Oh, look - "I sprained my fifth metafilter, and I don't have insurance! Hope me!" June 8, 2010 1:38 PM   Subscribe

What is it with (US) mefites and lack of health insurance?

Sometimes, it seems like a really disproportionate number of people on AskMe who have medical or other issues also don't have health insurance. Does anyone know what;s going on here? Maybe it's me, I don't know. I just feel like I'm constantly seeing "What's wrong with my body, and how do I fix it without having insurance?" type questions.

Is there some kind of correlation or self-selection going on here? ("I can't afford a doctor, but I can afford $5 so I can ask the smarter intarwebs instead?") Is it a total coincidence? Am I making this all up? Are there a lot more Americans living without health insurance, proportionally, than I thought?

I guess I'm not looking for a definitive answer so much as some really smart speculation.

(I wasn't sure where to put this, I hope it's not out of place. It seemed way too chatty for AskMe.)
posted by Citrus to MetaFilter-Related at 1:38 PM (201 comments total) 8 users marked this as a favorite

People who have health insurance generally just go see the doctor, I think, when a strange growth appears.
posted by Mister_A at 1:42 PM on June 8, 2010 [13 favorites]


People with health insurance don't need to ask questions about how to get healthcare.
posted by electroboy at 1:42 PM on June 8, 2010 [25 favorites]


That, plus insurance costs money and I don't have any.
posted by theichibun at 1:42 PM on June 8, 2010 [4 favorites]


If we were to assume that most Mefites are between 18 and 34 (I'm 35, but still), the CDC says 25% of them don't have health insurance. That's a pretty sizable minority.
posted by These Premises Are Alarmed at 1:42 PM on June 8, 2010 [1 favorite]


My guess is that those who have health insurance are more likely to ask their doctor/insurance company questions. Those who don't have insurance are more likely to take a "DIY" approach, including asking on AskMe. So yeah, self-selection.
posted by Emanuel at 1:44 PM on June 8, 2010


Going to the doctor is A LOT more expensive than $5.

I can't speak for the entirety of Metafilter, but among real life people I know, the smarty college kids that aren't yet into their real careers all don't have any insurance. I live in NYC, and here, it seems that there's a long internship/part-time period where you go to the doctor only if in serious danger of death.
posted by Threeway Handshake at 1:44 PM on June 8, 2010 [3 favorites]


what Mister_A said. It's also possible some askers are just saying it because they want responses other than "go to a doctor now" - maybe they have insurance but not the money for a copay, or don't like doctors, or are intimated, or whatever.

I don't know, I'd guess that's not usually the case but I can imagine it happening.
posted by Solon and Thanks at 1:46 PM on June 8, 2010


Our system is designed to keep the poor sick and beholden to large companies.
posted by The Whelk at 1:46 PM on June 8, 2010 [25 favorites]


Any quality health insurance policy is going to cost hundreds of dollars, every month, and often one's employer pays, but if one is unemployed, or at a job which does not offer that benefit, you are screwed. So having paid $5 for MeFi, or having a nice computer with which to ask the smarter interwebs (thank you!) from, is really not relevant to being able to afford insurance. For an under-employed person in the U. S., it's just not very possible, and you need to stay healthy until you get a job with bennies or marry someone who has that job or do well enough to spare hundreds of bucks monthly for a (probably) high-deductible policy with a lot of loopholes favoring not you.
posted by Danf at 1:47 PM on June 8, 2010 [8 favorites]


Over 40 million Americans don't have health insurance. Some tiny percentage of that huge number is both on Metafilter and has a health issue that they have some question about. That would be true even if those two groups were randomly dispersed, but they're not: the demographics skew things toward Mefites not having health insurance, as These Premises Are Alarmed explains. And people without health insurance are especially likely to turn to AskMe first because they'll have a harder time getting health care.

People who don't have health insurance aren't all ascetics who never spend any money frivolously. Almost everyone does some frivolous spending even if they're poor (which is not to imply that everyone without health insurance is poor ... or that all Mefi accounts cost $5). Also, they might have bought the account back when they had health insurance and didn't anticipate losing it. Also, spending $5 on a lifetime Metafilter account isn't necessarily frivolous; it could be quite frugal if it lets you ask lots of AskMe questions that end up saving you money in all sorts of ways.
posted by Jaltcoh at 1:48 PM on June 8, 2010 [1 favorite]


Aren't there 43 million Americans without health insurance? And 12,000 active MetaFilter users? So there might be some cross over there.
posted by ThatCanadianGirl at 1:50 PM on June 8, 2010 [1 favorite]


Who are these Rockefellers that can afford an iced latte but can't afford in utero surgery to correct their unborn child's heart defects? This is inconceivable!
posted by Admiral Haddock at 1:52 PM on June 8, 2010 [24 favorites]


An example from my experience:

I was downsized from IBM in 1999, which left me with a COBRA payment of $776 a month to continue my insurance, having just lost my job. I couldn't afford that, (it being more than my mortgage), so I opted to go without insurance until I found another job. The economy crashed, and I got laid off again. Being in your 50's without permanent employment is becoming more a normal situation in this country- aged employees carry an insurance risk that employers don't want to pay for.

Private insurance, you say? I have had a heart attack. I'm effectively uninsurable. A high-risk pool would cost me over $2000 a month, if I could find anyone to underwrite me.

This is why the health care system is broken here- the insurers have set themselves up as gatekeepers between the ill and the healthcare providers. In many places in the US, if you don't have insurance, doctors won't take you as a patient.

If you work in the health insurance industry in the US, consider yourself an accessory to manslaughter for profit. More people die here from lack of accessible medical care than accidents.
posted by pjern at 2:01 PM on June 8, 2010 [135 favorites]


> "Any quality health insurance policy is going to cost hundreds of dollars, every month, and often one's employer pays, but if one is unemployed, or at a job which does not offer that benefit, you are screwed."

Because I don't see many people discussing the actual figures (this is information I wish I'd known before I moved to the US, it just... ugh, god): my husband's employer pays for his, so that base coverage is technically free. On top of that we pay $410-ish dollars to include me plus we also have AFLAC. When we have a kid, it will go up to $800 a month (I think all following kids incur no extra charges). On top of that we also have co-pays. Insurance doesn't cover everything either. It makes sense to check with a community of level headed people before taking what is a fairly significant risk of getting a bill you can't pay for, instead of hauling your ass with a rash straight to the doctor's surgery.
posted by saturnine at 2:05 PM on June 8, 2010 [1 favorite]


I am a healthy, 32 year old woman with no chronic medical conditions or history of horrid medical issues... and to buy my own health insurance would cost me roughly $450 per month. And that's the cheapest plan I found when I was looking for insurance last winter when I was unemployed. Also, please note that that plan did not cover anything to do with pregnancy -- if I had that insurance and ended up pregnant and carrying that pregnancy to term, I would be on the hook for all associated costs, including all tests and lab work. When I had employer-provided insurance just prior to that, the coverage wasn't any better, and even though my employer was footing most of the bill, I was still coughing up roughly $100 a month for insurance. Plus the $30 co-pay for any and all office visits. The costs add up astonishingly quickly. With most insurance, if I have a minor issue that requires an office visit, lab work, and a prescription, I'm looking down the barrel of at least $100 that I need to pay on top of what my insurance would cover. Without insurance? It's easily 3x that amount.

I am very lucky, in that I found a new job relatively quickly, and that the new job has truly excellent health care benefits. There are millions of people in this country who are not as lucky as me. If they want to come to AskMe and ask their questions about how to get medical attention without insurance, I have no problem with that.
posted by palomar at 2:06 PM on June 8, 2010 [1 favorite]


I am being reduced to 10 hours/week at the end of the month. Since I will be working less than half time I loose all my benefits. In order to keep them it would cost about $600 a month - and that is without actually going to see the doctor which would add co-pays and other charges. Our system is fucked.
posted by nestor_makhno at 2:07 PM on June 8, 2010


Until recently, I had a job that gave me reasonable (though not exceptional) health insurance. And then I realized I would rather die than remain at that job. Given that, I decided to take my chances.
posted by orville sash at 2:07 PM on June 8, 2010 [1 favorite]


Even if you're on the public teat you might not have insurance. I recently went on SSDI and there's a two-year waiting period for Medicare... thinning out the herd, perhaps?
posted by jtron at 2:11 PM on June 8, 2010


BUT AT LEAST WE DON'T HAVE SOCIALISM
posted by jtron at 2:11 PM on June 8, 2010 [46 favorites]


Is this really a good use of MetaTalk? Just asking, no real ax to grind.
posted by fixedgear at 2:12 PM on June 8, 2010 [1 favorite]


i got laid off a few months ago and so don't have insurance. I should have insurance again shortly, though.
posted by empath at 2:12 PM on June 8, 2010


I grew up in a one income household with a parent that worked for himself, I've never had any form of insurance ever (except car insurance, of course). I just have to hope i don't get sick, because I either have to get better or die.
posted by dead cousin ted at 2:14 PM on June 8, 2010 [1 favorite]


I am very lucky. I have good insurance, a flexible spending account for co-pays, a doctor I like well enough who doesn't have a months long waiting list, my own transportation to get to the doctor, AND an employer that gives me time off to go SEE the doctor (and a boss who won;t gripe if I need to take a few hours off!).
That's actually a pretty good sized list of things I need to have before going to the doctor is a great option. I think if one or more of those things are missing than asking MeFi can seem like a darn good use of $5, especially if that Abe Lincoln was spent years ago.
posted by pointystick at 2:17 PM on June 8, 2010 [7 favorites]


One reason I'm in Japan is health insurance. National health insurance that covers everything (except, no joke, pregnancy and birth control). It's not cheap, and you have to pay 30% of your medical bills, but there is no deductable. Also, medical care here costs less.

When I had my gall bladder out, I spent a week in the hospital recovering. The pre-insurance bill was something like $4000, but I ended up paying just over $1300, and then, out of some wonderful strangeness I still don't really understand, I got reimbursed for $900 of that.

I'm not bragging (okay, maybe I am), but that same surgery would have run (based on what I could find online) $50,000 before any kind of hospital stay. Even those lucky enough to enjoy health insurance are facing, at that point, a 10% they have to cover on their own, or five thousand dollars, to get rid of something that causes referred pain all over their body.

The kicker? If I lived in the States, I probably wouldn't have, or be able to get insurance. I've had two back surgeries for disc issues. Nothing that could ever be even tangetially related to my back (oh, your knees hurt? hmm, does that maybe have something to do with how you walk because of your back pain?) is going to be covered (at least until Obamacare actually kicks in), which kind of makes health care expensive and useless at the same time, for me.

tl;dr People don't have insurance because it's far too expensive, and it doesn't really work. Furthermore, even with insurance, health care in the States is too damn expensive, leading to people using AskMe to find alternatives to going to the doctor when they have a $500 deductable.
posted by Ghidorah at 2:18 PM on June 8, 2010


I have socialism AND healthcare.

In YOUR face.
posted by blue_beetle at 2:18 PM on June 8, 2010 [3 favorites]


I was downsized from IBM in 1999, which left me with a COBRA payment of $776 a month to continue my insurance, having just lost my job. I couldn't afford that, (it being more than my mortgage), so I opted to go without insurance until I found another job.

A few years ago, my partner got laid off. At his job, we had had absolutely gold-plated insurance, which was great...until the layoff, when the COBRA premiums were $1450/month--also more than our mortgage. It's one of the hidden flaws in COBRA that you can only buy the insurance you had when you were employed; there's no way to opt for a cheaper plan to tide you over. (We paid the insane premium because I have chronic health issues and didn't want to risk a period without insurance and all the problems that can cause down the road.)

I remember a MetaFilter conversation about insurance a year or so ago where one member was opposing health care reform based mostly on the fact that he had really great insurance through his employer and didn't want anything to happen that might jeopardize that. People were wrestling with him, but he could not see how fragile the great insurance through your employer really is.

But to address the question, my guess is the same as Mister_A's: people who don't have insurance are more likely to ask questions here that people with insurance might just go ask their doctor.
posted by not that girl at 2:19 PM on June 8, 2010 [1 favorite]


To really answer the question, it's self-selection bias. People who have health insurance don't ask medical questions on internet discussion groups. And it's always Americans because pretty much every other country with Interweb users also has some form of universal coverage.
posted by GuyZero at 2:20 PM on June 8, 2010 [1 favorite]


blue_beetle: you are welcome to distribute some of your healthcare and/or socialism to my face or indeed any other part of my ominous body
posted by jtron at 2:31 PM on June 8, 2010 [3 favorites]


It makes me both sad and angry-- furious-- reading these threads about how completely fucked over Americans are over healthcare. It's a fucking crime.
posted by jokeefe at 2:33 PM on June 8, 2010 [16 favorites]


A good friend of mine has to buy her family's health insurance entirely out of pocket. Her family is insured through the IEEE, so they get access to a group rate, they just have to pay it all. Her insurance is OK; not great, but pretty average. The details of her policy, roughly, are:

$5K individual deductible / $15K family deductible
$35 office visit copay / $100 Urgent Care copay / $250 ER copay
Drug copay, $35/month, $50/month for a name brand if a generic is available
After the copay, her insurance pays 75% of the cost for an in-network provider, 50% of the cost for an out-of-network provider.

For her family of four, she pays $2200 a month.

Insurance is EXPENSIVE. it is OMG so expensive. What's truly shameful, and the #1 reason I support continued health care reform, is that my husband's employer pays much less for much better coverage:

$100 family deductible, applicable to out-of-network providers only; the network is so large that I only found out about this deductible this year, seven years after joining the plan
$0 office copay / $0 UC copay / $0 ER copay
No drug copay unless for a brand name for which a generic is available; $15 a month in that case
100% covered in-network, 80% covered out of network
(There are other perks. There is no lifetime benefits cap on our insurance; we can self-refer to specialists; there is no limit on physical therapy or mental health benefits; they are extremely generous when it comes to allowed benefits. I've had physicians discussing "cost-effective symptom management" with me; when I tell them who provides my insurance, they say "OH! Good. Then we can treat this the right way." Plus there's a mobile medical service who will make house calls if an office visit to my PCP is inconvenient or impossible.)

For our family, my husband's employer pays $1750 per month. We pay $0.

Why the difference? My husband's employer, a Large Software Company in Redmond, self-insures. They hire an insurance company to administer the plan, but there's no profit motive in it. The comparison makes me ill; I think of another friend of mine whose two-year-old developed breathing problems one evening while I was at her house. Her husband was bundling the little girl up to take her to the ER while the wife was at the computer checking the bank balance to make sure they could afford the ER copay. And somebody is making a PROFIT on that shit.
posted by KathrynT at 2:33 PM on June 8, 2010 [23 favorites]


I recently had a visit to the hospital. I am self-employed and pay about $450 a month for my 40-year-old ass to be insured, I had no pre-existing conditions (I do now, thanks much). Four hours in the ER plus a CT ended up costing me $2500, that's with insurance covering most of it.

The ambulance ride was $1000, for Pete's sake.

Health care is really fucked, even for those with insurance. I'd be looking at $12,000 for a shortish ER visit for a non-life-threatening (but very painful) incident.

For all those (temporarily, in many cases) gold-plated insurance assholes who opposed socialist health care, fuck you, you goddamn barbarians.
posted by maxwelton at 2:35 PM on June 8, 2010 [4 favorites]


You've won this round, Mister_A...
posted by electroboy at 2:35 PM on June 8, 2010


The tone of the question "What is it with (US) mefites and lack of health insurance?" felt sort of off to me, because it makes it sound like a choice, which it often isn't. I don't think the internet is anyone's first choice for medical advice; if someone is asking something on Metafilter, it's for a reason and that reason is not necessarily "I'm lazy" or "I'm cheap" but because going to the doctor can be a big deal; pointystick makes some really good points in that even if you HAVE health insurance which many people don't, going to the doctor can be a big deal if it means taking time off work, and just because you have health insurance doesn't mean you don't have to pay. The health insurance at my last job was so bad that I paid to continue with the company I'd been on when I was still a dependent (which if the law then had been what the law is now I could have gotten for free). I had health insurance through my job but if I hadn't had the other health insurance for which I was paying I probably wouldn't have gone to the doctor very often.

