I am not pretending. Stop trying to put your words into my mouth. Where are the solutions for the overbooked nursing programs? Where are we getting the new physicians? How are we going to encourage them to be primary physicians. How do we get them into rural as well as urban America? What about the cost of medical school? When you decide to only pay the healthcare system xyz amount, how are we going to address the suppliers? What’s the plan with R&D?
When the government says you’re not covered for a drug, where do you go? Who do you appeal? Right now you can theoretically challenge private insurance, but challenging Medicaid… and Medicare is a different beast.
Insurance for everyone is a political line, not a realistic approach; the way it’s being discussed today.
And need I remind you, Bernie didn’t win. The Democrats are split on the issue already, and the fuck you people attitude towards anyone who questions it isn’t going to bridge that divide. The GOP hates the idea entirely.
When I was in medical school, there was a program that paid for your education and in exchange you spent time working in an under-served area when you graduated. Is that not still a thing?
The amount of money you can make specialized vs. a generalist or internationalist is staggering, and considering how much education they need already… what’s a a little more at that point? They still have those programs, but the real problem is when specialist see patients who can and should be treated by primary physicians instead, aka hospitals and specialized clinics pull from family doctors. It’s more expensive for the system and the patient, but no one likes the idea of gatekeepers, although the true HMOs have that already.
We’re talking roughly 3 more years of school to more than double your paycheck and that’s after roughly 7 years of expensive school already. SP fixes this you say, no that just changes who pays and potentially what they will pay but it doesn’t make those school debts ago away or change the nature of the work as it’s practiced here.
There may still be, but getting medical care to rural populations is a growing and widening problem. And it isn’t just doctors, but the ancillary human resource considerations that are doing it.
My brother had to give it up, after 25 years of practice in a city of 35,000 and move to a bigger city. The main reason? If you don’t have a very good and very skilled coder working within your practice, a doctor is going to get crushed and end up bankrupt. That’s why doctors band together in group practices…it’s the best way to get yourself to a point where you at least can the kind of certifications and skilled coders, office practice managers, and aides that will ensure reasonable reimbursements.
Yeah, hard to do a group practice, shared billing, shared staff, in the middle of nowhere. And even if a physician is business savvy, some of them are and some aren’t, they still need quality staff. Hell I get asked questions sometimes, and know the answer, but I have to remind them I am IT. You always assume someone knows better than you do but I’ve been in the office with the guides turning pages right next to the coders and the billers and the managers in a hospital system trying to figure out what the hell it is Medicare or Medicaid wants.
3 different health system, full pledged hospital and clinic combinations, all billing Medicaid and Medicare differently, personally calling up those programs myself and getting different answers each time.
They have new rehab requirements going on right now… that they’re not enforcing which is good because you can’t get a straight answer about that one either. Live but unenforced… a program that took years to come up with a requirement their people can’t even understand. And don’t get me started with the L1 modifier mess they did, 2 years and they pulled that neat idea.
I’m not necessarily saying we need single-payer. Germany has a very regulated non-single-payer system from what I understand, originally set up back during the “Second Reich (the first was the Holy Roman Empire under Charlemagne)” (1870-ish-1918) under Bismarck. It seems to work for them pretty well.
Of course, in Germany most medical education is paid for by the government, so people aren’t paying student loans off forever when they get out.
The thing is that most of that work can be done remotely, especially coding, so it isn’t necessary to have all those skills locally for the rural doctors.
Coders don’t work for free. The physician can of course hire some billing company that is off in a big urban city that does it for them… how many rural physicians do you know that do that? The physician groups I know, in an area of urban/rural setting are much more likely to partner together and share staff, not just billing staff but the medical assiistants, the registrars… all of them, and not rely on a distant call center to do it all for them. And then of course you have the EMR.
The Bannon thing was a major milestone for the Trump Administration. People in DC have long since figured out Emperor Trump had no clothes, but Bannon had a mystique. He was supposed to be a Machiavellian plotter, scheming in his lair to overthrow government as we know it. He compared himself to Darth Vader, and reporters passed in on in hushed tones, admiring his balls.
Then he presented his ultimatum to the Freedom Caucus. If you pull that sort of thing, you’re either very sure of the outcome … or very, very naive.
