Medicaid

[ursus arctos]

dglh touches on an essential part of health care here that is very difficult for anyone not familiar with the system to understand.

We consumers spend a great deal of time arguing with insurance companies over coverage, both whether a particular procedure is covered at all and how much of its cost is covered if it is. Doctors also spend an inordinate amount of time arguing with insurance companies, most often through specialized staff that they have had to hire to do nothing but that.

For the large majority of the under 65 population that is not covered by Medicaid (national coverage for the impoverished), virtually no health care procedure can be undertaken without interacting with an insurance company unless one is completely indifferent to and fully able to bear its cost.

[San Bernardhinault]

It's almost impossible for someone not versed in the system to even understand what insurance they're buying. It took me 5 years to work out what the out-of-pocket number meant. I still haven't the faintest idea what the difference between a ppo and an hmo is. I still can't really work out what deductibles mean when some are percentages and some are flat numbers and some apply to certain things and some to others. I remain baffled by how my annual check up, which is surely preventative and cost-saving for the insurance company, appears to cost me money.

It's sufficiently complex and overwhelming that I can't imagine anyone would voluntarily leave a job to start working independently. It is surely the most prohibitive thing to entrepreneurship in the US. People are still, to a large extent, indentured to large employers because leaving large employers screws with health coverage. It's better since Obamacare came in, but even with the ACA you still end up spending multiple days a year just trying to navigate what insurance you want...

[Pérou Flaquettes]

Thanks everyone for your replies, I understand much better now.

[S. aureus]

It doesn't help that the insurance companies are evil and often incompetent, and apparently filled with bald-faced liars.
Examples:
The procedures that my wife underwent were approved by our insurance company in advance. On 2 occasions they changed their minds, in one case we received a letter notifying us of this the evening before the procedure, the other not till a couple of days later (they'd mailed it the day before). One of these, as far as I'm aware, they never did cough up for and I believe the hospital swallowed the cost of it.
My wife was on rather expensive medicine for a while, which was subsidized by the manufacturer. The insurance company insisted on reimbursing us for it, even after we (repeatedly) pointed out that we weren't really paying for it and they should be reimbursing the manufacturer. Indeed, they were still trying to give us money a year after she'd died (so a good 3 years after this particular treatment).
Over the 5 year course of her disease we received 3 (maybe 4) letters from them informing us that they were no longer covering one of the hospitals/doctors etc that she was using. These invariably got resolved without any problems except upping my stress level.
They were rarely capable of pulling up records if you were talking to them on the phone, never called you back if they said they would, gave you call back numbers and e-mail addresses that were not valid and used false names ("who did you say you spoke to? There's no-one here with that name.")

[ursus arctos]

As important as it is true

[Flynnie]

It's worth noting that support for Medicare for All is at something like 70% these days. People are aware what the problem is, and I think the "single payer = communism" line doesn't work well for anybody who has any experience of online or has left the United States, because once you've met one foreign person, you've met one person who tells you that dog won't hunt.

Who knows how long it'll take the Democratic Party to actually embrace a popular policy that 7/8ths of their voters support, but I have a feeling they won't be able to kick the can down the road much longer. Not with probably 40% of the country having a pre-existing condition of some sort.

[San Bernardhinault]

That's very true, Flynnie. I think the new framing of it as "extending Medicare" really helps. "Single Payer" is a really odd phrase (and I never understood quite what it meant), but people were always able to present it as a terrible communist infection. But extending something that already exists, and using it to cover more people, seems very natural.

[Gerontophile]

The phrase "Single Payer" only works because, "taking it away from you before you can complain, tax" doesn't sound good. No matter how much good it may do.

[Gerontophile]

I learned three things today:

1. You can get pills on someone else's medical (see 'Friends' passim)
2. American painkilllers are fucking serious about their ambition
3. Tyres are not as impenetrable as I once thought, and cars don't have inner tubes.

He is able to change partners, but is too bloody lazy to do it himself. Or, he wants me involved, which means he cares.