I think all of this is compounded as well by this general belief that either a) you are faking it b) you should suck it up. The idea of sick days sort of feeds into this; limiting the number of days you are allowed to call in sick implies that either you're going to abuse them or that you should just quit whining and come in anyway. I think some of this perceived resistance to going to the doctor might come from years of being told, in one way or another, that whatever you have is really not that big a deal so you should suck it up; it's probably not important enough for a doctor to look at it, and really you can't afford to miss another day of work anyway.
posted by Mrs. Pterodactyl at 2:37 PM on June 8, 2010 [4 favorites]


I actually think that our socialised medical system here in the UK could do with an Ask Mefi triage system in place to stop the amount of people who come in going "I have a slight cough, give me antibiotics".

So AskMe is on some level providing a useful service and reducing pressure on the health system, or would be, if the US had a health system...
posted by knapah at 2:38 PM on June 8, 2010


In the old days, you paid the mafia to protect you when you couldn't go to the police. They extorted you in the process, could decide not to protect you at any time and you had no recourse.

In the US, insurance companies operate basically like the mafia. You pay them loads of money to protect you from insane health care costs (which they help drive up by the way), but they extort you and can decide not to cover you arbitrarily. It's totally fucked and anyone who has tried to navigate the US health care system will tell you so, unless of course their mattress is stuffed with billions of dollars extorted from their constituents.
posted by milarepa at 2:46 PM on June 8, 2010 [12 favorites]


Note that when you do have gold-plated insurance the US medical system is a goddamn dream. It's fantastic. It's not surprising people don;t want to rock the boat if they got theirs.
posted by GuyZero at 2:56 PM on June 8, 2010 [1 favorite]


Just wanted to clarify, I did not mean to imply that there was anything wrong with asking medical advice here, or any kind of choice involved in not having insurance. What I was saying was more akin to, "What's with this (perceived) statistical anomaly? Is it real, or am I seeing things?"

From the responses, it seems pretty real. Thank you for the great insight, everybody.
posted by Citrus at 3:03 PM on June 8, 2010


think all of this is compounded as well by this general belief that either a) you are faking it b) you should suck it up.

This is some of the resistance my SO encountered, and why I'm asking the question I'm asking in AskMe right now.
posted by ShawnStruck at 3:28 PM on June 8, 2010


To be honest, even people with insurance would rather ask MeFi than go to the doctor. Sad but true.
posted by smackfu at 4:10 PM on June 8, 2010


Sorry, I mean to add a qualifier like "sometimes" in there.
posted by smackfu at 4:10 PM on June 8, 2010


Can't afford health insurance, uninsurable because of past diagnoses I have had, plus every time I do scrape up dinero to see a doc it turns out to be a big fat waste of time and bigger waste of money.

Thank God I believe in divine healing. I'm not joking.

People used to be able to go to the doctor whether or not they had insurance. But those days seem long gone.
posted by St. Alia of the Bunnies at 4:22 PM on June 8, 2010 [3 favorites]


People used to be able to go to the doctor whether or not they had insurance. But those days seem long gone.

Not really. Most of the developed world works that way.
posted by GuyZero at 4:30 PM on June 8, 2010 [2 favorites]


People used to be able to go to the doctor whether or not they had insurance.

That's because health insurance used to be like auto insurance -- something you bought in case something really big happened and you needed to be carried through the rough financial times caused by that. But health insurance, these days, is like if your auto insurance were to pay for your fill-ups, and your oil changes, and all that basic maintenance stuff.

Back when HMOs first started, this was a great idea. They were supposed to work to keep people well, and not have them have to visit the doctor quite as often for what was wrong because they were going to cover keeping things going right. But that idea fizzled and we're left with this bastardized system.

Hell, I can't even comparison-shop for procedures I might need because nobody will actually tell me what having an x-ray or a colonoscopy or whatever costs. Because they don't know. Because they have separate compensation deals with every insurance provider, and if they were to actually tell someone what something cost out-of-pocket, they might open themselves to lawsuits about unfair comparative compensation from various companies.

At least the local health clinic will "discount" their rates heavily for me when I appear as a walk-in-no-insurance patient. Because they know I'm there because I really fuckin' need it and not because I just have a sniffle that I can pay a $10 co-pay to have a consult. Still, I have health issues which go unchecked because I cannot afford to just drop into a doctor for everything, and if it's not really compromising my daily life, then I don't bother.

I still wonder what these things will develop into and how bad the results will be by the time they require actual attention.
posted by hippybear at 4:31 PM on June 8, 2010 [6 favorites]


Thank you Tommy Douglas.
posted by futureisunwritten at 4:33 PM on June 8, 2010 [15 favorites]


Thank you and bless you, Tommy.
posted by five fresh fish at 5:15 PM on June 8, 2010 [2 favorites]


Just an FYI. Even having insurance isn't all it's cracked up to be.

I had a surgery last year. I jut got my hopefully final bill two month ago. Sure, $3,000 (total) beats $12,000+, but that's still my discretionary income for more than a year. And since I don't intend to do nothing besides pay bills it will take me longer than that to pay off.

Medical bills are surreal. You can't read them. You have to guess what you are paying for. The first bill came and it was $1,200 or so. I thought, "God am I glad I have insurance, but hey, even if not, $4,000 doesn't seem horrible." Then I couldn't find the actual surgery on the bill. I called, but until the surgeon is done with his notes and such they don't bill you. So it was like 3 months out when another bill arrived. Maybe $800 this time. Still no surgery charge. I paid it and called them and asked, "Am I done now?" I was told that "all patient responsible fees" had been paid and they were just waiting on the insurance company. Of course the insurance didn't pay it all. So a final bill for $1,000.

If I'd had a way to predict how much that surgery would've cost, such as an askme question, I could have considered waiting a month or three and cranked my flex money to the top. I did try to find out, but the hospitals won't give you an estimate, my insurance company would only tell me what percentages they cover, etc. So I went in having no idea.

In the end I wouldn't have decided to wait regardless, but I would have considered it.

Oh, and I still live in fear of yet another bill. Now imagine having no job and no insurance. I can't.

When I was a student I had an illness that required a 3 day hospital stay followed by a 9 day stay, and checkups for a year, and more tests than a season of House1. I think the final tally on that one was $250,000 of which my insurance at the time paid 90%. $25k in 1993 on top of student loans, so yeah, still paying.

I hate a need for insurance, but without it I'd be living under a bridge.

1. Was labeled a closed ended undiagnosed illness.
posted by cjorgensen at 6:00 PM on June 8, 2010 [4 favorites]


Is there some kind of correlation or self-selection going on here? ("I can't afford a doctor, but I can afford $5 so I can ask the smarter intarwebs instead?")

As suggested in the first few comments, people without health insurance might be more likely to post these questions. Alternately, people might be more likely to point out that they don't have health insurance than to point out that they do.

Is it a total coincidence? Am I making this all up?

Absent some kind of detailed statistical analysis, it's hard to say. Most likely, I think, there's some truth to it, but there's also some selective memory or confirmation bias or something.

Are there a lot more Americans living without health insurance, proportionally, than I thought?

Hard to say--how many people did you think there were without health insurance? If I had to guess, just based on your question, I'd say 'yes.'
posted by box at 6:04 PM on June 8, 2010


I actually think that our socialised medical system here in the UK could do with an Ask Mefi triage system in place to stop the amount of people who come in going "I have a slight cough, give me antibiotics".

In Ontario we have this. It's called TeleHealth and it's a 1-800 number you call to speak with nurses who can sort out for you whether or not you need to go to urgent care, or whether you can deal with it at home. I've used it loads of times when my son was wee, and a few times for my husband and myself. It's a fantastic service and probably saves the tax payer millions of dollars by keeping people out of doctors' offices, urgent care clinics and hospital emergency departments.
posted by ThatCanadianGirl at 6:08 PM on June 8, 2010 [1 favorite]


Ghidorah: "I'm not bragging (okay, maybe I am)"

Just saying you're getting your medical coverage in another country is bragging. Hell, I would.
posted by KevinSkomsvold at 6:16 PM on June 8, 2010 [1 favorite]


I work for an insanely large corporation at which more than half of the workforce is contractors. The contracting agency I work is basically a temp agency, and therefore doesn't supply benefits. However, temp is a misnomer, as the positions they fill at this company are all indefinite, long term positions. Some of these people have been out here 30 years in the same job as "temps."

The insanely large corporation hires more and more contractors rather than employees so as to circumvent the unions.
posted by MexicanYenta at 6:37 PM on June 8, 2010 [2 favorites]


Just an FYI. Even having insurance isn't all it's cracked up to be.

Yup. I have health insurance - not through my job, I buy it myself. It's $150/month, which is cheap compared to what many people here have quoted but a lot of money for me. And it covers virtually nothing. (Unless I get hit by the proverbial bus, then I think it covers something like 80% of my hospitalization.) Anyway, if I had a minor medical problem (say, a rash) I would almost certainly turn to the internet for help before spending $200 on a visit to the Dr., and $100 on Rx medication that I might not need. And it would take a lot of minor medical problems to reach my $5,000 deductable. When/if I turned to the internet I would probably say "my insurance doesn't cover X" rather than "I don't have insurance", but I could see how someone else might simplify if they were asking a question.
posted by DestinationUnknown at 6:39 PM on June 8, 2010 [1 favorite]


Thank you Tommy Douglas.
posted by futureisunwritten at 7:33 PM on June 8 [5 favorites +] [!]


OK, what is this about?
posted by Jaltcoh at 6:40 PM on June 8, 2010


OK, what is this about?

Jack Bauer's grandpa!
posted by Sys Rq at 6:49 PM on June 8, 2010 [1 favorite]


(Educate Yerself)
posted by Sys Rq at 6:51 PM on June 8, 2010 [2 favorites]


Oh, I get it.
posted by Jaltcoh at 6:56 PM on June 8, 2010


My last 10 years in the US were all without health insurance.

It's great to be in Seoul, where the government insures me and doctor visits cost less than $10. Pharmacy afterward? Maybe $6.
posted by Joseph Gurl at 7:05 PM on June 8, 2010


I can barely contain my rage at the state of the "health" "care" "system" in the USA.

I am a highly educated white-middle-class female US citizen, 42 years old. I grew up in Hawai'i, a state which has a law on the books that requires businesses to provide health-care coverage to employees who work at least 20 hours a week. Fortunately, I had very good health care in the late 1980s and early 1990s, even though I was working part-time food service and bartending jobs. I remember paying a $3 copay for a doctor visit at Kaiser Permanente, and that was the end of it. I never even saw a bill for any of the health care I obtained, even for surgery, because it was all covered by my plan.

Health care costs have skyrocketed in the 20 years since I lived there. Many Hawai'i employers now routinely refuse to allow their employees to work more than 19 hours, in order to avoid having to pay for their health insurance. The result? Many people work 2 or 3 jobs just to get by, but are left to fend for themselves entirely when it comes to health insurance.

In the years since I left Hawai'i, I have gone for frighteningly long stretches of time uninsured. When I did have coverage, it was either through a shitty plan obtained via my university that still left me paying the lion's share of the costs, or through marriage/domestic partnership. At one point I lived in Canada for two years on a spousal work permit; during that time I was so stunned at the ease with which I obtained health care, and the low out-of-pocket cost, that I sometimes embarrassed the doctors with my over-the-top expressions of gratitude. (Thank you Tommy Douglas indeed! I loved your country, and I wish I still lived there.)

I'm now divorced and living in Oregon. When my ex left me, my insurance coverage went right along with him. I scrambled to get back into school, in part so that I could get on the university's insurance plan and see doctors at their clinic until I could figure something else out. I graduated last year in the middle of a recession; the school cut off my insurance immediately. I have been mostly unemployed - and entirely uninsured - ever since, despite my best job-hunting efforts. Like most of my friends, I'm on the "hope against hope I don't get seriously ill" plan.

And I'm one of the lucky ones, in part because of my race and class privilege. I am frugal, responsible, debt-averse and financially conservative (low risk tolerance) by nature, so I try not to think much about the fact that I am just one serious illness or injury away from bankruptcy, or the fact that a number of my friends are in the same boat, because it's so damn depressing.

I've been fortunate in that I have remained relatively healthy so far. But I'd turn to AskMe in a heartbeat if I needed it, because frankly, while it isn't the best option, it's better than most of my other options at this point. If AskMe can help even one American get advice that wouldn't otherwise be available to them, I'm all for it.

Most of the people I know are furious about the state of health care in this country. And for damn good reason.
posted by velvet winter at 7:10 PM on June 8, 2010 [24 favorites]


MexicanYenta: "I work for an insanely large corporation at which more than half of the workforce is contractors. The contracting agency I work is basically a temp agency, and therefore doesn't supply benefits. However, temp is a misnomer, as the positions they fill at this company are all indefinite, long term positions. Some of these people have been out here 30 years in the same job as "temps."

The insanely large corporation hires more and more contractors rather than employees so as to circumvent the unions
"

I've worked for companies like those before.
posted by ShawnStruck at 7:43 PM on June 8, 2010 [1 favorite]


I've been under-employed for the last three years. I gross about eight thousand a year and supplement that with retirement savings that aren't nearly adequate and that I really shouldn't be touching for at least another 15 years.

I spend about $375 a month to get health insurance with a $3000 yearly deductible.

So, there's no way I can afford to go to the doctor. The insurance is only there to protect me from losing my home if I get hit with a catastrophic illness.

That's what makes me so mad about the healthcare debate. It's not about health care, it's about insurance. Fuck insurance. I've got insurance and it's not nearly good enough. I don't need health INSURANCE, I need access to health CARE.
posted by anon.sock.puppet at 8:07 PM on June 8, 2010 [5 favorites]


What is it with (US) mefites and lack of health insurance?


Not enough chickens.
posted by webhund at 8:41 PM on June 8, 2010


Aside from insurance issues, or perhaps not so much aside, it's good to find validation/support/other people's experiences with the malady that you are searching for information about in AskMe. That's a natural impulse. I have turned to AskMe many times myself even when I've had insurance.

But I will just chime in and add to the list of those who have described what is currently a stark reality in the US, which is that even if you are insured, you are just one slip away from becoming uninsured, and in some cases, uninsurable.

Add to this that the House recently voted to deny the majority of COBRA benefits for anyone laid off or fired after June 1 and you have a recipe for further disaster. If the Senate follows the House's lead, anyone who loses a job after June 1 will have to spend 84% of his or her unemployment benefit on COBRA coverage alone.

Relying on the private market for insurance is impossible if you have anything that could remotely be checked off as a pre-existing condition, whether that's a heart attack, chronic illness of any kind, or something as basic as a prior history of hay fever that could lead to an insurer denying coverage for any illness related to the lungs, such as pneumonia, bronchitis, or asthma. It's legal in 9 states for an insurer to deny coverage if a woman has been a victim of domestic violence, on the basis that domestic violence is a pre-existing condition.
posted by blucevalo at 9:31 PM on June 8, 2010 [1 favorite]


I've been laid off for slightly more than a year. I was fortunate to get the Obama COBRA subsidy that reduced my insurance premiums to 25% of the rack rate. My insurance rates go up in July to $675/month for a basic plan with a $3000 deductible, plus separate deductibles for in-hospital care, mental health care, and prescriptions. My COBRA access will run out before the end of the year.

I tried very hard to avoid doctors for nearly ten years, knowing that I was one diagnosis away from being uninsurable. Then I had a heart attack, and while dealing with that, had to go through a ton of scans and biopsies for colon cancer (negative, but now on my record). This means I'm essentially uninsurable on the open market. I've got a friend who works in insurance and he can't figure out how I can stay insured and keep my house unless I marry someone rich and tenured.

This shit keeps me awake at night. God knows I'm trying to find a job, but until then I sit tight and hope nothing else breaks. My water heater is better protected than my health.
posted by wingtippedhipster at 9:31 PM on June 8, 2010


To clarify: "84% of his or her monthly unemployment benefit"
posted by blucevalo at 9:32 PM on June 8, 2010


I've got a friend who works in insurance and he can't figure out how I can stay insured and keep my house unless I marry someone rich and tenured.

Not that it helps much, but you're not alone.

God knows I'm trying to find a job, but until then I sit tight and hope nothing else breaks.

I'm right there with you. As are many of my friends.

The fact that so many of us are living like this just breaks my heart.
posted by velvet winter at 9:50 PM on June 8, 2010


I actually think that our socialised medical system here in the UK could do with an Ask Mefi triage system in place to stop the amount of people who come in going "I have a slight cough, give me antibiotics".

