how high it is, if you're significantly ill or injured, anyway. If your policy isn't awful, most preventative stuff is exempt from the deductible anyway - it's a lot cheaper for the insurer to cover a colonoscopy than to have to pay for a couple of surgeries/chemo for a colon cancer down the road. It's all over the place, though - my scope was covered, but I had to pay for the GoLytely script to clean me out before the scope, and for the propofol sedation for the procedure.

IMHO the main reason the slow down in increase isn't going to last is because of the increasing use of "customized" therapy for cancer - it works (in some cases, anyway) pretty well - but it's INSANELY expensive. And I dunno how much cheaper some of them are going to get, at least in the short term. And if they ever come up with a treatment for Alzheimers that actually works...

MM MD

By "customized" therapy Are you referring to cancer immunotherapy? Its INSANELY expensive now just like sequencing a persons genome was 15 years ago. I'll go out on a limb and predict that by 2035 it will cost around a $1000 for something equivalent to the Car-T cell therapy offered by Novartis(which I believe runs about $480,000 a treatment).

You all are being a little to harsh on Leon’s post IMO, I think it’s more cynical/hopeless than hateful, quotes per below focus on the genuine issue that in our political system the rich companies get to make the rules.

“I don't see a solution bc the quite frankly the big players in the game make the rules. Theoretically if insurance companies were non-profit and functioned as originally intended (a theoretical pot of money to which we all contribute and pool risk/resources), we'd probably be able to cover a ton of people. But who's got the money, and therefore can buy the politicians? The insurance companies.”

Addendum:

Also will add I 100% support UHC, but I completely understand how some of us in healthcare can get a little jaded when we see on a daily basis the small segment of patients who abuse the hell out of the system, verbally abuse us and then take no personal responsibility for anything. It can make you jaded. For example in my state if you have Medicaid you get free transportation to doc appointments, which sounds reasonable but I literally have patients get free transit 4+hrs to me requesting a controlled substance because all the doctors closer have refused due to them getting caught misusing. And there is literally nothing we can do except send them 4 hours home on societies dime and next week they try someone the next town over. That sort of stuff can make you jaded quickly.

Yeah, no. His whiny, ignorant and frankly repulsive “they want it now for free” rant is disgusting. What people actually want is to be able to get care and not go bankrupt or, alternatively, get care vs. die. The solution is beyond obvious, literally every other country with running water has figured it out.

In the short term yes there are clearly most countries doing things much better, but healthcare costs are exploding in Europe as well so they are going to be facing tough issues in the next 20 years also. Rest of world seems better at resisting urge to have to have the “best” technology at all times compared to USA, so have been able to hold down costs, but they are escalating everywhere rapidly.

**** off.

Also obviously health insurance companies are horrible, absolutely no reason except corporate greed/power to not have it like Switzerland(?) where insurers are non-profit entities.

?

I’m confused what your so upset about. I’m a doctor in a clinic for the uninsured. I support UHC, I vote straight ticket Dem. Healthcare is f’ing complicated.

What you are describing here is called a job. Almost all of them have a similar level of disillusioning bull**** (if not more) but for a fraction of the pay.