As Obamacare losses mount, so do the lawsuits

[Adam White]

Interesting article:

http://www.theguardian.com/society/2015/aug/25/gp-appointment-waiting-times-in-us-worse-than-nhs

Apparently people can wait long times for basic appointments in the USA, too.

I think judging an entire health system by worst case scenarios is ridiculous. I remember when Tampa General amputated the wrong leg (by mistake). Horror story - but I wouldn't use that as an example of what healthcare is like in the USA as a whole.

[finehoe]

...opponents of the Canadian system gained considerable political traction in the United States by pointing to Canada’s methods of rationing, its facility shortages, and its waiting lists for certain services. These same opponents also argued that “refugees” of Canada’s single-payer system routinely came across the border seeking necessary medical care not available at home because of either lack of resources or prohibitively long queues.

This paper by Steven Katz and colleagues depicts this popular perception as more myth than reality, as the number of Canadians routinely coming across the border seeking health care appears to be relatively small, indeed infinitesimal when compared with the amount of care provided by their own system. Katz is an associate professor in the Departments of Medicine and Health Policy and Management at the University of Michigan. Karen Cardiff is a research associate at the University of British Columbia’s Centre for Health Services and Policy Research. Also at the University of British Columbia are Morris Barer, professor and director at the Centre for Health Services and Policy Research’s Department of Health Care and Epidemiology, and Robert Evans, professor at the Centre for Health Services and Policy Research’s Department of Economics. Marina Pascali is a Dallas-based health care consultant.

Surprisingly few Canadians travel to the United States for health care, despite the persistence of the myth.

http://content.healthaffairs.org/content/21/3/19.full

[Adam White]

...opponents of the Canadian system gained considerable political traction in the United States by pointing to Canada’s methods of rationing, its facility shortages, and its waiting lists for certain services. These same opponents also argued that “refugees” of Canada’s single-payer system routinely came across the border seeking necessary medical care not available at home because of either lack of resources or prohibitively long queues.

This paper by Steven Katz and colleagues depicts this popular perception as more myth than reality, as the number of Canadians routinely coming across the border seeking health care appears to be relatively small, indeed infinitesimal when compared with the amount of care provided by their own system. Katz is an associate professor in the Departments of Medicine and Health Policy and Management at the University of Michigan. Karen Cardiff is a research associate at the University of British Columbia’s Centre for Health Services and Policy Research. Also at the University of British Columbia are Morris Barer, professor and director at the Centre for Health Services and Policy Research’s Department of Health Care and Epidemiology, and Robert Evans, professor at the Centre for Health Services and Policy Research’s Department of Economics. Marina Pascali is a Dallas-based health care consultant.

Surprisingly few Canadians travel to the United States for health care, despite the persistence of the myth.

http://content.healthaffairs.org/content/21/3/19.full

It's worth considering that a lot of this 'health tourism' or whatever you might want to call it, comes down to convenience. If you live close to the US border (or maybe just across the channel from France), you might decide to go pay to get the procedure done rather than wait a few weeks or months.

One thing I've always found ridiculous is the notion that a) people only have to wait in single-payer systems and b) it's only in a single-payer system that bureaucrats are making decisions about what you can and can't get done .

People will always have to wait, regardless of the system. And someone is always going to make decisions about what is or isn't covered - whether that is a public employee or a guy working for an insurance company. The only people who will always be able to get what they want, when they want are the people who are rich enough to pay for it out of pocket at the going rate.

[Tacachale]

I have no wish to get involved in this debate, but in the 90s one of my relatives went to Germany from England for a needed heart operation that he couldn't get at home. If he hadn't done that, the other options were France and the US. Their perception is that the UK has created a two-tiered system, where people who could afford better treatment or insurance (or spend their life savings for it) can get it privately, and the masses get ok but universal insurance they have to wait in line for.

The benefits of the UK system, which my relatives understandably don't really see, is that there are *much* lower costs per capita, and universal coverage, which theoretically provides for better average outcomes. The thing with US healthcare is the costs. No matter what side of the debate you're on, we pay by *far* the most on healthcare in the world, without appreciably better outcomes.

More food for thought is healthcare research. Private companies fund a lot of research in the US. If they weren't making money on it, they'd cut back and that would take a lot to replace (the US alone historically performs about half of all healthcare research in the world). Our government is already heavily subsidizing research as well so it won't be a matter of just shifting the funding to the public sector. Europe and some Asian countries are increasing their output, but still aren't remotely close. If American research declines, either other countries will have to subsidize a lot more than they've historically been used to, or it won't happen at all.