In the UK, your GP is the triage system. The result is one of the most efficient medical systems around. Also, there's NHS Direct, but they're pretty useless in my experience.
posted by grouse at 10:17 PM on June 8, 2010


The ambulance ride was $1000, for Pete's sake.

It seems to me there is no lower 'strategy' or 'business plan' than to take 'heapingly' from people as they 'stand' before you, at their weakest, in their darkest hours, with the least power to barter, argue, dispute, or heck, even talk lucidly...

Modern medicine is no short of amazing... modern decency levees much to be learned.

Having insurance companies actively spending capital to get people 'un-covered' is madness, I have typed it in before 'round these parts, but studies show that this injects an inefficiency to the system.

To those Canadians mentioning Mr. Douglas, (Boxing Champeen extraordinaire, yes, strong, brave, insightful man... He discovered early that it is the ideas that win the day, power has many facets, and the power he chose to adopt was not the transitory power of physical force and coercion... he brought people in with his big ideas.

There is a lesson to be learned by myself, and my fellow Americans in his alegory (fable?) of the mice, and the cats who helped 'govern' them in mouse-land.

But it's important to remember that he and his ideas were not embraced universally, (o.k, only distributed pockets of opposition, [but real, and a force to keep in mind nonetheless]) by people in 'The C.a.n.', there are people actively working today in opposition to the principles he laid out, which the Liberal party adopted, and with their legislative power, enacted as law, and eventually, 'enshrined' into the Supreme Law of the Land, ensuring that simple 'statute law' could not overturn or replace it (though this is through the mechanism of the current 'Transfer Payment system'*, and could (theoretically) disappear if that were severely altered [I have heard rumblings of calls to begin altering or removing these programs] and the RCMP who stalked him no less than those facing 'McCarthys' wrath' south of the border (by some accounts worse [note that there are public calls for the RCMP to release the 'files' they kept on Tommy Douglas] I have been following the calls to release these for a while, but they seem to now be gaining more traction).

But even the U.S. inteligence agencies were terrified of the 'little man with the big ideas up in Canada'... They had a program following his daughter, Shirley Douglas, mother of star of 24... Mr. Southerland, and even went so far as to label her a 'terrorist' 'criminal' (for 'palin around with terrorists', sound farmilliar?), for helping found a Black Panthers Breakfast Club.
Again, and this applies to folks from the states also, this film (keepers of the flame *the Best Doc on Tommy Douglas re:socialized medicine) is seriously worth watching, and thinking about, and considering; the battle to extend health care to those in need is... not yet mission accomplished (in our USA), and to Canadians, as 'bugets crunch'... be prepared to need to re-battle these 'socializing battles'.

Conservative ideas are hard to argue with sometimes, ie, *I* am *here*, if 'we' did something to change things... *I* might not still be *here* any longer. (note; oikos, oikonomy [sp. and understanding of Latin constructions is nada] concerened only with matters of ones own home)
The universe in the round has a conservative bias! (motion? or mass? or energy? momentum? some science thing right? right.)

"No lie to preposterous for them to spread and no tactics too despicable..."- Tommy Douglas 1948.

posted by infinite intimation at 10:59 PM on June 8, 2010


It's depressing but this is one of the main reasons that me and Mrs. Vacapinta cannot at all envision ever moving back to the U.S.

In the late 90's when a friend and I were working on a startup together, I fell off a wall and my leg landed all wrong. I was screaming in pain. I put ice on it and lay at home, unable to walk, hoping it would just heal by itself. I didn't have health insurance and we were all working hard making every dollar stretch so that we had more time to secure another round of funding.

I still recall how inhumane it all felt. Left to just whimper and walk around with old crutches I had borrowed from a friend.

When I arrived here in the UK and got an NHS card and then my EHIC card, I was so emotional I almost cried. It felt like I had won the lottery. And, at the same time, like an abused child who is treated kindly for the first time, it also dawned on me that what I had now was not a prize. It was something that, at least since governments were formed, should have always been a basic human right.
posted by vacapinta at 2:33 AM on June 9, 2010 [24 favorites]


Australia is often criticised for being a high taxing nation, as are many Scandinavian countries, but I am relived that those tax dollars mean that I have a safety net. Reading some of these anecdotes makes me break out in anxiety. I can't see how a nation that cannot take care of its sick is a nation that can be a beacon of liberty and freedom. The healthcare stories in this thread, and on AskMe pages sometimes read like Animal Farm-esque nightmares. You know, poor Boxer's fate when he can't haul shit around for the pigs? I loved living in the US but I was so aware that I was only a few dollars away from living on the street. All those homeless Viet Nam vets and mentally ill dudes eeking out food from bins in Santa Monica - poor buggers. It's an outrage.
posted by honey-barbara at 4:15 AM on June 9, 2010 [6 favorites]


Once the federal government concedes to giving comprehensive drug coverage to all Canadians and getting out of the insurance business entirely, I think we should rename ourselves Utopialand.
posted by Hiker at 5:22 AM on June 9, 2010


That's for Canada, btw.
posted by Hiker at 5:22 AM on June 9, 2010


I've started to feel resentful every time I hear someone talking casually about going to the doctor. For me and most of the people I know, that's a fantasy, and it's a fantasy which isn't going to become a reality in the foreseeable future.
posted by Pope Guilty at 5:33 AM on June 9, 2010 [3 favorites]


Starting this September, people shouldn't be able to be denied healthcare due to pre-existing conditions. We'll have to see.
posted by delmoi at 6:03 AM on June 9, 2010


My understanding is that in Canada (and other places) we have universal access to health care, while in the US Obama is trying to move the country toward having universal access to health insurance. Not the same thing. Is that accurate?
posted by ThatCanadianGirl at 6:22 AM on June 9, 2010 [4 favorites]


delmoi - the pre-existing conditions "inability to deny" that goes into effect this year is only for children. This won't happen for adults with pre-existing conditions until 2014.
posted by catlet at 6:31 AM on June 9, 2010


vacapinta, that made my heart hurt. I feel the same way every time I read a post by one of my fellow MeFites who probably should have headed to a doctor last week/month/year/decade, but simply can't afford to.

I graduated last year and work at a very small nonprofit. I don't have a drug plan or dental benefits, so it's safe to say that if Canada was like the US with respect to health care, I definitely wouldn't have insurance either. I make ends meet...barely. To think that something like a broken arm could financially destroy me is incomprehensible.
posted by futureisunwritten at 6:36 AM on June 9, 2010


Are there a lot more Americans living without health insurance, proportionally, than I thought?

I'm going to go with "Yes." Also, if you don't have insurance, you will try any recourse available to you before marching yourself into an ER.

For reference: I've gone to the urgent care clinic (categorically *NOT* the ER) for antibiotics for a case of bronchitis without insurance and it set me back $450. The same episode *with* insurance? $25.

If you haven't lived with the horrors of the US health care system it's easy to think that said horrors are grossly exaggerated... but they're not.

Also: one thing no one else has mentioned that sheds some light (to non-Americans) on what this situation is like - the FIRST thing you're asked when you go into a clinic or ER is insurance information. Not what your problem is. Even before your vital signs are taken, you are asked to show proof of insurance. If you don't have any, a very nice financial services counselor comes and talks to you (while you are trying to deal with your MEDICAL EMERGENCY) about how you're going to PAY for the care you are attempting to receive. Insurance coverage takes precedent over your fucking vital signs.

It's so bad that nurses working in urgent care may advise you NOT to use their services, even if you do have insurance, because the copays are significantly higher than seeing your doctor. (Happened to me and I wrote an angry screed about it.)

So yeah, even if you DO have insurance coverage as an American, you financially meet a stranger in the Alps every time you have an emergency come up where you can't call your PCP and wait six weeks for an appointment wherein you can take time off work. It's pretty easy to see where AskMe or even Yahoo Answers seems like a better *first* step than calling your doctor if you don't have HEAPS of time or money to spare.

(To add to my rage on the subject: I'm "lucky." I have a pre-existing condition and I *can* buy private insurance due to high-risk pool laws in my state. Unfortunately, it means I have to pay HALF my month's salary for it. I live rent-free courtesy of my partner owning our home outright - if I also had to pay rent, I wouldn't be able to afford insurance. It's that bad. Oh, and AskMe helped me find said insurance, for which I am eternally grateful.)
posted by grapefruitmoon at 6:47 AM on June 9, 2010 [7 favorites]


>> People used to be able to go to the doctor whether or not they had insurance.

That's because health insurance used to be like auto insurance -- something you bought in case something really big happened and you needed to be carried through the rough financial times caused by that.


And that's because health care didn't used to be as good as it is now.

Surgeons weren't even consistently washing their hands until the late nineteenth century, and anesthesia more effective than booze didn't really start showing up until then either.

Radiation therapy has been around for about a century--Marie Curie was messing around with it--but it didn't leave the realm of quackery in favor of empirical medicine until the middle of the last century.

Antibiotics were first identified and used deliberately in the 1930s.

Scientific medical education did not become dominant for about two decades after the 1910 Flexner Report.

Chemotherapy was first attempted in the 1940s.

The first successful cardiac surgery was in 1896, but such procedures really only came into their own in the 1950s.

The first successful internal organ transplant was in the 1950s.

Ultrasonography was first described in the 1940s and has made massive strides in usefulness and clarity even since the 1980s.

The first magnetic resonance images of human subjects occurred in 1977.

I could keep going, but in short, almost everything we associate with modern medicine has been around for less than a century. The freaking thirty-second President of the United States was confined to a wheelchair due to a paralytic illness for which there was no treatment. It wasn't just that he couldn't afford treatment, because he could, it's because there was no treatment. And--in true "No shit, Sherlock" fashion--medical expenses really started to rise around the 1950s.

Look, I understand that health conditions are scary. I've had two surgeries this decade. Hell, without modern medicine, I wouldn't even have been born, as my mother almost delivered me around twenty weeks. Even today that isn't considered viable. So count me in as one who thinks that modern medicine is important and that it's important that we expand access to it.

But there's still something deeply wrong about people who have been saved from what would have been fatal or permanently incapacitating diseases and injuries as little as a few decades ago bitching about how expensive said salvation is.

Damn straight modern medicine expensive. If you want to make an argument that we need to find better ways of making this available to everyone--a moral and political argument--you can do that, but for f*ck's sake, stop arguing that because medicine didn't used to be expensive that it shouldn't be today--an economic and historical argument. Making the political argument while ignoring the history is just, well, ignorant.

It also has the unfortunate side effect of making the moral and political argument really, really easy to dismiss as magical thinking. Until all you people who want universally-available health care can come up with some way of paying for that that doesn't involve massive hand-waving, i.e. one that seriously considers the history and economics of modern medicine, you should assume that you have nothing of value to say. "Waste, fraud, and abuse" and "greedy insurance companies" aren't legitimate arguments, they're Care Bear Stares.

I'm not saying I have the answer here. There may not be one. But the sort of cavalier treatment of these issues which is on display both in this thread and in most such discussions on MeFi really pisses me off.
posted by valkyryn at 6:48 AM on June 9, 2010 [3 favorites]


If you have insurance, negotiating the maze to figure out what you can and can't do, how much things cost, and which doctor is on your plan (so you pay the cheaper, i.e. only mildly outrageous in-network rate) is a huge bureaucratic hurdle. It's only when you have an emergency of some sort that you say "to hell with this" and either do all the research on short notice or just go wherever you can get in and pay an arm and a leg.

This observation is brought to you by my husband's toothache and the three dentists he's seen in the last three days while we figure out whether it's just gum disease or a root canal gone bad and whether the co-pay damage after insurance is in three figures or four.
posted by immlass at 6:49 AM on June 9, 2010


Is that accurate?

In Canada, once you present your Health Card, you've got full access to health care at a hospital or clinic. You've no guaranteed access to the medicine you need to fix your diagnosis.

In the States, once you present your proof of Insurance, you've got varied degrees of access to health care. You've no guaranteed access to the medicine you need to fix whatever varied degree of diagnosis you've been given.
posted by Hiker at 7:03 AM on June 9, 2010


Valkyryn -- you are talking like no other countries have managed to have a viable health care system, like it's some magical thing that has never been achieved. When the reality is, it's the US that is miles behind everywhere else. Higher costs (at every level) and worse outcomes.

So my answer would be to look to other countries to see how they do it. Oh, wait, it's probably socialism. Best we just let our citizens die, then.
posted by gaspode at 7:05 AM on June 9, 2010 [19 favorites]


Until all you people who want universally-available health care can come up with some way of paying for that that doesn't involve massive hand-waving, i.e. one that seriously considers the history and economics of modern medicine, you should assume that you have nothing of value to say

I dont know...My tax rate in the US was 33%. Here in the UK it is 40%.

Best 7% of my income I have ever spent in my life! And I am overpaying because I am also helping to cover those who make much less than me and those who make absolutely nothing. That is good for my soul, though.
posted by vacapinta at 7:06 AM on June 9, 2010 [28 favorites]


Tax me. Tax me on my investments, tax me on my income, tax me on my small business if that's what it takes to get universal health care for the people of this country who are currently unable or afraid to attend to their health. A physically healthy country is one that is good for business and good for investors.

And then, once we get access, maybe providers will be able to see patients at all socioeconomic levels rather than rationing care because HMOs and Medicare have dropped reimbursement so low that, for many practitioners I know (i.e. not "I heard about this," but "I had this conversation twice this week alone, with a neurologist and a psychiatrist") it is a decision between limiting their practice to people with PPO insurance or cash, or not being able to make the money required to pay the overhead that comes from offering the fruits of modern medicine that valkyryn describes.
posted by catlet at 7:34 AM on June 9, 2010 [5 favorites]


So my answer would be to look to other countries to see how they do it.

Okay.
posted by valkyryn at 7:38 AM on June 9, 2010


Count me in as another uninsured person living in fear here in the wonderful US of A. I got laid off in April and my insurance, which already sucked (I had to pay over $1000 out of pocket for a CT scan, which took me over a year to pay off - as it turned out there was nothing identifiable wrong with me so possibly I shouldn't have listened to the AskMe go to the doctor people) and didn't include dental or vision. I balked at paying $600 or so a month COBRA for that out of my $255 per week unemployment benefit and so here I am, hoping I don't get sick and that if I do, they don't take my house. Hell, I already went bankrupt once due to my son's medical expenses and I had insurance on that fateful day when he tied his skateboard to his friend's scooter and went for a ride. Surgery to put a plate in the broken bone in his arm so he would still be able to use his right hand as an adult cost over $9,000 more than the insurance would pay. I was just lucky that I managed to go bankrupt before they changed the rules on that as well. I sometimes lie awake in bed and try to figure out just what I would do if anything happens to me. Die, I guess.

valkyryn, I was born in 1963. In my lifetime, I've watched basic medical care - like help for a cold or the flu or a child's broken arm - skyrocket beyond any reasonable rate of inflation. None of those therapies have changed much. In the late 80s my daughter broke her arm riding her bike (yes, my family seems to have broken arm karma) and I didn't have insurance. We went to the hospital and the bone was set and a cast put on. When the bills came in, I started crying. There were bills that said things like "You may not have seen this doctor, but if you had needed him, he was actually in the building, so pay us $110." The total was around $2500, which is to say, approximately 10 times more than my parents paid for the the cast on my own broken arm roughly twenty years before in the early 70s. Twenty years later and we're looking at today, where that same treatment is probably going to cost at least $8,000. Has your salary increased at that rate? Because mine hasn't.
posted by mygothlaundry at 7:50 AM on June 9, 2010 [17 favorites]


valkyryn, can you explain why, in 1991, long after all these "advances" came about, I was paying $28 every two weeks for health insurance and now, here in good ol' 2010, I'm paying nearly $480 per pay check for the same? Is it the advances in our styrofoam slipper technology? The wondrous selection of Redbook in the waiting rooms? Please...

I'm not sure how it is in the world you inhabit but for you to insist we compartmentalize the argument into a moral and political argument vs. a economic and historical argument is sky-high bullshit. I'm not being overly dramatic when I say that this issue affects Americans more deeply than you care to know. I work in the insurance industry. I know. For purposes of the original question and for the guys who stand around the mantle in tweed jackets talking about their golf game, fine; go nuts. Unfortunately you're out of touch with reality on this one.
posted by KevinSkomsvold at 7:55 AM on June 9, 2010 [8 favorites]


To pile on a bit, the medical system in the US, possibly the world, is broken.

