Ex-SWoo
3944
The main difference is that you go in to the day knowing that you’ll spend most of the day getting your various tests done and then you’re done for the year. You also know the total cost is going in.
In my experience in the US you need to get a physical from your primary care doctor who then gives you a battery of tests to schedule. You then need to schedule each of them yourself while trying to figure out what your coverage options are, then run around the city to various clinics getting your tests done and schedule a follow up session with your doctor for the results. This can take weeks or even months and I feel exhausted by the end of it (and heck, I even skip certain tests because I can’t be bothered after a certain amount medical BS I need to put up with).
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3945
Well, people in the US can schedule all their tests at once - this is often the case when a patient lives out-of-town and flies in annually to see their doctor. Typically this is something large medical centers can accommodate, not so much small community hospitals. But yeah, it requires extra effort coordinating with insurance companies, etc.
That said, taking a few days off for medical exams would not work for a lot of Americans, for example single parents. So I’m glad there are options.
God that description of the Japanese system sounds so nice
I’m not saying that having choice of doctors is unimportant. But here is a question for your wife.
Would she rather have her existing doctors but have a 20% copay or have a plan with a $5 copay and have limited choice of doctors?
I’ve read that three times now, trying to be certain that it says what it seems to say.
Given the complexity of her medical issue(s), and the number of doctors we had to go through to get the proper diagnosis I know she’s opt for the choice. But that’s because we could (in theory) afford a higher copay.
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3950
Seems pretty straightforward!
While most people prefer a doctor who lives nearby, there are a few cases in which they don’t:
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Patients with rare disorders or who need quaternary care. If the only clinics for your condition are at the Mayo and UCSF, then you might travel regularly to those hospitals.
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Patients with a long, complicated medical history. There are 40 year olds who still go to their original pediatric practice, because they are still managing a pediatric diagnosis (eg tuberous sclerosis) and want a doctor who is familiar with their history.
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Ongoing treatment. For instance, patients undergoing chemotherapy who move away during treatment. It is generally better to finish treatment where you started.
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Retirees who move somewhere where they aren’t satisfied with the quality of care (eg Mexico) will sometimes continue seeing whoever they saw before moving
And of course, they aren’t necessarily flying in solely to visit their doctor, often they are planning to visit family and want to schedule their medical appointments while they are in town.
I think what Potter is saying with those tweets is more than “choice of doctors”. He’s illustrating that Americans are being misled about Medicare For All plans because politicians in the pockets of health insurance and medical companies are putting out the false narrative that our current system of health insurance gives people more “choice” than a MFA plan would, when the reality is that your choices under the current system are severely limited.
Forget about choosing an actual physician for a moment, focus on the fact that our current system limits the very choice you have on PLANS, often giving you no choice at all. The vast majority of Americans receive their health insurance through their employer (or their spouse’s or parent’s employer). Those employers in turn only offer plans from a single insurer, usually whomever their insurance broker can get the best deal from. In most cases, your employer may offer two plans from the same insurer, a standard plan with co-pays, prescription coverage and sizeable monthly premiums, and a High Deductible plan that is basically catastrophic insurance where you pay for pretty much everything at rates negotiated by the insurance company until you hit an agreed upon deductible, which is usually quite high, but in return your premiums are lower. In some cases employers ONLY offer the high deductible option because it saves them money as well.
So right away, before you even get to the part where you choose doctors, you’ve had your choices limited. Maybe the insurer your company picked doesn’t cover a procedure that your neighbor’s insurance company does cover. Maybe the hospital closest to you is out-of-network for the insurer your company picked, but not for the insurer you had at your previous job last year. Better hope you don’t need to visit the ER this year. That doesn’t even take into account the chaos created when your company decided to switch insurance providers to save themselves money, and suddenly the network of doctors and facilities your family has been using for several years may no longer be accessible to you unless you want to pay outrageous out-of-network rates.
The simple fact is that our current system of employer-based healthcare is broken. It severely limits our choices at every level, and it costs both employers and employees a ridiculous amount of money. Health insurance is literally the largest operating expense at any company (excepting perhaps those that still manage pension plans). Medicare for All could take that burden off of companies, open up the entire healthcare market (any and all hospitals, doctors and facilities) to covered participants, and help rein in the ridiculous markup in even the simplest healthcare costs through volume/fixed pricing. When you remove the need for so many middlemen (insurance brokers, insurance companies, medical manufacturing, hospital administration, etc.) to be making profits at every step of the process, you can pay for MFA with a payroll tax that would likely cost the average employer and employee LESS than what they are currently combining to pay in health insurance premiums and associated costs now.
The problem is taking down an industry that has become more than 20% of the American economy and controls damn near every legislative body in government thanks to the obscene amounts of money involved. It would take a decade or more of relentless legislative reform and bipartisan support, and we will never see anything like that in our lifetime.
SlyFrog
3953
Yeah, I’m not sure why people hyper-zoomed in on “choice of doctors.”
He’s saying we have literally little choice as to anything. Choice of insurers. Choice of coverage options. Choice of providers. Choice of experts. Choice of health care facilities. Choice of treatments (how often do we learn that something experimental or slightly off-label is not covered).
And he’s right.
Scuzz
3954
I know two people who live hours away from at least one of their doctors. One is a heart specialist and the other moved a couple years ago but still comes back here to see their GP, heart guy and sadly now a doctor for the cancer he has.
This is such a good post. Nailed it, front to back, top to bottom. As usual, the big money decides and runs everything.
Yeah, the ACA is probably dead next year.
5th Circuit says since the mandate tax was repealed and the mandate is no longer a tax, the mandate is unconstitutional. Sends the case back to the district court to determine if the mandate is severable or the entire act fails.
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3958
The ACA isn’t going anywhere next year.
Very well argued, thanks.
This makes the (very questionable) assumption that Trump will win in 2020. If Trump loses, it changes the entire trajectory of the decision. With Democrats in control of at least the House and the Presidency, a decision by the courts to invalidate the ACA simply moves healthcare to the top of the “to-do” list assuming it wasn’t there already. That would make a Medicare For All proposal that much more likely.
If the courts decide not to invalidate the ACA despite the taxation aspect no longer being present, then Dems get a little more breathing room to attempt healthcare reform that “fixes” the existing system rather than tearing it down and rebuilding it. Either way it’s likely to result in a win for Democrats (assuming they win the Presidential election) and a black eye for Republicans who failed to do anything with healthcare reform and will undoubtedly attempt to block any Democratic progress on the issue (which will not be popular with most Americans, especially if the courts decide to invalidate the ACA).
Twitter thread from a law professor, make of it what you will.
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3962
Roberts didn’t overturn the ACA even when he had far better legal support for doing so.
Would they, though? Without the individual mandate adverse selection would send the ACA into a death spiral pretty quickly, I’d have thought.