[Tacachale]

More food for thought is healthcare research. Private companies fund a lot of research in the US. If they weren't making money on it, they'd cut back and that would take a lot to replace (the US alone historically performs about half of all healthcare research in the world). Our government is already heavily subsidizing research as well so it won't be a matter of just shifting the funding to the public sector. Europe and some Asian countries are increasing their output, but still aren't remotely close. If American research declines, either other countries will have to subsidize a lot more than they've historically been used to, or it won't happen at all.

Scratch that, it's only Asia that's increasing. The Europeans and the US government are sitting on their hands, and US private entities are going backwards. There's not even been much net gain from 2007-2014 across the world. Not a good trend.

http://www.nejm.org/doi/full/10.1056/NEJMp1311068?query=featured_home&

[Adam White]

Their perception is that the UK has created a two-tiered system, where people who could afford better treatment or insurance (or spend their life savings for it) can get it privately, and the masses get ok but universal insurance they have to wait in line for.

That's probably correct. You can get it if you want to pay for it. That's the same way it is in the USA, really. Prior to Obamacare, you'd essentially bankrupt yourself if you had to seek medical help and weren't lucky enough to be insured. My friend Roy has an unpaid medical bill for about $30K because he broke his arm and didn't have insurance.

[Tacachale]

Their perception is that the UK has created a two-tiered system, where people who could afford better treatment or insurance (or spend their life savings for it) can get it privately, and the masses get ok but universal insurance they have to wait in line for.

That's probably correct. You can get it if you want to pay for it. That's the same way it is in the USA, really. Prior to Obamacare, you'd essentially bankrupt yourself if you had to seek medical help and weren't lucky enough to be insured. My friend Roy has an unpaid medical bill for about $30K because he broke his arm and didn't have insurance.

It's still like that under Obamacare. The major difference is that more people are insured now (89% as of 2016, up from 82% just a few years ago). For those that do have coverage (especially those with private insurance), they won't face problems like that the vast majority of the time. However *everyone* is paying a lot more in total than they do in any other First World country, and the uninsured are basically screwed.

[spuwho]

Their perception is that the UK has created a two-tiered system, where people who could afford better treatment or insurance (or spend their life savings for it) can get it privately, and the masses get ok but universal insurance they have to wait in line for.

That's probably correct. You can get it if you want to pay for it. That's the same way it is in the USA, really. Prior to Obamacare, you'd essentially bankrupt yourself if you had to seek medical help and weren't lucky enough to be insured. My friend Roy has an unpaid medical bill for about $30K because he broke his arm and didn't have insurance.

One friend of mine got cancer. Rang up over 300k in medical bills. Had no insurance. Declared BK and then negotiated down with all of the providers post BK and in reality spent around 45k.

Another friend of mine got really sick and found out he was HIV positive. He couldnt afford the treatments and had no insurance. The hospital financial advisor recommended he quit his job, file for disability and bankruptcy and then welfare would pay for his HIV meds until it was fully suppressed. He did just that and he paid zero for his health care.

This is way before the ACA existed. So there are plenty of ways to deal with it.

One single woman I knew had no insurance for her and her daughter. She simply called the different hospitals when she needed something and asked to quote her the non-insured cash price of a procedure. Then she asked if they offered payment plans, almost all providers did. Many made very good financing offers like "$500 down and $100/mo at 3% interest. She got some really great deals. As far as she was concerned, health care was like buying a car and when I did a compare, one year cost her less than having private insurance and a deductable.

So there are other ways to tackle health care. Its just that all of the negotiations on the pricing are hidden. Those with private policies usually only see the premium and deductables.

[finehoe]

One friend of mine got cancer. Rang up over 300k in medical bills. Had no insurance. Declared BK and then negotiated down with all of the providers post BK and in reality spent around 45k.

Another friend of mine got really sick and found out he was HIV positive. He couldnt afford the treatments and had no insurance. The hospital financial advisor recommended he quit his job, file for disability and bankruptcy and then welfare would pay for his HIV meds until it was fully suppressed. He did just that and he paid zero for his health care.

This is way before the ACA existed. So there are plenty of ways to deal with it.

One single woman I knew had no insurance for her and her daughter. She simply called the different hospitals when she needed something and asked to quote her the non-insured cash price of a procedure. Then she asked if they offered payment plans, almost all providers did. Many made very good financing offers like "$500 down and $100/mo at 3% interest. She got some really great deals. As far as she was concerned, health care was like buying a car and when I did a compare, one year cost her less than having private insurance and a deductable.

So there are other ways to tackle health care. Its just that all of the negotiations on the pricing are hidden. Those with private policies usually only see the premium and deductables.

Are you serious?  So we all should declare bankruptcy and/or quit our jobs and go on disability/welfare to deal with a health care issue?  These are the "other ways" to tackle health care?   

[spuwho]

One friend of mine got cancer. Rang up over 300k in medical bills. Had no insurance. Declared BK and then negotiated down with all of the providers post BK and in reality spent around 45k.