Half of the problem is health insurance, and the other half is malpractice insurance. (Funny how the insurance companies get it from both sides...)

I'm not *blaming* the insurance companies per se, but that it is a system that's out of whack (scientific term) and that out of whack-ness has compounded year over year over year.

I don't know the numbers out of hand, but healthcare costs are going up by a solid percentage every year. If that keeps happening, in some short amount of time it will take up the entirety of the GDP. We are in for a healthcare crash, real soon. Obamacare sucks, but it is something.

Further, one thing I see in the practice of medicine is that a lot of doctors seem to be doing it wrong. Going from this hospital to that, 2-3-4-5 different offices where they see patients, having what amounts to 5 different jobs. With all that driving around, no wonder they have to charge so much. If they all stayed put, their workload would go down and their profit would go up. I'm not talking obscure, high-demand specialties. GPs, and other first-line specialties like orthopedists and ENTs and the like.

A family member needed to have an outpatient operation on her knee. We were late, the nurses were late, the doctor was late. All because we were all sitting in the same traffic jam. Because we all were coming from nearby suburbs to a storefront outpatient shop in the city. Because their OR rates were cheaper than those of the dozen or so hospitals we drove past on our way there. That's broken.

Why the difference? My husband's employer, a Large Software Company in Redmond, self-insures. They hire an insurance company to administer the plan, but there's no profit motive in it. The comparison makes me ill; I think of another friend of mine whose two-year-old developed breathing problems one evening while I was at her house. Her husband was bundling the little girl up to take her to the ER while the wife was at the computer checking the bank balance to make sure they could afford the ER copay. And somebody is making a PROFIT on that shit.

There is plenty of profit motive in it- the more they turn the screws on the providers, the cheaper the bill is for their customer, the Large Software Company.

The downside of that is happening in my company, with somewhere between 200 and 600 employees. We are self insured, and it is indeed cheaper. Unless, as has happened in recent years, you get a confluence of a poor economy, and a few employees with some major medical problems. I feel awful for everyone. We are all working really hard, lean and mean, just to break even. Because our insurance bill is squeezing us dry. It sucks for the people we had to lay off, the people who remain working harder than ever for less pay, the poor people who have gotten sick, the owners of the company whose ENTIRE LIVES are in the company. If the company fails, they have nothing. All because some of their employees got sick.

It's easier for Redmond because their pool is bigger and thus more stable. But it would be even easier for everyone if we all were in the pool.
posted by gjc at 8:27 AM on June 9, 2010


People with health insurance don't need to ask questions about how to get healthcare.

People with health insurance are too afraid of their insurance companies to ask ANYONE for advice on health issues lest it not be covered and turn into a pre-existing condition for future insurance issues.
posted by whatzit at 8:32 AM on June 9, 2010 [3 favorites]


valkyryn, can you explain why, in 1991, long after all these "advances" came about, I was paying $28 every two weeks for health insurance and now, here in good ol' 2010, I'm paying nearly $480 per pay check for the same? Is it the advances in our styrofoam slipper technology? The wondrous selection of Redbook in the waiting rooms? Please...

I'm not sure how it is in the world you inhabit but for you to insist we compartmentalize the argument into a moral and political argument vs. a economic and historical argument is sky-high bullshit. I'm not being overly dramatic when I say that this issue affects Americans more deeply than you care to know. I work in the insurance industry. I know. For purposes of the original question and for the guys who stand around the mantle in tweed jackets talking about their golf game, fine; go nuts. Unfortunately you're out of touch with reality on this one.


It is an unfortunate negative-feedback system where everyone squeezes everyone for more profit, which causes everyone to raise their rates, and blame everyone else. The political parties have their Chosen Bad Guys, but in reality, it is all of them. Nobody is making any money because everyone else is making the money. Over and over again.

They way I see it, nobody is the bad guy, nobody is the good guy. There are just a LOT of them. One fifth of our GDP is healthcare costs, right? That means that it's expensive, but it also means that ONE FIFTH of our citizens, roughly, are making their living off of healthcare.
posted by gjc at 8:36 AM on June 9, 2010


When the bills came in, I started crying. There were bills that said things like "You may not have seen this doctor, but if you had needed him, he was actually in the building, so pay us $110." The total was around $2500, which is to say, approximately 10 times more than my parents paid for the the cast on my own broken arm roughly twenty years before in the early 70s. Twenty years later and we're looking at today, where that same treatment is probably going to cost at least $8,000. Has your salary increased at that rate? Because mine hasn't.

One problem is that there are a lot of patients who will go into the office and say "I'm not paying that." And then they need to make it up on everyone else who isn't as forceful. If the hospital needs to keep Dr. Vascular on staff to meet the what-if needs of their level of promised care. Somebody has to pay the salary. Split it with every patient, or only charge those who use his services. But what happens, unfortunately, is both. And then everyone says "not me, chief" and the price has to inflate high enough that the costs are covered by the few suckers who do pay.
posted by gjc at 8:45 AM on June 9, 2010


to insist we compartmentalize the argument into a moral and political argument vs. a economic and historical argument is sky-high bullshit.

Political arguments not based in history are what we tend to call "ideology" if we're feeling generous and "nonsense" if we aren't. The fact that the issue may be an emotional one doesn't change this much. The fact that you put the word "advances" in quotes suggests that you're no more in touch with reality than you suggest that I am, but if you're willing to pay nineteenth-century prices for nineteenth-century medicine, don't let me stop you.

Yes, medical costs have increased faster than inflation. Of course they have. That's because, as I suggested above, medical care has changed faster than inflation. There are millions of people living normal lives who would have died had they been born in 1900 instead of 1950. And yes, I can explain why this difference continues to accelerate: We're consuming far more medical care in terms of both quantity and quality.

For example, organ transplantation is far, far more common today than it was even twenty years ago. As recently as the late 1960s, almost all cardiac transplant patients died within sixty days. Today the survival rate is upwards of five years, and we're doing more than two thousand heart transplants every year. Given that transplant procedures cost somewhere in the neighborhood of $500,000-1,000,000 in the first year, that's nothing to be sneezed at.

MRIs were only introduced in the late 1970s, and at $1-3 million a piece ($2-4 million installed), they're not exactly cheap machines. As early as 1980, it was almost impossible to get one. Now it seems as if it's almost impossible not to get one almost every time you go to the emergency room.

It's not just procedures either. As a society, we've decided that we want the highest possible quality of care delivered by highly trained professionals. Licensed Practical Nurses, LPNs, who receive a two year degree, have almost entirely been phased out of hospitals in favor of full RNs with bachelors degrees. This may or may not lead to a higher quality of care, but it does drive up medical costs. We could decide that we're okay with perfectly competent professionals who don't have the maximum available amount of training to deliver our care, but no, that's not good enough for the Americans. We have to have the best, and cost be damned.

These are just three examples, but they underline the fact that we are consuming far more medical care per capita than we were fifty years ago, and the medical care we're consuming is inherently far more expensive than it was fifty years ago.

So, yes, obviously it's an emotional issue. But emotions are not actually negotiable currency. We need to find humane ways of managing what passes for a health care system in this country, but trying to do this while ignoring the brass tacks of the matter produces fiscal crises and sovereign debt problems, not better health care outcomes.
posted by valkyryn at 8:50 AM on June 9, 2010 [2 favorites]


Dear Citrus,
Looks like you are employed in a profession that's generally pretty well paid, with pretty good benefits. A huge number of Americans are employed in jobs with non-existent, or crappy, benefits. Another huge number of Americans have several part-time jobs, again with non-existent, or crappy, benefits. Students, unemployed, disabled, and other people may also be in that big group of Americans with non-existent, or crappy, benefits.

Your job and social circle may have effectively insulated you from people who live quite differently, and not necessarily by choice. The ask.mes are a pretty good indicator that there are all these people who cannot afford medical care at all, or can't afford their deductible, or find the medical system too monolithic to deal with. People who are too poor to pay for an Internet connection and a MeFi membership get Medicaid, and get medical care.

You may find, if you are curious, that you are also insulated from a great deal more. I find my comment to have an aggressive tone, which is not intended.
posted by theora55 at 9:06 AM on June 9, 2010


MetaFilter: I find my comment to have an aggressive tone, which is not intended.
posted by fixedgear at 9:20 AM on June 9, 2010 [2 favorites]


My understanding is that in Canada (and other places) we have universal access to health care, while in the US Obama is trying to move the country toward having universal access to health insurance. Not the same thing. Is that accurate?

This is exactly correct, and this is the crux of the argument I've had with a lot of fans of the Obama/Romney plan.

I remember working at Wal-Mart, and the first day, one of the other employees pulled me aside and quietly told me: don't buy the insurance. It cost most of your check, only gave you access to one doctor in town (and this was not a small town, it was Muncie, Indiana), and the copays and deductibles were sky-high). Unless you got catastrophically ill, you would have been better off not buying the insurance and putting some fraction of that money in a savings account.

You have to pay a lot of money (or find someone else to pay a lot of money) to get insurance that's better than no insurance at all. Every other industrialized nation has solved this problem. It is a form of national insanity that we steadfastly refuse to acknowledge this, and insist that our system must be built to cater to the biggest sources of the problem. It is as if, instead of having the dragon slain, we have decided to just feed him a virgin every month.
posted by Pope Guilty at 9:23 AM on June 9, 2010 [3 favorites]


Just chiming in on the stats, those 40-45 million uninsured estimates are point in time estimates; ie at any given time there are 45 million uninsured Americans. Because being uninsured is a transient state for some, if you widen the time frame you get higher numbers, up to nearly 70 million if you try to figure out how many people were uninsured for at least one month out of a given year.
posted by yarrow at 9:33 AM on June 9, 2010


theora55, I usually love your comments to bits n pieces, but... maybe Citrus is from a country where your job or your pay or your whatever, 'insulation,' doesn't make a shred of difference as to whether you get health care.

To many people outside the USA, having your health cover have so much to do with your class or income is disconcerting. Why is your work/employer even involved? I know you take it for granted, but Citrus' puzzlement doesn't necessarily come from class ignorance, it possibly comes from seeing the USA's health care very much as 'Other'. That your job or income have to do with your right to health care is a practice/ideology/notion that could withstand some unpacking it seems to me

Yes, we can buy private healthcare in Australia, Europe, UK etc but there is never a doubt that we will be cared for in a public hospital. [Of course we naturally whinge about waiting times in triage, but that is the way of all ERs it seems to me.] GP fees, psychologist fees, specialist fees, MRI X-rays etc are rebated in part [usually at a high percentage of a scheduled fee], or are 'bulk-billed' to the state. I have had the world's best surgeons operate upon me at least 11 times in the last 8 years, have had my own room, free drugs, at home rehabilitation, specialist appointments and have not had to pay a cent. I have been seen in ERs within 30 minutes in the 15 or so times I have need to go there. I may have had to wait two weeks or one month at most for a particular specialist appointment.

I am poor. I am 'insulated' by my nationality and its craaaazy socialist desire to have a safety net for everyone. There are 30 million people in the USA without insurance, that's more than my country's whole population. It's a fucking travesty.
posted by honey-barbara at 9:37 AM on June 9, 2010 [9 favorites]


I have never had a job that offered benefits. I have not had any health insurance since I turned 18. If it hadn't been for the Health Right clinic in Morgantown WV I would likely have died of pneumonia about 10 years ago. My boyfriend and I have about $150 left each month after bills. He's scared about what will happen when we are required to buy insurance. He says he won't pay and will just pay the fine instead. I expect we'll both be dead before age 60 because of lack of medical care. MetaFilter is what we do in the meantime.
posted by irisclara at 9:59 AM on June 9, 2010


I'll just chime in to say that I could have written pretty much every word of velvetwinter's comment. I'm the same age, gender and demographic. I'm very fortunate to be in a good, apparently stable job now where I have excellent benefits.

However, due to my utter lack of benefits (of any kind) for 90% of my adult life, I now have 2 issues:

The first is that I have zero tolerance or understanding for how to navigate the byzantine system that is U.S. healthcare, because, well... I just didn't use it. Ever. And now I have no idea how it even works. So I don't use the benefits I do have, for routine maintenance I probably should get.

The other is, and tagging onto that theme, that I haven't been to the dentist since I was eighteen, and now I'm basically terrified to. Fortunately I don't have any problems with my teeth. But I bet I could sure use a good cleaning. There again, I have no idea where to even start.

Just illustrating the fact that there are facets to this issue that no one can really comprehend until you've lived them.
posted by lonefrontranger at 10:09 AM on June 9, 2010 [1 favorite]


. Now it seems as if it's almost impossible not to get one almost every time you go to the emergency room.

Maybe part of the problem is the desire to justify the expense of that machine by using it for everything.

I remember reading about a study a few years ago that found that the most significant factor determining whether a newborn went to the NICU was the availability of NICU space. In other words, once a hospital has a NICU (a good thing to have, surely) it will fill the beds there, sometimes with babies who don't necessarily need to be there but might as well be since there's a spot available. This is one way costs are driven up unnecessarily.
posted by not that girl at 10:19 AM on June 9, 2010 [2 favorites]


Y'know what's really awesome? I spend so much money every month on medication (i.e. my entire income that doesn't go to rent; I get one scrip that would cost about $1500/mo for free in samples from my doc) that going to the dentist is a pipe dream. As a result (and thanks to terrible genetics) I have teeth that pretty much guarantee I won't be taken seriously applying for any job this side of crack-dealer-lookout. LOLSELFPERPETUATINGCYCLEOFPOVERTY.

valkyryn's right, though, these mysterious "painkillers" I take are made from the miracle drug "opium," only recently discovered, and the Laser Dentures I'd need are about a bazillion dollars each (and that's without the monthly satellite uplink charge). If only leg braces were made out of soft, moldable plastic rather than gold from a dragon's hoard, I could replace the one that lets me walk (and is going on 8 years old [yer s'posed to replace 'em every year or two]). I'm just glad I don't live in a barbarian country like Japan or Korea or France or the UK or Germany or Canada where they just don't care enough about the patient to use current technology.
posted by jtron at 10:47 AM on June 9, 2010 [15 favorites]


PS I'm not very close to my parents and my girlfriend tells me I'm terribly decorative. If anyone from a proper country would like to adopt me, email's in the profile.
posted by jtron at 10:48 AM on June 9, 2010


This article is quite interesting - talking about how the availability of medical services drives up the "need" when those services can be biilled for. It's all about making money.
posted by ThatCanadianGirl at 10:50 AM on June 9, 2010


My understanding is that in Canada (and other places) we have universal access to health care, while in the US Obama is trying to move the country toward having universal access to health insurance. Not the same thing. Is that accurate?

It is and it isn't in that your explanations don't really mean anything.

First, there is the system of how payments are made. In Canada the provincial governments make all (nearly all) of payments to doctors, hospitals, etc. This is the "single-payer" system. Doctors can charge patients directly, but they're not permitted to charge both patients and the government. A clinic is either-or. So there are private GPs in Canada but very few and they're used by the rich and/or businesses. Behind the scenes the costs are split between the Federal and Provincial governments with the Feds giving a big chunk of federal tax dollars every year to each province in the form of a healthcare transfer payment. THis system also streamlines paperwork since costs are fixed and known and there's only one payer (the province).

Second there's the question of costs. If you only have one payer then they have a lot of negotiating leverage. So Canadian health costs are lower basically by fiat. A GP gets so many dollars per visit regardless of the doctor, the patient, etc. In the US a popular doctor in a nice clinic is free to charge more than an ugly doctor with an ugly office. Insurance companies negotiate rates, but none have infinite leverage to set prices unilaterally. That plus the cost of malpractice insurance means the US doctors just plain old charge more to do stuff. Plus the loses to insurance company overheads. So everything ends up costing more.

So yes, Canadians have universal "care" in that there's a unified government-run system for setting fees and paying doctors out of tax revenues. In the US it's basically a free market unless you're on Medicare or going through the VA.