They laughed at him.
Now the Vader mask has slipped and people are starting to second guess the image they have of the master plotter. Could it be he hasn’t been adroitly subverting the administrative state after all? If it possible that Bannon, like Trump, is just another rich asshole who has failed upward and actually has no idea what he’s doing?
Over on Vice there’s a righteous rant, posted a few days before the Freedom Caucus incident, that says it’s the latter. Like all good rants its meandering and repetitive, but it’s well worth a read:
He is not a Svengali; he’s a shipwrecked banker who washed ashore and wound up the president’s ventriloquist. Hate is still just hate, no matter how intricately ornamented it is with Ronald Reagan idolatry. Bannon is like if the tire mud flap with the giant-breasted silhouette got a library card…
Trump’s most Bannonesque executive orders were crafted with crazed delusions but in toothless, vague language, and then passed to Trump with no counsel from relevant agencies. The “travel ban” was vicious in its intent, but so poorly designed it resulted in bedlam countrywide before federal judges ultimately halted it. (According to one report, Bannon welcomed the chaos and protests, which seems less like a tactical maneuver than the cackle of a madman.)
Everything he does feels reckless and improvised, wired to blow, the pandemonium fallout of a lunatic trying to operate a complex machine…
There is nothing more dangerous on this planet than a man who is terrified that people are laughing at him, that his intrepid walks on runways do not look triumphant but instead like he missed the last train. He waited his whole life for this moment, to look grizzled on television—grizzled in that regal, Norman Rockwell, smells-like-an-old-baseball-mitt way—but he just looks like a scavenger, old and beaten. Sometimes what looks at first like the weathered wrinkles of a wise man is really just a layer of grime that you could spray off with a hose.
I had a lot of discussions when I lived overseas where I tried explaining things like “pre-existing conditions” and “medical bankruptcies” and people looked at me like I came from a land of savages. Americans mostly don’t know how shit we have it, since we don’t have anything to compare it to.
Back in my twenties, I was relayed a story about a childhood friend whose father became so exhausted and stressed fighting with an insurance company that he laid down one day and died. Nice story. But, people in fights with their insurance company about coverage was considered a basic fact of life. They simple have no incentive to pay up, so if you get sick, you need to make sure someone is there spending hours and hours making the insurance company actually does what you are paying into your insurance for.
Last year, my insurance gave me shit about a condition my wife developed and they tried to weasel out of covering it by theorizing it must surely have been an existing condition predating the ACA, so they could deny coverage. (Ignoring that my wife had been covered by a different provider for ten years before joining me on my insurance. I guess that isn’t important.) The hospital basically told them to prove it or go fuck themselves, and the insurance provider (Aetna) caved after a few weeks. The delay this caused landed my wife an overnight stay in the hospital which I surely hope cost them as much money as possible.
Insurance companies were and are pure, pure evil. The only thing keeping them from taking our money and grinding each and everyone of us into paste when we are no longer profitable are all those “laws, restrictions, and bureaucracies” that republicans complain about it.
Yep. I’ve had more than enough experience watching my mother who knew the in’s and out’s of the system get fucked over and delayed constantly dealing with my step-father. Hell, they tried to retroactively deny things they approved more than a few times. Imagine that scenario: Insurance company says “we’ll pay for this expensive thing,” then 2-3 months later they say “we’re not paying for it, it’s all on you.” You know right after you buried your fucking spouse, because they hope you’re too emotionally devastated to respond in time so they’re off the hook for something they already agreed to do.
I mean this is an industry that had literal death panels. People testified before Congress that their job was to deny service to people so they would die and the company wouldn’t have to pay for it. They got promotions/raises for doing so effectively. But, that’s fine as long as someone makes a profit.
The funny thing about how bad insurance is over here is how good insurance is outside the US, and NOT because of government mandates.
My mom moved to Australia for work, and about 8 months later passed away by a freak blood clot. We were all prepared to have her buried there because flying her body back to the US was crazy expensive and after a lot of talking we just couldn’t justify the cost.
Then we get a phone call from the private insurance company she had life insurance through. They had been going from person to person spending two days trying to find out how to get in contact with us. Why? Because the insurance she had 100% coverage for flying the body back to her home country.