Another friend of mine got really sick and found out he was HIV positive. He couldnt afford the treatments and had no insurance. The hospital financial advisor recommended he quit his job, file for disability and bankruptcy and then welfare would pay for his HIV meds until it was fully suppressed. He did just that and he paid zero for his health care.

This is way before the ACA existed. So there are plenty of ways to deal with it.

One single woman I knew had no insurance for her and her daughter. She simply called the different hospitals when she needed something and asked to quote her the non-insured cash price of a procedure. Then she asked if they offered payment plans, almost all providers did. Many made very good financing offers like "$500 down and $100/mo at 3% interest. She got some really great deals. As far as she was concerned, health care was like buying a car and when I did a compare, one year cost her less than having private insurance and a deductable.

So there are other ways to tackle health care. Its just that all of the negotiations on the pricing are hidden. Those with private policies usually only see the premium and deductables.

Are you serious?  So we all should declare bankruptcy and/or quit our jobs and go on disability/welfare to deal with a health care issue?  These are the "other ways" to tackle health care?   

Nowhere did I say this was a recommended course of action.

I was providing examples of how different people dealt with catastrophic or just general health care events.

Filing BK was simply a means by which someone can reorganize their debts while undergoing a life change of some kind, in this case, the kind that they need to stay alive.

What I did want to share is that many providers will work with you. Filing BK is strictly a personal decision, not the ultimate option.

[Adam White]

One friend of mine got cancer. Rang up over 300k in medical bills. Had no insurance. Declared BK and then negotiated down with all of the providers post BK and in reality spent around 45k.

Another friend of mine got really sick and found out he was HIV positive. He couldnt afford the treatments and had no insurance. The hospital financial advisor recommended he quit his job, file for disability and bankruptcy and then welfare would pay for his HIV meds until it was fully suppressed. He did just that and he paid zero for his health care.

This is way before the ACA existed. So there are plenty of ways to deal with it.

One single woman I knew had no insurance for her and her daughter. She simply called the different hospitals when she needed something and asked to quote her the non-insured cash price of a procedure. Then she asked if they offered payment plans, almost all providers did. Many made very good financing offers like "$500 down and $100/mo at 3% interest. She got some really great deals. As far as she was concerned, health care was like buying a car and when I did a compare, one year cost her less than having private insurance and a deductable.

So there are other ways to tackle health care. Its just that all of the negotiations on the pricing are hidden. Those with private policies usually only see the premium and deductables.

Are you serious?  So we all should declare bankruptcy and/or quit our jobs and go on disability/welfare to deal with a health care issue?  These are the "other ways" to tackle health care?   

Nowhere did I say this was a recommended course of action.

I was providing examples of how different people dealt with catastrophic or just general health care events.

Filing BK was simply a means by which someone can reorganize their debts while undergoing a life change of some kind, in this case, the kind that they need to stay alive.

What I did want to share is that many providers will work with you. Filing BK is strictly a personal decision, not the ultimate option.

I think it's a real shame that a person dealing with, say, cancer would have to spend time trying to work out a payment plan or something to deal wiht the ludicrous (and completely unnecessary) debt.

[MusicMan]

One issue that has not been mentioned is this:  politicians, the people who actually bring health care laws and policy to reality, get fantastic health insurance policies 'gratis' through their jobs, which are completely different than the policies they subject the rest of us to.  If Senators and Congressman had to get health insurance the same way ordinary citizens do (i.e. write a monthly check for the policy and be subject to annual physicals to determine their premiums), the entire health care system in this country would change overnight.

[Adam White]

One issue that has not been mentioned is this:  politicians, the people who actually bring health care laws and policy to reality, get fantastic health insurance policies 'gratis' through their jobs, which are completely different than the policies they subject the rest of us to.  If Senators and Congressman had to get health insurance the same way ordinary citizens do (i.e. write a monthly check for the policy and be subject to annual physicals to determine their premiums), the entire health care system in this country would change overnight.

It might - but then again, I think the current salary for US Congressmen is $174K. 

[finehoe]

One issue that has not been mentioned is this:  politicians, the people who actually bring health care laws and policy to reality, get fantastic health insurance policies 'gratis' through their jobs, which are completely different than the policies they subject the rest of us to.  If Senators and Congressman had to get health insurance the same way ordinary citizens do (i.e. write a monthly check for the policy and be subject to annual physicals to determine their premiums), the entire health care system in this country would change overnight.

Actually, since 2014, all members of Congress and their staffers have to purchase coverage through an online exchange, just like everyone else who doesn't receive insurance from an employer.

Nearly 13,000 members of Congress and staffers are currently enrolled in gold-level Small Business Health Option Program plans on the Washington, D.C., exchange.

http://www.latimes.com/business/la-fi-laz-congress-members-health-insurance-20150218-story.html