Having said all that you can clearly see that medical facilities in the US compete for your business. Middle to high-end medical facilities in the US are really, REALLY nice compared to Canadian facilities. (There is, of course, a wide range of variation in both systems depending where you end up going. The are dirty old hospitals in the US and nice new ones in Canada, but) My wife had minor surgery in Canada and here in the US and there's a big difference. We had two children in Canada and seeing friend's childbirth experiences here in the US, there is again a big difference. Sadly I doubt there's any difference in effectiveness or medical outcomes - the day surgery ward in St Mike's in Toronto was horrible but I don't think it results in a worse outcome for patients. The TVs and private rooms and views of the mountains and free food in the US hospital was very nice but again, it didn't really have any impact on the effectiveness of the doctor or the final outcome. Although in my anecdotal experience, it's very hard to get a nice doctor in Canada (Toronto at least) while here the GPs in the US are very nice. My wife even had one that did med school at U of T.
posted by GuyZero at 10:53 AM on June 9, 2010 [2 favorites]


But I bet I could sure use a good cleaning. There again, I have no idea where to even start.

Ask co-workers who their dentist is until you find one that likes their dentist. THis may not take long. Call that dentist. Make an appointment. Go to the dentist's office at the appointed time. They'll make you sit in a funny chair. The dentist will stick his hands in your mouth. At the end he or she will give you instruction on what to do next.

It's honestly less confusing than a trip to Lowes.
posted by GuyZero at 10:56 AM on June 9, 2010 [2 favorites]


I'm just glad I don't live in a barbarian country like Japan or Korea or France or the UK or Germany or Canada where they just don't care enough about the patient to use current technology.

Snark is duly noted. And sure, they use expensive technology too. And they're all going broke. Just like we are. They don't even have to pony up half-trillion dollar defense budgets on top of their unsustainable health care spending, and they're still going broke.

There ain't no free lunch. Maybe we do want to provide medical care for everyone. But it's gonna be massively expensive, and the only argument I've seen that we can actually afford to pay for these things is "No, it won't," which isn't an argument as much as it is a-historical magical thinking. Which is what I've been carping about all day.
posted by valkyryn at 11:00 AM on June 9, 2010


Which gets us back to the elephant in the room in American politics - how damn much we spend on "defense," and how little it gets us, and how much could be improved in the life of schmucks like me - and thus in the health of the nation - just by bringing our expenditures in line with other developed Western countries.

Except, by the way you talk, every wealthy nation that provides health care is fucked economically. Is there anywhere that's not fucked economically, by your standards? What sort of health care is available there?

"Unsustainable" health care spending my ass. "Unsustainable" is wasting human and economic resources the way the US does with its health system. I know I'm not the only person who'd be a hell of a lot more productive (personally/creatively/economically) without shit like this taking up so much of my time and mental energy.
posted by jtron at 11:06 AM on June 9, 2010 [4 favorites]


So, yeah, medical care eats up a lot of the Canadian government's budget but the irony is that the US ends up sucking even more money out of its economy overall per patient because the system is so inefficient. The US' real problem is that the horrible inefficiency of the medical insurance industry is often referred to as "jobs".
posted by GuyZero at 11:07 AM on June 9, 2010 [2 favorites]


Is there anywhere that's not fucked economically

Somalia has pretty low taxes so I guess they're doing OK.
posted by GuyZero at 11:08 AM on June 9, 2010 [4 favorites]


hippybear: At least the local health clinic will "discount" their rates heavily for me when I appear as a walk-in-no-insurance patient. Because they know I'm there because I really fuckin' need it and not because I just have a sniffle that I can pay a $10 co-pay to have a consult. Still, I have health issues which go unchecked because I cannot afford to just drop into a doctor for everything, and if it's not really compromising my daily life, then I don't bother.

grapefruitmoon: It's so bad that nurses working in urgent care may advise you NOT to use their services, even if you do have insurance, because the copays are significantly higher than seeing your doctor.

Some years back, when I had no medical coverage at all, I had a very serious bout of bronchitis. I couldn't lie down because I stopped being able to breathe and my temperature hovered at 100F with the occasional spike. I kept strugging through, until a friend pinned me down and asked "You keep saying you can't afford to see a doctor. Can you afford to be hospitalized?" I went to the local medical center, because it was the only one I could remember how to find (that fever was costing me a notable chunk of my IQ). I told the clerk that I was having trouble breathing, but I had no coverage. The clerk explained that they charged a lot more for emergency walk-ins, but that if I could walk a block and a half to their other location and wait an hour, she could sneak me in with a regular appointment. I did so, and the doctor who saw me carefully fudged the paperwork so I was billed for the shortest possible appointment and made sure the prescription she gave me was for the cheapest possible drug. When I thanked her, she told me she'd much rather see someone who needed her than someone with a sniffle and a $10 co-pay.

That whole affair could have cost me hundreds of dollars. I got away with about $100 of costs, because the folks on the front lines don't like the way things work, either.

posted by Karmakaze at 11:13 AM on June 9, 2010 [6 favorites]


theora55, I usually love your comments to bits n pieces, but... maybe Citrus is from a country where your job or your pay or your whatever, 'insulation,' doesn't make a shred of difference as to whether you get health care.

Look at his profile.
posted by ROU_Xenophobe at 11:13 AM on June 9, 2010


I've said this before and I'll say it again: mr. epersonae & I got married so he could get his wisdom teeth out. I love him, but WTF should being married or not (and who either of us happened to be employed by) have to do with affording health care?
posted by epersonae at 11:16 AM on June 9, 2010 [5 favorites]


GuyZero - access to health care means that if I break my arm I go get an x-ray and a cast and then go home. Access to health insurance means that if I break my arm, I may have health insurance but unless I can afford the deductible and the co-pay I may have to choose between food and rent for the next while. (Also - my Toronto doctor is very nice!)

Oh also again for the others - often dental hygenist colleges are looking for patients to practice on. If you live in a city that has such a school give them a call. Maybe they an look after you.
posted by ThatCanadianGirl at 11:19 AM on June 9, 2010


Thanks ThatCanadianGirl but the prices at the UIC Dental School are above what I can pay right now, unfortunately
posted by jtron at 11:23 AM on June 9, 2010 [1 favorite]


Deductibles and co-pays vary, but sure, yes you might have insurance and still not be able to afford being treated. Certainly I think the Canadian system works better in general, especially considering the amount of time I was unemployed and/or in grad school with 2 kids in Canada. But the people who like the US system the way it is aren't the poor ones and there are enough of them to keep the status quo.
posted by GuyZero at 11:23 AM on June 9, 2010


I've had solid medical coverage through employers or COBRA since I was nineteen years old, and I'm 39 now. I never ask medical questions (except once during an unfortunate wasabi-related incident.) It's kind of like the media -- if everyone shown in the media is thin, you feel like the only fat person, and if the homeless crazy guy is always carrying a gun on tv, then you assume the homeless crazy guy on your street is, too.
posted by davejay at 11:25 AM on June 9, 2010


theora55, I usually love your comments to bits n pieces, but... maybe Citrus is from a country where your job or your pay or your whatever, 'insulation,' doesn't make a shred of difference as to whether you get health care.

Maybe valkyryn doesn't appreciate the urgency involved in not having health care because in Valhalla all of the Einherjar are healed and resurrected every day after battle so that they might feast with Odin in his great hall. ;)
posted by jtron at 11:25 AM on June 9, 2010 [11 favorites]


Isn't there some way that we could all get a group rate for being members of Metafilter?
posted by dpx.mfx at 11:33 AM on June 9, 2010 [3 favorites]


I just sent one person here a Memail, but now since I've seen this come up a few times in these comments, I'll share with everyone: if you need dental work and can't afford it, try a dental school. The one I've been going to, the University of Texas dental school in Houston, charges pennies on the dollar. All the students' work is checked by a professor. They work slower than a regular dentist, but the work is very good and very thorough. I had four wisdom teeth extracted, plus two others, for something like $385 total. (A quick googling turns up an average price of $2000 for just the four wisdom teeth.)

Also, if you do have dental insurance, you can still go there. They told me you would have to pay up front, and then submit the receipts to the insurance company, but the insurance companies generally have no problem with reimbursing you.
posted by MexicanYenta at 11:35 AM on June 9, 2010 [1 favorite]


But I bet I could sure use a good cleaning. There again, I have no idea where to even start.

Ask co-workers who their dentist is until you find one that likes their dentist. THis may not take long. Call that dentist. Make an appointment. Go to the dentist's office at the appointed time. They'll make you sit in a funny chair. The dentist will stick his hands in your mouth. At the end he or she will give you instruction on what to do next.


You forgot the part where he goes…ok you can do; A which would be $8000, you teeth would look like new; B which would be $3000 and you teeth would look alright or; C which is $1000 and we pull them all out. Thats kinda where I am now.

Fuck I hate dental insurance. such a fucking joke.
posted by ShawnString at 11:45 AM on June 9, 2010 [2 favorites]


Well, I dunno. I take dental advice under advisement. If you have horrible teeth, yes, it's expensive. Orthodonture is expensive but generally worth it, even as an adult. But dentists, unlike doctors, will attempt to outright sell you stuff you don't really need. A lot of it is comparable to cosmetic surgery, stuff like veneers, etc. $3K for a course of braces & straightening sounds about right. But dental insurance isn't really like car or medical insurance and never has been in my experience. Car insurance just covers accidents. Medical insurance sort of covers everything, for varying degrees of everything. But it generally covers all non-elective procedures and maintenance. Dental insurance is somewhat between the two. I've always had great dental insurance and we still fear the orthodontist for my kids and we shelled out about $3K for my wife's braces. That just how it works.
posted by GuyZero at 12:07 PM on June 9, 2010


You're entitled to health care delivered by competent, dedicated professionals who will triage your problems against the problems of others such that overall the healthwise quality of life of the population as a whole is elevated as much as possible within the budgetary constraints. That is because the GOAL of the system is health care.

Unless you're in the US.

In which case you, unless you're a rich motherfucker or an employee of some large corporations, get the dregs of a system designed from top to bottom to coax as much money as possible from patients and employers by tricking everyone into thinking that they entitled to live as long as the best stainless-steel machines and greying-temple personnel can make you live. That is because the GOAL of the system is profit.

Rule one, in any system that seems to not be working properly, is follow the money. You will find in almost every case that the system is working as designed, just not towards the goal you desire.

...

My GP's office is a couple of rooms in the bottom floor of a nondescript commercial building down the street. There's no big signs or anything. It's just a blank door with the name of him and his partner on it. You open the door and there's a little waiting room with a few chairs and magazines. Fluorescent lighting in a suspended ceiling. No TV. The receptionist is an older woman, friendly and businesslike. The doctor is smart and competent, a younger man in casual attire. Their mission: deliver health care. Their employer: the government of Ontario.

I wish I could pack this up and ship it to my friends in the states as easily as I can do so a gallon of dark maple syrup. I love you guys and you deserve to have this just as much as we do, because it's a basic human right.

The right to be treated humanely by one's fellow humans.
posted by seanmpuckett at 12:12 PM on June 9, 2010 [15 favorites]


You're entitled to health care delivered by competent, dedicated professionals who will triage your problems against the problems of others such that overall the healthwise quality of life of the population as a whole is elevated as much as possible within the budgetary constraints.

Forgive the snark, but are we also entitled to ponies? Cause I don't see how the universe guarantees us health care more than it guarantees us ponies.
posted by valkyryn at 12:24 PM on June 9, 2010


Entitlements are a function of the society we exist in, not of the universe.
posted by Pope Guilty at 12:28 PM on June 9, 2010 [6 favorites]


People with health insurance are too afraid of their insurance companies to ask ANYONE for advice on health issues lest it not be covered and turn into a pre-existing condition for future insurance issues.

This. I know that I am very fortunate to be young and yet well-insured, but I'm still scared. The reforms coming in the next 4-5 years should help, but until then, I have no idea what to "avoid."
posted by tantivy at 12:29 PM on June 9, 2010


Forgive the snark, but are we also entitled to ponies? Cause I don't see how the universe guarantees us health care more than it guarantees us ponies.

No, not the ponies, just the health care. And not the universe. Just our societies.
posted by ThatCanadianGirl at 12:34 PM on June 9, 2010 [4 favorites]


Except, by the way you talk, every wealthy nation that provides health care is fucked economically. Is there anywhere that's not fucked economically, by your standards? What sort of health care is available there?

Norway and Canada are actually looking pretty good. But they're both basically petro-states, i.e. economies who make a lot of money selling raw materials to others. It just so happens that they were both well-established, industrial, first-world economies before that happened, which might explain why they look more like the US/UK than they do like Venezuela/Iran/Russia. The lesson here is that if you've got a tiny population and happen to be among the world's largest exporters of petroleum products and happen to have developed robust political institutions before you discovered oil, you're basically good to go.

Australia's looking pretty good too. Low defense spending, manageable deficits and a projected return to surplus in the current decade. But again, small population with more than its fair share of natural resources. Observers are starting to express nervousness about their economy's dependence upon the export of raw materials. Still, probably in a better position than the petro-states. Sheep are pretty sustainable.

China isn't looking as bad as it might. They've got some housing bubble problems on the horizon, but they've been running a surplus for years. 'course their access to health care is atrocious by US standards, and they've also got to urbanize a population the size of the United States' in the next few decades, which doesn't sound like it's going to be a ton of fun. The lesson here is that there's no limit to what you can do with an unlimited supply of what amounts to slave labor.

India doesn't appear to be headed for any kind of crisis either. Then again, they've got 410 million people living below the Indian poverty line, so I'm not sure that's something we want to model.

I think Israel might actually be doing okay, but I know less about their economy than other nations'. I'd like to think that their political travails don't require detailing.

In short, there are some places that are both more-or-less okay economically and provide a lot of health benefits. But they've got a few things in common. They're small, and they're huge exporters of natural resources. The United States simply can't do what they're doing.

There are also places that appear to be doing okay economically, i.e. they aren't facing immediate need for drastic cuts in services, but their overall standard of living is way lower than the US's.

What do I think? I think we've forgotten that good health isn't a right. I think we've forgotten that in most of the world, and most of the Western world until quite recently, access to health care was limited, and even the health care to which one had access was pretty awful by modern standards. I think we've moved beyond the point of diminishing returns. It's time for a reality check. It's time to come to terms with the fact that we could spend 100% of GDP on health care and we'd still all die. We simply can't afford to spend 20% of GDP--10% of which comes from taxes--on what some economic thinkers would characterize as an unproductive sector of the economy.

And most of all, I think we've got to stop pretending that we can pay for every social service that we'd like to see. Spending money on health care means not spending money on other things. Maybe we want to spend money on health care and not on other things. Maybe spending money on health care is a moral imperative. But moral imperative or no, an argument which argues that we can spend essentially unlimited funds on health care without affecting any other sector of the economy is not an argument that needs to be taken seriously.
posted by valkyryn at 12:46 PM on June 9, 2010


What do I think? I think we've forgotten that good health isn't a right.
We hold these truths to be self–evident,
That all men are created equal,
That they are endowed by their Creator
with certain unalienable Rights,
That among these are Life, Liberty and the pursuit of Happiness.–
That to secure these rights, Governments are instituted among Men,
Deriving their just powers from the consent of the governed.
I'm sorry, you were saying?
posted by Nothing... and like it at 1:02 PM on June 9, 2010 [4 favorites]


Set aside how inefficient and over-priced the US health industry is. How every medical practice has to hire at least one person whose job is dedicated to processing health insurance paperwork. How we pay twice as much as the next most expensive country for access to health care. How an employer-based health insurance system doesn't make sense because it was a byproduct of wage caps and not a result of actual health policy and planning. Access to health care should be a basic human right (along with food and shelter), not a privilege.
posted by mandymanwasregistered at 1:06 PM on June 9, 2010 [1 favorite]


A month ago, I had my first ever surgery. It went great. I have no idea if I have paid everyone involved yet.

Each party involved in the surgery (the surgeon, the anesthesiologist, the facility, the nurses, the testing labs, am I missing anyone?) bills as an independent contractor. The patient gets the statements ("THIS IS NOT A BILL," but it looks like one) of what was done, the insurance company receives each as a bill and: 1) renegotiates the amount of each bill, 2) pays a percentage, minus whatever arcane deductible system they employ, and 3) passes on the rest to the patient.

So, let's say there were six billing parties in this surgery. I get six statements of what was done and how much it cost. My insurance gets six bills. My insurance then sets a lower amount for what each procedure should have cost. And then it pays what it owes out of that. I'm left with six bills for the difference between the insurance payout and the lowered negotiated cost.