There are a bunch of other examples I have from both her time and my time down there. There’s literally no way an American insurance company will expend any effort to proactively supply coverage they were contractually supposed to give. Any US insurance company would have waited for us to acknowledge that we had that coverage and they were supposed to pay for it.
The problem with the US health system is very cultural. There are just things that are so ingrained that people can’t see the bigger picture, and I don’t have any hope of us solving and real issues while non-extreme republicans hem and haw and try and make excuses for our health care system and try and dismiss other country’s without any actual first hand knowledge.
If we can identify and solve the cultural issues, we can make great strides no matter what the solution ends up looking like. Until those cultural issues that are blinding people are brought to light there’s no compromise that’s going to happen.
I keep coming back to the same point, I know, but it’s constantly relevant. The culture Kall is talking about is “profit first” and it’s a terrible way to run a health care system. Incentives for health care providers need to be patient outcomes first and all else second. I can’t see this happening in the US without regulation so massive that you might as well just have the government take over.
I agree. I don’t believe in a lot of government control, but this is one of those things I do. In business, there’s a constant tug of war. When it’s money and goods, I’m fine with that because the stakes are of similar nature, if that makes sense. When it’s a matter of health, the stakes are not.
I give the ACA all the credit for my insurer not even attempting to fuck with me when I was in the shit. Possibly Blue Cross of Michigan wouldn’t have bent me over while I was trying to not die doing my job while in recovery (which was sadly a closer thing than you might think), but…yeah, thanks BIG GOVERNMENT for making that not an option.
As I said before, this is already starting to happen. The pay per visit, per encounter is already shifting out the door, without SP. All the major health systems are preparing for it. The days of dollars walking in the front door have been ticking down for sometime now, and the shift is there… there is a reason why you are seeing the hospitals aligning with clinics and specialties… they’re preparing to be able to offer communities comprehensive care while maintaining costs.
There are lots of ways to do this but making sure your physicians are paid while the system itself might not receive a check for a patient or the full amount until the end of year helps.
There are already insurers who do not pay just because a patient walked in the door.
Health systems do this all the time. There are sometimes cracks about someone getting a bill after a year of service, but it could literally be a year of the health system trying to work with the insurance company before the patient ever sees their statement.
Was this a grandfathered plan because I thought pretty much everything out there now covered pre-existing, well since Trumpcare died anyway.
Fortunately, I didn’t have to follow up their reasoning enough to know the details of their logic (assuming there was any), but no - it wasn’t a grandfathered plan, just a normal HSA family plan through my employer that my wife joined when we got married. And from what little I’ve read on the subject, all that pre-existing condition crap - which this wasn’t - died in 2014, so I can’t imagine what they saw that they were trying to take advantage of. Made me super angry, though.
Yeah it sounds like your insurance company tried to bullshit it’s way out of covering. Good for you for not backing down. The best thing, out of all the stuff and there are some other goods ones too like the maximums, is getting rid of the pre-existing stuff. I know there are moral hazards in the marketplace with existing conditions, but for the employer based plans… no one should have to stop getting treatment just because they switched or a lost their job.
I’d certainly be happy to be wrong in this instance, but doesn’t this mean that we’re relying on the goodwill of the (profit-motivated) insurance industry to make patient-oriented outcomes happen? Without some outside pressure on them, there will be always be someone providing useless cut-rate insurance to suckers (incidentally raising riskier patient’s premiums) or tying patients up in bureaucratic hell (as has been described upthread by @mrcjhicks and @ShivaX and others). Not to mention all the people that the industry simply won’t cover at all due to them being too poor or having too many health issues to be profitable. By the time you put in regulations to force the insurance industry to do all those things (and I’m sure there’s even more I’m not mentioning), there’s very little in the way of “free market” left in it. So why bother with all the overhead of a separate insurance industry at all? A single payer system will assuredly not be perfect or solve all these problems, but it has got to be much simpler and efficient.
OK, now, having said all that, it’s probably not politically feasible to do single payer without a political Tunguska event. So we may well be stuck with the inefficiency of a private insurance industry, in which case what @Nesrie has described about comprehensive care becoming important to them is a promising step. I’d like to see amendments to the ACA that make that kind of approach mandatory, which I see as the next evolution of the essential benefits clause.