Problem with this system is, whether you are good with numbers or not, you have no way of telling how many bills you will get, or even whether everyone working on you will be in network (and even they might not know this) and how much the negotiated price will be on each. So in the weeks after surgery you get a paperstorm coming from an unpredictable number of directions, the dollar figures on the statements don't agree with the dollar figures from insurance, and you wind up just writing checks and hoping no one screwed up the billing.

And that's why I Ask Metafilter about medical issues, even though I have insurance. I want to be extra-informed about something before I commit. Oh, and forget making an informed descision based solely on my meeting with my doc. My doc might spend five minutes with me per visit. That's say an hour and a half of my time per visit for five minutes of face time. So it's worth it to do my homework with the help of Metafilter so I know what to ask in those five minutes.
posted by zippy at 1:10 PM on June 9, 2010 [3 favorites]


Spending money on health care means not spending money on other things. Maybe we want to spend money on health care and not on other things.

Like, say, a war in Iraq that would have paid for universal health care for all with money left over?
posted by pjern at 1:11 PM on June 9, 2010 [7 favorites]


Their employer: the government of Ontario.

This is not true. They're employees of the clinic they work in. They send all the bills for patient services to their sole "customer": the Government of Ontario. But they're not government employees the way civil servants or elected officials are. They're like the LCBO.
posted by GuyZero at 1:16 PM on June 9, 2010 [3 favorites]


I'm sorry, you were saying?

I don't see "access to health care" listed there.
posted by valkyryn at 1:26 PM on June 9, 2010


>>Spending money on health care means not spending money on other things. Maybe we want to spend money on health care and not on other things.

Like, say, a war in Iraq that would have paid for universal health care for all with money left over?


I say again, maybe we want to spend our money differently. If it were me, I'd cut the defense budget by 50%, means-test Medicare and Social Security, gut our agricultural subsidies, and eliminate student lending entirely.

But let's not pretend that we can get something for free. We can't. We're already spending too much, and expanding our entitlement programs means spending more, not less.
posted by valkyryn at 1:29 PM on June 9, 2010 [1 favorite]


I bet I could sure use a good cleaning

In addition to a dental school, check your local community colleges to see if they have a dental hygienist program. The school I used to work at offered cleanings for $10, IIRC.

Oh, and if you find you can pay for an actual dentist office visit, in addition to asking around for recommendations, I cannot recommend highly enough finding a dentist who has TV in the ceiling. As a dental-phobe, I am willing to pay extra for that. (For reals: my current dentist is no longer on the preferred provider list, and I'll pay a bit extra on some services to keep her and the TV.)
posted by epersonae at 1:32 PM on June 9, 2010


Of course healthcare isn't a right. Unless you, as a society, decide that it is. Rights aren't something built into the nature of the universe, they're just the result of enough people agreeing that "we're all going to support each other's efforts to do [something]", where "something" might be speaking freely, voting in elections, marrying who you want to, or receive healthcare. Just because it's not a right in the USA now doesn't mean it can't be, or that it shouldn't be. If enough people agree that it should be then they can just do a bit of legislative pen-waving and, poof, it is. Arguing whether or not it currently is seems like a weird distraction.

I'm slightly puzzled by the objections about healthcare being too expensive for the state to cover. Yes, healthcare is extremely expensive and yes, I agree with valkyrin that the quantity and quality of healthcare that's offered to us these days are dramatically higher than a handful of decades ago, which inevitably drives up costs.

I think that it's reasonable for the majority to over-pay for their care somewhat -- through the continuous premiums that constantly healthy people pay -- in order to cover the comparatively rare expensive conditions that crop up for the unlucky few. This is exactly what an insurance company does, of course. It's just that, instead of paying an insurance company I, as a Brit, pay the Govt what's called "national insurance" - an 11% tax that mostly goes toward the NHS.

Given the effective choice between a tax- (therefore, government-) based system and a private insurance-based system, I think the choice is pretty obvious when you consider what each party's ultimate goals are:

Govt Funded: Given our budget, provide the highest possible standard of care to our patients
Private insurance: Given our budget, divert the maximum possible profit to our shareholders

If you start with the belief that a society has the responsibility to look after its less able members (which I do) then, yes, the tax burden will increase as more low-earners join the pool. But in addition to basic compassion that I think is essential to call ourselves a proper society, this extra money means that I know I'll never have to choose between healthcare and rent, even if I lose my job or have a particularly expensive illness.

The UK system has its problems, like any large organisation (or network of organisations, if you prefer to see it that way). But I strongly believe that the basic principle, being based on delivering healthcare rather than profit, is a sound one. Taxes would go up, but at the same time the need to pay private health insurance would vanish unless, as in the UK, you want to buy extra cover for premium services.

Arguments about the current Economic problems in Europe aren't really relevant. Yes, we have serious problems over here, and they're from the same places that your problems are coming from: massive collapse in the financial markets (formerly one of the UK's few big profit centres) combined with continuing commitment to a couple of expensive wars and defense projects.
posted by metaBugs at 1:50 PM on June 9, 2010 [18 favorites]


I'm sorry, you were saying?

That "life" part must read differently for you than it does for me.

posted by milarepa at 2:02 PM on June 9, 2010 [4 favorites]


Maybe we do want to provide medical care for everyone. But it's gonna be massively expensive,

It's massively expensive right now and we don't have anything near universal coverage.
Health care costs have been rising for several years. Expenditures in the United States on health care surpassed $2.3 trillion in 2008, more than three times the $714 billion spent in 1990, and over eight times the $253 billion spent in 1980. Stemming this growth has become a major policy priority, as the government, employers, and consumers increasingly struggle to keep up with health care costs. [1]

In 2008, U.S. health care spending was about $7,681 per resident and accounted for 16.2% of the nation’s Gross Domestic Product (GDP); this is among the highest of all industrialized countries. Total health care expenditures grew at an annual rate of 4.4 percent in 2008, a slower rate than recent years, yet still outpacing inflation and the growth in national income. Absent reform, there is general agreement that health costs are likely to continue to rise in the foreseeable future. Many analysts have cited controlling health care costs as a key tenet for broader economic stability and growth, and President Obama has made cost control a focus of health reform efforts under way.

Although Americans benefit from many of the investments in health care, the recent rapid cost growth, coupled with an overall economic slowdown and rising federal deficit, is placing great strains on the systems used to finance health care, including private employer-sponsored health insurance coverage and public insurance programs such as Medicare and Medicaid. Since 1999, family premiums for employer-sponsored health coverage have increased by 131 percent, placing increasing cost burdens on employers and workers. [2] With workers’ wages growing at a much slower pace than health care costs, many face difficulty in affording out-of-pocket spending.

Government programs, such as Medicare and Medicaid, account for a significant share of health care spending, but they have increased at a slower rate than private insurance. Medicare per capita spending has grown at a slightly lower rate, on average, than private health insurance spending, at about 6.8 vs. 7.1% annually respectively between 1998 and 2008. [3] Medicaid expenditures, similarly, have grown at slower rate than private spending, though enrollment in the program has increased during the current economic recession, which may result in increased Medicaid spending figures soon. [4]
(emphasis mine) cite
posted by rtha at 2:21 PM on June 9, 2010


valkyryn writes: It's time to come to terms with the fact that we could spend 100% of GDP on health care and we'd still all die.

I think it's interesting to note that you seem to be saying that the purpose of health care is to prevent the inevitable -- i.e., keep us from dying.

Certainly the purpose of some health care is to save lives in an immediate sense -- to keep people from dying when in fact their lives can be saved. But more often the purpose of good health care is to improve quality of life and keep bodies functioning.

I have a number of chronic health issues, and right now I am extremely fortunate in that I have good insurance. Since I have good insurance, I'm fortunate enough to be able to maintain a relatively good quality of life. Without good insurance or medical care, I risk not being able to function in a way that contributes to society, contributes to my family in both an economic sense and in an emotional sense, etc.

We simply can't afford to spend 20% of GDP--10% of which comes from taxes--on what some economic thinkers would characterize as an unproductive sector of the economy.

If our society (the US) can get health care costs down into manageable ranges, and ensure access to decent care for most (if not all) citizens, then those "unproductive" people suddenly turn into productive members of an economic system who can better contribute to said system. Frankly, I find it more than a little disturbing to think that my worth as a person is based on how much I can contribute to the economic system, but if that's the way we're playing it, I need decent & affordable medical care in order to be able to contribute.
posted by dryad at 2:38 PM on June 9, 2010 [6 favorites]


Honestly, the purpose of a single-payer system is more about cost control and minimizing paperwork than anything else. That everyone gets coverage is a side benefit and makes the plan easy to sell. It is silly that the US has the best productivity levels in the world in almost every industry except healthcare where it's literally the worse, behind third-world nations.
posted by GuyZero at 2:43 PM on June 9, 2010


WellPoint's CEO got a 51% pay raise earlier this year, which is sickening (ha!) considering they tried to raise rates on their individual customers by up to 39%. The roar of outrage over the proposed rate increase made them back down.
posted by rtha at 2:55 PM on June 9, 2010


It's time to come to terms with the fact that we could spend 100% of GDP on health care


The health care industry would like us to.

This is the pile of bills from my spider incident.

There is no hope, short of winning the lottery, that I'll ever be able to pay those off. I live pretty much paycheck to paycheck as it is, and have no real assets, and I never will thanks to the "health care" system in this country.
posted by pjern at 3:02 PM on June 9, 2010 [1 favorite]


A system that randomly deprives citizens of the ability to participate in mandatory financial activities, creating apathy, anger, and bitterness? Sounds great
posted by jtron at 3:18 PM on June 9, 2010 [2 favorites]


Also the whole "you may die lol" part of it, that's great too
posted by jtron at 3:18 PM on June 9, 2010


The US is only of about 3 or 4 nations in the world that people generally want to migrate to. There was a global survey recently on the topic. It is quite literally the case that from a macro perspective it doesn't matter if 10 or 15% of the population dies prematurely (and painfully) annually. There's a guy from Belarus with a medical degree who'd like your passport thanks. And a few million more people like him. Germany and Sweden have to keep their people going 'cause no one wants to go there for the most part. And the French and Japanese have to keep their people going because they don't want you goddamn foreigners.
posted by GuyZero at 3:26 PM on June 9, 2010


Doctors in the US earn over twice as much as their peers in other countries, and also about twice as much as other professionals in this country who have a similar training regimen. I wonder if maybe anyone's considered that this explains some of our high health care costs?
posted by miyabo at 3:46 PM on June 9, 2010 [1 favorite]


The US is only of about 3 or 4 nations in the world that people generally want to migrate to. There was a global survey recently on the topic.

Citation please?
posted by pompomtom at 4:27 PM on June 9, 2010


Valkyryn, if the answer is that there is no answer -- no way to cut costs -- how do you explain the fact that I get DRAMATICALLY better coverage than my friend for $450 less per month? If it's just a pure market situation, why do I pay so much less for so much more?
posted by KathrynT at 4:30 PM on June 9, 2010


Citation please?

I spend too much time listening to NPR while half asleep. Feel free to consider it made up until I find one.
posted by GuyZero at 4:37 PM on June 9, 2010


I thought there was a survey recently, but there's this one from 2006 which isn't very recent, but is still probably fairly reflective of current opinions:

"14 per cent of respondents in 19 countries said that they would choose the United States if they could live in any country. Australia was second on the global list with 12 per cent, followed by Canada with 10 per cent. No other country reached double digits. Respondents were allowed to choose any nation or territory they wanted for resettlement, except their own."
posted by GuyZero at 4:41 PM on June 9, 2010


The US is only of about 3 or 4 nations in the world that people generally want to migrate to. There was a global survey recently on the topic. It is quite literally the case that from a macro perspective it doesn't matter if 10 or 15% of the population dies prematurely (and painfully) annually. There's a guy from Belarus with a medical degree who'd like your passport thanks. And a few million more people like him. Germany and Sweden have to keep their people going 'cause no one wants to go there for the most part. And the French and Japanese have to keep their people going because they don't want you goddamn foreigners.
posted by GuyZero An hour ago [+]
Perhaps a trade arrangement could be worked out, then. HEY GERMANY, SWEDEN, FRANCE, OR JAPAN! Do you want a high school teacher/artist/video guy? He's disabled, but housebroken, and speaks a little of three out of your four languages (plus can do a great Skwisgaar Skwigelf). Email's in profile. Sorry, Belarus, but you scare me.
posted by jtron at 4:43 PM on June 9, 2010 [1 favorite]


Thanks GuyZero!
posted by pompomtom at 5:09 PM on June 9, 2010


(plus can do a great Skwisgaar Skwigelf)

Thats are ridgodulous. Nobody can impressionate Skwisgar with any degree of accuracies.
posted by Pope Guilty at 5:47 PM on June 9, 2010 [1 favorite]


What do I think? I think we've forgotten that good health isn't a right.

We hold these truths to be self–evident,
That all men are created equal,
That they are endowed by their Creator
with certain unalienable Rights,
That among these are Life, Liberty and the pursuit of Happiness.–
That to secure these rights, Governments are instituted among Men,
Deriving their just powers from the consent of the governed.

I'm sorry, you were saying?


Nothing about doctors in there. You can't make someone else's labor a right.
posted by gjc at 6:13 PM on June 9, 2010


Nothing about doctors in there. You can't make someone else's labor a right.

Can the objectivism. Nobody's talking about making doctors slaves and pretending that they are is willfully malicious horseshit of a sort that drags down the discourse.
posted by Pope Guilty at 6:15 PM on June 9, 2010 [5 favorites]


No habeus corpus or Miranda or self-incrimination in there either, huh. I guess those aren't rights either. Also, suck it NRA - you ain't got no rights to those guns.
posted by GuyZero at 6:15 PM on June 9, 2010


But to be fair, it is straight-up socialism for countries with universal health care. They all, to my knowledge, set fixed rates for medical services. The government dictates the price structure of the market. It's quite possible you find that philosophically untenable. You should note that in practice it has not stopped Canadian doctors from owning BMWs, large houses and cottages in the Muskokas.
posted by GuyZero at 6:17 PM on June 9, 2010 [1 favorite]


I'm an American and I don't have health insurance. Last Monday, I was in a pretty bad bike accident and while the hospital still "treated" me (let me lay down on a bed in the hallway for a while), as soon as they saw I wasn't going to die from a traumatic brain injury (on their shift, at least) they showed me the door and instructed me to leave. When I expressed concern that my toe may be broken they asked me about insurance, then put a band-aid on my toe, and reiterated that I needed to go. So I limped hard out of the emergency room and had to acquire bandages and a cane (so I can walk) on the black market.

They may still send me a bill for thousands of dollars which could totally derail my plan to go to graduate school.

I know I know, I shouldn't be poor to begin with, because being poor is morally wrong and poor people are sub-human. I get it.

posted by fuq at 6:38 PM on June 9, 2010 [5 favorites]


And here I am, a privileged Canuck, who does his best to avoid going to the doctor. Not because it will cost me, but because I don't particularly like going to the doctor. Every time I see him, there's something wrong with me!
posted by five fresh fish at 8:11 PM on June 9, 2010


We simply can't afford to spend 20% of GDP--10% of which comes from taxes--on what some economic thinkers would characterize as an unproductive sector of the economy.

Um... you are talking about human beings here, right?
posted by jokeefe at 8:13 PM on June 9, 2010 [12 favorites]


It's time to come to terms with the fact that we could spend 100% of GDP on health care and we'd still all die.

I do agree that our society needs to come to grips with death. If I'm (un?)lucky enough to make it another forty or fifty years, I hope I'm allowed to pull the ripcord when I'm riddled with cancer and doomed to death. It is insane to spend six- and seven-figure amounts to keep dead people alive another month or two.
posted by five fresh fish at 8:28 PM on June 9, 2010


When I expressed concern that my toe may be broken they asked me about insurance, then put a band-aid on my toe, and reiterated that I needed to go.

Sorry, but what more would you expect? They can't heal it for you. You expect a leg cast? Magic pills? A splint?

As for the post-accident trauma, did they test pupil dilation? Take a pulse, measure BP? If so, what more did you expect them to do? CAT scan?

In a Canuck hospital I'd expect I'd end up seeing a doctor or resident eventually, but I'd expect the same results. Kind of like in Canada I see the doctor to get meds, but in the USA I saw a practitioner nurse. In all cases, though, they have the exact same result.
posted by five fresh fish at 8:52 PM on June 9, 2010


The treatment you'd get in Canada depends on whether or not the attending physician thinks there's a real problem. Getting an x-ray in emerg in Canada is pretty standard. I don't think I've ever had an emerg visit that didn't involve an x-ray (well, except once).

To be fair, it depends on what kid of hospital you went to in the US. Some will give you a MRI without any proof of insurance. Others will basically kick you out without a credit card under all circumstances. It is a free market, which is a bit if a drag if the nearest hospital is the latter sort and not the former.
posted by GuyZero at 9:34 PM on June 9, 2010


Fractures in the foot bones (metatarsals) are notoriously hard to spot on X-rays. Given this and the fact that it's generally best to avoid having too much exposure to X-rays, in that specific case an x-ray probably wouldn't have done you much good. Even if a fracture was found, there's basically nothing that can be done except telling you to keep your weight off it. Which, as I know from experience, the pain will take care of nicely. The best drug you could be prescribed would basically just be ibuprofen (painkiller and anti-inflammatory), which is far cheaper if you just buy it over the counter.

Of course, I don't know anything about the rest of your case so I can't comment on the rest. IANAMedic, I just go drinking with them occasionally. You'd have to be mad or desperate to take my advice on medicine seriously. Which illustrates the point of this thread quite nicely.
posted by metaBugs at 4:45 AM on June 10, 2010 [1 favorite]


Sorry, but what more would you expect? They can't heal it for you. You expect a leg cast? Magic pills? A splint?

This point could have been made in a much less jerky manner.
posted by josher71 at 4:55 AM on June 10, 2010 [1 favorite]


how do you explain the fact that I get DRAMATICALLY better coverage than my friend for $450 less per month? If it's just a pure market situation, why do I pay so much less for so much more?

Without knowing way more about you and your friend's situation than we do, there's no way of saying other than to point out that the market for medical services is almost entirely irrational and that the presence of government actors in that market is chiefly to blame. Then again, I'm not really sure that health care works as a market anyways,* so this doesn't necessarily bother me all that much either way. Health care is gonna be expensive any way you slice it.

>>Nothing about doctors in there. You can't make someone else's labor a right.

Can the objectivism.


I'm not an objectivist by any stretch of the word, and though I wouldn't have put it the way gjc did, there's a difference between not arbitrarily killing you, i.e. what the drafters of the founding documents had in mind, and not spending money on you to prevent your death from natural causes, i.e. the provision of health care.

Then again, I don't believe in human rights at all and view civil rights as a pragmatic tool of civilization not a moral imperative, so arguing this on the basis of rights isn't going to work with me. There are no rights. Only duties. But even then, arguing that I as an individual and/or we as a society have a duty to pay for as much health care as everyone wants is gonna be a tough sell.

Listen: You are going to get sick. You are going to die. It's going to suck. But ultimately, we can't do anything about this, so why we, as a society, should spend billions of dollars proving this thousands of times per year is beyond me. Trying to treat cancer in an eighty-year-old? Giving someone a new heart? Drastically expensive. Hooking someone up with a morphine drip and round-the-clock care? Pretty damn cheap. End result? One dead body. Timeframe? Approximately the same, much of the time. Only in one situation you've also got an extra couple of hundred grand, which could be spent on things like education, infrastructure, or even routine medical care for the rest of us.

I think that's sort of an elephant in the room here. The elderly account for some 50-60% of all health care expenditures. Most of this care produces very little in the way of positive results, i.e. you get an extra year or two of life at most. Even keeping someone on blood thinners for a decade or three is cheap compared to admitting someone to the hospital for a week or two. Spending a million dollars on a newborn with esophageal atresia is one thing. The kid's got his whole life ahead of him. Spending a million dollars on a senile nonagenarian is something else. They arguably had their turn. Especially when, as is the case, there is a finite amount of money that can be spent and every dollar spent on health care is a dollar not spent on something else.

Yeah, that's right. I want to cut Medicare. Big time. I'd even be okay with using that money to spend on health care for the rest of us. I'm not actually opposed to the government getting involved in health care as such. I just don't think we can keep buying everyone as much health care as they could possibly want, which is what we're trying to do now.

This is why we spend more money per capita than anyone else and 10% of the population is uninsured: we're spending more than half of it, something like 10% of GDP, on the old. Keeping young and even middle-aged people healthy isn't that expensive. Less goes wrong, and most issues tend to be acute, e.g. trauma, pregnancy, the odd infectious disease. With the exception of truly horrific trauma, those are comparatively cheap, largely because they don't take all that long to treat. We could do a lot more of that for a lot less than we're spending now. Hell, we could do top-flight pre- and post-natal care for a dozen pregnancies for what it costs to keep just one octogenarian alive for an extra six months. I think that calculus is pretty easy.

Something's gotta give, and I think it should be Medicare. And defense. That too.

*Why should the market health care work at all like the market for, e.g, cars, petroleum, or food? That doesn't strike me as a rational assumption at all. I don't believe in The Market, I believe in markets, whose diverse characteristics are not easily generalizable. This is a derail, and I don't really want to go here, but getting some assumptions out in the open is probably useful.
posted by valkyryn at 4:59 AM on June 10, 2010 [1 favorite]


Can the objectivism. Nobody's talking about making doctors slaves and pretending that they are is willfully malicious horseshit of a sort that drags down the discourse.

Thanks for the well reasoned argument.

Rights are things people *can't* do to you without due process.

Universal healthcare is a great idea for a lot of reasons, but it's not a right.
posted by gjc at 5:10 AM on June 10, 2010


. Trying to treat cancer in an eighty-year-old? Giving someone a new heart? Drastically expensive. Hooking someone up with a morphine drip and round-the-clock care? Pretty damn cheap. End result? One dead body. Timeframe? Approximately the same, much of the time.

Um. Wow. Just... wow.

My grandparents are 86 and I would easily give them half of my own liver to see them attend my wedding or hold their future great-grand-children. Their lives are every bit as valuable as my own.

(Also: who's to say that I won't die tomorrow? Shit happens and deciding that you know better than nature about mortality is the height of hubris. I've seen people live decades longer than they were "supposed to" and also seen people just drop dead at a relatively young age. Death is truly, truly unknowable and to pretend otherwise is arrogant beyond belief.)
posted by grapefruitmoon at 5:59 AM on June 10, 2010 [5 favorites]


Death is truly, truly unknowable and to pretend otherwise is arrogant beyond belief.

I know you're going to die. I don't know when. But I know that you will.

Their lives are every bit as valuable as my own.

You're conflating moral value and economic value. Essentially, you're saying that human life, being morally beyond price, has an infinite economic value. Which is an interesting take, but one that should be argued for, not assumed.
posted by valkyryn at 6:03 AM on June 10, 2010


Whether or not you are correct, the "Let's just let old poor people fucking die already!" argument will probably not gain much traction here.
posted by josher71 at 6:59 AM on June 10, 2010


valkyrin - Essentially, you're saying that human life, being morally beyond price, has an infinite economic value. Which is an interesting take, but one that should be argued for, not assumed.

It's possible (and probably necessary) for a state-run healthcare system to have a more nuanced view.

The British NHS deals in Quality Adjusted Life Years (QALY). Broadly speaking, a full year of life for a completely healthy person = 1 QALY. A year spent with a lower quality of life (e.g. immobile, in pain, on a special diet, etc) counts as less than 1 QALY, with the exact number being decided by a combination of patient/public panels and some acturial jiggery-pokery.

The NHS budget is therefore planned with a view to achiving the maximum possible increase in the population's QALY. So in the funding scheme, saving babies who could go on to live full, healthy lives (let's say ~70 QALY) gets proportionately more funding than saving the very elderly, who statistics say might only live five years more, most of it bed-bound (let's say ~3 QALY).
The system is acturial and percieved by some as quite callous; every now and again one of the tabloid newspapers will throw a strop because NICE advises against (and therefore the NHS refuses) supplying a particular drug on cost-effectiveness grounds. It seems pretty sound to me though.

Again, anyone rich who wants treatment that's not deemed sufficiently cost-effective for the NHS is welcome to go private and buy it themselves.

This year-old BMJ article says that the NHS values a QALY at £20-30,000 [PDF], and discusses the pros and cons of changing that figure along with the problems in administering it. Fascinating reading for anyone interested in how the NHS works.

So it is very possible to have "universal healthcare" (assuming I understand the term correctly) without committing to spend all of your resources on tiny, incremental benefits for those who won't last long anyway. The system isn't about giving every possible procedure to anyone who asks, it's about giving the greatest possible benefit spread across the population.


You're conflating moral value and economic value.
I will say though, that you, valkyrin seem to be conflating moral and economic value too, just from the opposite direction. To me, your post sounds as if you're saying "they have no economic value therefore there's no moral reason to keep them comfortable and/or alive". Which, if I may be a bit cheeky, is an interesting take but one which must be argued for, not assumed. ;)
posted by metaBugs at 7:09 AM on June 10, 2010 [12 favorites]


To clarify:

NICE is the "National Institute for Clinical Excellence". They do a lot of things I don't know much about, but their relevance here is that they're the body who determine how many QUALYs a year with a given condition is worth, the maximum that the NHS should spend per QUALY added, and the cost-effectiveness of treatments (QUALYs gained / resources spent). If you imagine the NHS as a private company, NICE are the actuaries. Among other roles.

In the fourth paragraph, where I wrote "save", it might've been better to write "treat". Obviously I don't think that "saving" someone from a particular condition is necessarily free from long term effects, and won't make them immune to further problems or, indeed, immortal. I only mention this because a similar comment by someone else once led to a weird, tiresome derail.
posted by metaBugs at 7:55 AM on June 10, 2010


Josher71, it's not as Black & Whilte as that unfortunately: a large part of the 50-60% mentioned by valkryn is from the last 12 months of a person's life. And it is true that as a country you may need to discuss how optamistic and "can-do" you can afford to be.

It appears purely looking at those end-of-life costs that you may even be cruel to your old folk, using treatments and therapies for malpractice avoidance reasons or because of emotional pressures brought to bear by families, or because as a health professional you have a gung-ho attitude to illness, some of these interventions HURT and really don't add any quality to the persons last few months, but hey, if it makes you feel better, that's what's important.

I know some surgeons who go ahead with an operation on an almost training/experience basis where the anaesthetist was unable to convince the team in general that this was not in the patient's best interests. These are grey areas, its a judgement call and he/she is highly trained and authorised to make that call, and of course the families feel "something is being done" and are happy, even though instead of a few more days dying relatively peacefully and relatively painfree either at home or on a normal ward, they spend weeks intubated on a ITU until someone gets up the courage to institute a kind end of life protocol.

One thing I don't know if there are any stats on is the amount of chronic illnesses in the elderly that could have been avoided by prompt early intervention, antibiotics that avoided that abcess erupting, requiring expensive bowel resection and ITU treatment costs, early excision of that lump/bump/spot before the malignant melanoma requires a year of Interfearon therapy, expensive cancer drugs, there must be loads more examples of presentations where "an ounce of prevention" ....etc., etc., and that is what worries me most by what I'm reading from our Mefite members, people are actively avoiding using healthcare because they can't afford it, and so many of these problems will present as seriously chronic conditions later on.
posted by Wilder at 8:02 AM on June 10, 2010 [2 favorites]


MetaBugs, I agree!

I think while not perfect by any means, QUALYS at very least make the decision making process more transparent and less emotive.
posted by Wilder at 8:05 AM on June 10, 2010


GFM: it's not your liver you'd be giving. It'd be your child's, plus interest. It's always the next generation that pays.
posted by five fresh fish at 9:02 AM on June 10, 2010


valkyryn: I know you're going to die. I don't know when. But I know that you will.

As will you. someday, as well. Somehow, I get the feeling that that particular fact hasn't entered your thinking, or that you're somehow part of some privileged class that doesn't have to think about that.

There are no rights. Only duties.

So, we don't have a duty towards anyone weaker or sicker than we are? I want no part of that 'morality'. It smacks of neoconservative bullshit.
posted by pjern at 12:41 PM on June 10, 2010 [7 favorites]


I just got back from a big meeting with the department of public welfare and the one factoid that struck me like a blow to the face is that the upper income limit to be considered "medically needy" and eligible for Medicaid without any temporary incapacity or disability is $2500 every 6 months. It was set back in the '70s and has never been adjusted upwards. The upper income boundary for every other form of assistance is pegged to inflation and has been adjusted upwards over time except this one.
posted by The Straightener at 1:12 PM on June 10, 2010 [3 favorites]


valkryn: Essentially, you're saying that human life, being morally beyond price, has an infinite economic value. Which is an interesting take, but one that should be argued for, not assumed.

So you're saying that human beings are merely factors of production in an economic model?
posted by djgh at 1:33 PM on June 10, 2010 [1 favorite]


When the NHS or Canada's provincial health agencies place a limit on how much they're willing to spend on medical care it's hardly very different from the US system where the limit on how much the government will spend on your health care is either $0 or your life savings. In Canada everyone gets decent health care. In the USA the rich get infinite health care and the poor get zero. The US health system makes economic decisions just like every other system does.
posted by GuyZero at 1:55 PM on June 10, 2010 [2 favorites]


So, we don't have a duty towards anyone weaker or sicker than we are? I want no part of that 'morality'. It smacks of neoconservative bullshit.

I agree with you, pjern, but I think we can leave the neoconservatives out of this. It seems more to be a disconnect in levels of... I dunno, compassion? Empathy? Sympathy?

But why on Earth would there be a connection between those personality traits and one's political stances? That doesn't make a lick of sense! ;)
posted by jtron at 2:21 PM on June 10, 2010 [1 favorite]


Just because you have insurance, that doesn't mean you can afford to go to the doctor. As a freelancer, I pay $98/month to Regence for my policy. (And I'm lucky - that's a ridiculously cheap rate.)

However, I carry a $2,500 deductible. This means that I have to pay the first $2,500 of medical bills I incur in the course of a year. (After that, I have to pay 20% of the bills to a maximum of something like $20,000.)

Last year I broke my wrist. It ended up costing about $400 to see a doctor, get x-rays taken, and have a radiologist check the x-rays. I had to pay that entire bill myself.

For me, going to the doctor is pretty much a method of last resort.
posted by ErikaB at 2:26 PM on June 10, 2010


So you're saying that human beings are merely factors of production in an economic model?

I'm not the OP on this, but I'll take a stab at it. When money is the currency you are talking about, yes. We don't have infinite money, it makes sense to distribute it where it will do the most good. That someone's economic potential is different from someone else's doesn't change a person's inherent value as a human. It only recognizes that there are limited resources. If we want to increase the amount of money we spend on different people, we have to increase the amount of money we take into the system. There is a balance.

(I'd also mention that there is nothing stopping anyone from using their own resources to improve their health. As far as I know.)
posted by gjc at 2:58 PM on June 10, 2010


Just because you have insurance, that doesn't mean you can afford to go to the doctor. As a freelancer, I pay $98/month to Regence for my policy. (And I'm lucky - that's a ridiculously cheap rate.)

However, I carry a $2,500 deductible. This means that I have to pay the first $2,500 of medical bills I incur in the course of a year. (After that, I have to pay 20% of the bills to a maximum of something like $20,000.)

Last year I broke my wrist. It ended up costing about $400 to see a doctor, get x-rays taken, and have a radiologist check the x-rays. I had to pay that entire bill myself.

For me, going to the doctor is pretty much a method of last resort.


But that's what insurance is- paying someone to share the risk with you. For $1127 a year, they are willing to cover costs over $2500 a year. If you want them to take on more risk, you have to pay them more.
posted by gjc at 3:00 PM on June 10, 2010


GFM: it's not your liver you'd be giving. It'd be your child's, plus interest. It's always the next generation that pays.

That makes no sense whatsoever.

First off, I could gestate a fetus with half a liver. It can be done. Secondly, there is absolutely nothing to say that my children would ever have to give up any number of hypothetical organs to me in any similarly made-up situation like this one I just made up now. Thirdly, I don't see taking care of my family as "paying" for anything and if my future children did see things that way...

... well, they'd certainly be welcome on MetaFilter, obviously, but I dunno how friendly the family reunions would be.
posted by grapefruitmoon at 3:07 PM on June 10, 2010


Also to note...If you are buying your own insurance on the private market (as we are) the standard policy does not include things like dental or vision. Those are extra. A lot extra. Dental alone will cost you about half-again as much as your basic medical policy. So, in our case, our $1,200/mo family policy would jump to way over $1,500/mo if we were to add dental. As it is now, we really can't afford insurance, but we keep it (and struggle to pay for it) because we have kids and, as my recent back surgery reminded us, you just never know. Had we not had insurance, I have no clue how we would have paid for that. The hospital's bill alone was $33,000. It's unbelievable.

Right now, our son needs to have three wisdom teeth removed. At least two are impacted and will require serious oral surgery. We have no dental coverage, though, and are struggling to find a way to afford to pay for oral surgery out-of-pocket. We burned-through our tax refund paying off the deductibles for my back surgery. We're calling recommended oral surgeons to see what sort of pity they may take on an uninsured family. Most of them simply offer a low-interest credit card product. Gee...thanks. Meanwhile, our son is in pain.

As a further kick-in-the-nuts, we discovered that our medical policy does have an oral surgery provision...but only if it's needed due to an accident.

We looked into sending him to the IU dental school, but they have become extremely restrictive as to whom they will see. My son, by our reading, doesn't qualify.

But, I thank God every day that I don't labor under the tyrannical yoke of socialized healthcare. Yessir.
posted by Thorzdad at 3:24 PM on June 10, 2010 [1 favorite]


In Canada you'd be in the same boat and in the UK you'd face a fair wait to get dental work done under the NHS. Many countries don't include it in their national programs.
posted by GuyZero at 3:30 PM on June 10, 2010


We looked into sending him to the IU dental school, but they have become extremely restrictive as to whom they will see. My son, by our reading, doesn't qualify.

My dentist at the dental school that's treating me said even if someone thinks they won't qualify, they should apply anyway, and as he put it, "Say whatever you need to, to get your foot in the door." He said to do whatever it takes to get past the telephone call or fill-out-a-form application, and get an appointment for an initial in-person exam/evaluation by an actual dentist, because the people who screen you at the very beginning don't know what they're doing. Basically, he said lie if you need to.
posted by MexicanYenta at 4:45 PM on June 10, 2010


gfm: what I was trying to say is that the hundreds of thousands of dollars you'd spend to keep your grandparents past their due date is going to end up costing your (hypothetical) children their health.

As heartless as valkyryn seems to be, s/he ultimately is correct: there's only so much to go around. And if we keep your grandparents alive at great expense, it means there are others who — though they'd have been less expensive to treat and would have a chance to repay via their taxes — will not get to stay alive.

My last grandparent kicked it off the other day. And I am thankful that at age ninety she wasn't subjected to rounds of chemotherapy and radiation. Maybe her life could have been extended by another year or two — but at what cost? She'd have had a lousy quality of life, sickened by her treatments and endlessly locked up in hospital.

Instead, she spent her last three months in hospice, getting her final affairs in order, visited endlessly, provided as much dignity and self-reliance as possible, and spent only a week and a half in the dying stages.

Now myself, I want it even better: I want that call button to be connected to a heroin overdose. Every time I push the button, the countdown timer resets. And if I don't press it for 48 hours, pull the fucking ripcord. It's time to go. Check me outta here. Saranoya.

Spending heaps of money on those who are statistical outliers in the age game is foolish. Orders of magnitude more good comes from investing that money in younger folk's health.
posted by five fresh fish at 5:10 PM on June 10, 2010 [1 favorite]


IMO, society should ensure the basics of Maslow's pyramid of needs: basic food, shelter, safety, and health. Add in some education, because modern society requires educated people; and some form of mass transit, because modern society requires people to get to work.

It's essentially the foundation from which people can work to better themselves. Without that foundation, it's simply a scrabble for survival. We can do better for ourselves than that.
posted by five fresh fish at 5:15 PM on June 10, 2010


In Canada you'd be in the same boat and in the UK you'd face a fair wait to get dental work done under the NHS.

Of course, in Canada, I wouldn't be shelling-out the $1,200/mo for insurance, so I probably could more easily afford out-of-pocket dental costs. As for the NHS...I'm waiting now for dental. I haven't seen a dentist in at least three years. I doubt the wait in the UK is quite that bad. I'd gladly put up with a couple month wait, if it meant that I could actually afford it.
posted by Thorzdad at 4:23 AM on June 11, 2010


I doubt the wait in the UK is quite that bad. I'd gladly put up with a couple month wait, if it meant that I could actually afford it.

This was something that struck me during the healthcare debates - especially when that idiot Daniel Hannan came over to the US and started spouting off about how he wouldn't wish the NHS on anybody. The idea that because something's not perfect, that it shouldn't be implemented in the US. Imperfect free healthcare is better than no healthcare at all.
posted by djgh at 4:31 AM on June 11, 2010 [1 favorite]


gfm: what I was trying to say is that the hundreds of thousands of dollars you'd spend to keep your grandparents past their due date is going to end up costing your (hypothetical) children their health.

That still makes no sense to me.

First of all, who the fuck are you to decide anyone's "due date?"

My own grandparents have signed DNR's. They wouldn't want chemo or radiation if they got cancer - hell, my grandmother had breast cancer and elected to get a mastectomy instead of going through radiation. And she would have had another if it spread. I'm not for prolonging life just for the sake of doing it. BUT. If either of them wanted to extend their lives, I'd be all for it. I absolutely in no case feel like it's an either/or scenario where the elderly should be given palliative care just because they're "closer" to death.

Because on the other hand: there are terminally ill children out there. There are children who will die anyway even if they receive chemo and radiation. There are children whose lives will be merely extended with transplants. Mortality doesn't really give a shit about age. Sure, if you're elderly, you're statistically more likely to die anyway. And sure, your life has been longer. But cancer doesn't care if you're 86 or 6.

We're all worthy of the investment. I don't see it as costing my future children anything if their great-grandparents are alive to meet them. Medical care is not a zero-sum game. The more research that's done the more we all benefit. The more advances that are made everywhere the more treatment options are available for everyone. Sure, budgeting decisions need to be made - but that needs to become the realm of the patient and their doctor and not the insurance companies and not some draconian policies being suggested here in which there is an age limit past which, you should be just given a shot of morphine. I'm not sure how anyone would ever enforce this, and to me, it conjures up images of the fabled "Death Panels."

As the great philosopher Bill Hicks has said: The children are not our future. There is no future. Let's care for the people who are ALREADY HERE. I would certainly hope that whatever children I may or may not have would feel the same way about me and my parents.

(And before you ask in the hypothetical made up scenario in which my child and my grandmother both needed my liver or they would each die: of course I would give it to my child, duh, because I didn't give birth to my grandmother. But that's a totally emotion based decision, not necessarily a rational one.)
posted by grapefruitmoon at 4:52 AM on June 11, 2010 [1 favorite]


off topic slightly but a child in the UK in actual pain right now because of impacted wisdom teeth would be seen in clinic within 2 weeks by a dental or Max-Fax surgeon. Depending on the pain they would generally be operated on within 2-4 weeks after that point. Patients who kick-up a real stink and even exaggerate the amount of pain their child is in often move up the elective surgery list.

At very least there would be a strategy of pain relief notified to the GP and the child would generally leave that clinic with either paracetamol (if you think that's not good pain relief ur doin' it rong!) or something stronger again dependant on the level of pain.

Its different for adults and the 18 week rule kicks in. Adults must be operated on within 18 weeks of the specialist saying that is what is needed. You will co-pay £7.20 for your pain and/or antibiotic perscription, (people get really irate that it is per prescription item, I should show them this thread!) but you will not face one single additional bill for the operation. You may be in a ward of up to 6-8 individuals and you may not be guaranteed a single -sex ward depending on the age of the building infrastructure but mixed sex wards are in the minority now.

While hospitals in the UK do struggle with MRSA and C. diff infection, recent strategies have improved the picture as well as ring-fencing of elective beds.

What you are describing for a large group of the workers of the USA is painful for me to read. I knew this intellectually but hearing first hand accounts of relatively simple illnesses that can be treated, but if left untreated can have potentially life-altering outcomes, is simply horrifying.
posted by Wilder at 7:04 AM on June 11, 2010


GFM: we'll have to agree to disagree. I don't see that it is possible to continue spending fortunes on end-of-life extension.
posted by five fresh fish at 8:29 AM on June 11, 2010 [1 favorite]


I'm not understanding the focus on end-of-life extension when most of the truly egregious examples show how our imbalanced health care system creates disabilities and fosters pain amongst the otherwise able-bodied who could be functional contributors for decades more, often with relatively minor intervention.

Knowing that so many consider health care to only be for those who can afford it is incredibly depressing.

The privileged believe it's okay for those of us without their safety nets to suffer, that our contribution (or potential contribution) is worthless, that it's okay for our lives to be about struggle through and through, exhausting and wasting us years before our expire-by date. Considering also that those without privilege tend to work jobs with more physical and mental stress than the average bear, it's a rugged cycle.

I can't imagine being okay with seeing that cycle continue. Any time I've had the ability to interfere in that cycle, I've done so. If I'm fortunate again in the future, you can bet that a portion of my income will always go to helping others get health care, even if it just means directly helping someone pay a bill. I don't mind. I think it's important. A healthy nation of well people is a strong nation.

It truly puzzles me that anyone could see it differently. Humans are a renewable, programmable resource. Keeping that resource healthy and whole, functioning and capable, seems like a win for the whole world. It's just common sense.
posted by batmonkey at 10:45 AM on June 11, 2010 [4 favorites]


off topic slightly but a child in the UK in actual pain right now because of impacted wisdom teeth would be seen in clinic within 2 weeks by a dental or Max-Fax surgeon. Depending on the pain they would generally be operated on within 2-4 weeks after that point. Its different for adults and the 18 week rule kicks in.

As a point of comparison, when I was on my previous, crappy insurance (for which I paid $700 a month) before I got married, I developed serious pain from impacted wisdom teeth. I *had* dental insurance, and fairly reasonable dental insurance at that; $500 deductible, 80% covered. Once my teeth began hurting, I had to wait three months to see a dentist, who took one look at my X-rays and referred me to an oral surgeon. One month later, the oral surgeon saw me, agreed that those teeth had to come out ASAP, and booked me in his next available appointment, two months away. The clinic in which he did surgery with general anaesthesia -- he wouldn't touch me without it -- was fifty miles away from my house, and my delightful boyfriend got up that day at 4 AM so that he could drive me to the 6:30 AM appointment, even though it was his thirtieth birthday.

So. Six months from pain to surgery. The surgery ended up costing me a couple grand, because my insurance wouldn't cover the general anaesthesia. That's the American Way.
posted by KathrynT at 10:54 AM on June 11, 2010 [1 favorite]


What you are describing for a large group of the workers of the USA is painful for me to read. I knew this intellectually but hearing first hand accounts of relatively simple illnesses that can be treated, but if left untreated can have potentially life-altering outcomes, is simply horrifying.

The situation is bad for a lot of people, but not horrifying. Or at least, not medically horrifying. Medical care is almost always available.

It's the money to pay for it that's not. People are choosing financial stability over medical care. It isn't right, but that's what is happening.

Now, a lot of this is because I live in a large metro area. But all of this "I needed to wait a year and a half for X" is due in a lot of cases to patient passivity. If I'm in pain, I call every doctor in the book until I can find an acceptable appointment. Maybe my insurance only covers 80% instead of 90%. So it's up to me to decide how far to drive and how long to wait and how much I pay.
posted by gjc at 8:39 PM on June 11, 2010


gjc: perhaps consider yourself to be fortunate - your experience is different from a lot of others, and you've got the advantage of insurance as a door-opener.

There are many places where if you have -no- insurance and -no- money, it doesn't matter if you call every doctor within 25 miles - you can go to an emergency room or you can just wait for it to get better (if it does/can). Even though you can legally arrive at an emergency room to be seen for whatever ails you regardless of income (if you've the transportation), there is no guarantee you will be treated or even thoroughly examined/diagnosed, to say nothing of follow-up care. Even in major metro areas.
posted by batmonkey at 9:08 PM on June 11, 2010 [1 favorite]


gic, I reserve the right to be horrified.

My job involves helping set the policies for surgical standards in the UK, my partner is a pain specialist and anesthesiologist who delivers healthcare in the NHS, I find the examples here horrifying because access is not just based on income or a willingness to spend a larger % of your income than rent on healthcare insurance, access seems to be based of education. What I mean is those who know enough to manipulate the systems in their favour.

When I said earlier parents who exagerrate their child's symptoms and they get pushed up the elective surgery list, I wasn't actually making a value judgement, simply noting that those of us who know the healthcare system, or are educated enough to find out how to do that, will be seen sooner. But even mentally disabled users of this healthcare system have a whole lot of support, but even if they didn't, they wou;d still be seen within a relatively reasonable length of time.

What I'm reading here is that someone who works hard, earns just enough to pay for some kind of insurance cover, but doesn't have the education to know how to make the system work in their favour could still be waiting a very long time for treatement and paying a lot more in co-pays than others.

gic, I'm happy for you that you have the drive and education to be able to make the system work for you, but the whole point of the NHS is that it works for everybody, I guess that;s what some Americans find scarey. If you believe people in that situation to be less worthy than you, why do they have a right to a share of your tax dollars? Is that what I'm hearing?
posted by Wilder at 2:00 AM on June 12, 2010 [2 favorites]


If you believe people in that situation to be less worthy than you, why do they have a right to a share of your tax dollars? Is that what I'm hearing?

Not at all. I am all for universal, single payer healthcare.

But maybe not from the same perspective as many others: I am for it because it is a pragmatic solution to the problem of a system where laws (rightly) require that life-saving care be provided no matter what the ability to pay is. We have a system where if you are a skilled enough bullshitter, you can go into a hospital under a fake name, get whatever you want, and never pay. When those people do not pay, the costs are spread to those who can or are willing.

We Americans have socialized medicine for almost everyone as it is. It is just privately socialized, with a layer of people taking a cut (insurance). Anyone with insurance has socialized medicine, it is just that the load is spread among a bunch of tiny groups so that the insurance company can extract money out. We have Medicare for the elderly, Medicaid for the unfortunate, S-CHIP for many children.

The system would be more effective and cheaper for the patients, and probably just as or more profitable for the providers, if it was actually socialized and all the insurance and compliance costs went away. I am for universal healthcare because it would end up being a far more market based solution- there would be no barriers between the patient and the doctor of their choice.

But what I AM saying is that the idea that healthcare is unavailable is being over emphasized. The healthcare problem in the US isn't an access problem, it is a financial problem. And yes, an ignorance problem. People will stand in line all night for the latest gadget or concert ticket, but so many more people are comfortable waiting 6 weeks for an appointment because they are in pain. It's not that they don't have the wherewithall to get to a doctor (in most cases), but that they don't think they can because someone told them they can't. There will always be exceptions where people get screwed- and those are indeed horrifying. But the vast majority of people can get what they need.
posted by gjc at 9:19 AM on June 12, 2010 [1 favorite]


If I develop a pain, I'm pretty much on the "hope it goes away" plan, because it's pay rent or pay the doctor to have a look at it. I should not have to be a skilled bullshitter to get medical care.
posted by Pope Guilty at 9:28 AM on June 12, 2010 [2 favorites]


Ok gic, and thanks for responding, I understand a lot better now what you meant. But again I would respectfully point out that there is a difference between scamming and (apologies PopeGuilty) "bullshitting" the system and simply knowing what gets results.

small example to illustrate this: I became seriously concerned about a friend's mental health a few years back. This person rarely used the health services, was really leery about using them and had the typical mindset "i don't want to be a bother" that alerted me to the fact that they would on first GP consultation probably not get referred for further treatment and/or medication. There's only so much you can do to support someone who is seriously depressed, but I asked them to use certain phrases that I knew would trigger a reaction in the GP.

Yes knowledge of any system has the potential to be abused, but from what's been described here the largest financial gaps seem to relate to the fact that there is a profit imperative on delivery of your basic healthcare.
posted by Wilder at 1:45 AM on June 13, 2010


In the news: Woman shoots herself to get medical care.

Personal anecdote: this weekend, I tried to talk my friend with MS into letting us fund raise for meds for her, because she's been going without for months. She declined because she "doesn't live with her head in the clouds", saying there's no way we could get her the $3,300 per MONTH she'd need for what they cost without insurance.

This is real life in the USA for those without insurance, which is currently around a quarter of Americans. That doesn't count the "underinsured" - those who have some insurance, but only for catastrophic care or otherwise incomplete coverage.
posted by batmonkey at 6:59 AM on June 14, 2010


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