Health care in the USA

[Rusty Edge]

I'd say it's Spring. The motorcycles are everywhere today.

[Geo]

Over here, in Flanders Fields, its the "terror"cyclists.
Imagine them with groups up to 30 driving on the road, avoiding the bycicle lane at all costs.
Don't even dare to blare your horn as to give room, or they're on you before you realize it.

[Bearu]

The singular solution for the healthcare system in the United States of America involves the creation of a nationalized socialist healthcare system like the system in Cuba. The CIA world fact book indicates the number of doctors and nurses per capita exceeds the number in the United States of America and the people need to recognize the need for a dramatic paradigm shift in the suppression of the bourgeoisie. The people need to respect the health and the welfare of the people as a foundation for the fundamental liberty of the people from the brutal oppressive exploitation of the bourgeois class across the world. The Cuban healthcare system, for example, represents the single country in the world to eradicate the HIV virus from the mother to infant transmission from the population. The potential applications from the creation of a nationalized healthcare industry demonstrates the ability of the people to place the health of the entire population above the petty concern for the profits of a few lumpen humans.

[Elok]

My semi-insider's opinion (I work at a pharmacy) is that the ACA fundamentally failed to address the real problems of American healthcare.  It's kind of like if you had a patient with a three foot long leech attached to his neck, and you couldn't figure out how to get it off, but you didn't want the patient to die either, so after a lot of hemming and hawing you decided to just pay for an indefinite series of blood transfusions.  It's not the worst choice you could have made, and it certainly beats inaction from the patient's perspective, but trumpeting it as a major success is rather laughable.  The leech is only going to get bigger.

Hospitals, drug manufacturers, device makers, pharmacy benefits managers, and others have all grown so big and musclebound that they can all but dictate their price, and our healthcare system is so complicated that it's almost impossible for the average person even to figure out who to begin to hold accountable.  Market forces simply can't work in such an environment.  Eventually the sheer amount of freeloading, rent-seeking, profiteering, and miscellaneous skullduggery will overload even America's ability to pay, and there will be some sort of crash.  I don't know what that will look like, except "ugly."

[Buster's Uncle]

Shoot; I knew ObamaCare was a terrible deal in 1993 when it was HilaryCare.  The insurance industry is the problem, not the solution.  Duh.

There hasn't been a real Democrat in the White House since Jimmy Carter; and I'm not that sure about him.

[Elok]

I'd say it's only the problem insofar as it acts as a shield for providers' exploitative behaviors.  People hear "your insurance won't cover this $500 drug" and fuss about the stinginess of their insurance rather than ask just why the drug is so expensive in the first place.

[Buster's Uncle]

The drug is so expensive because supporting bureaucrats runs the cost of everything up to infinity.  I remember the late 60s, when our family practitioner had two ladies working for him, one mostly nursing with him in back.  -After he retired, the same practice had --- I'd estimate six people working the front.  Five of them were just doing the insurance paperwork.

It's been nearly 40 years since any medical insurance bean-counters directed that my balls be fondled against my will, but I'll hear no defense of those scum.

[Elok]

Honestly, the profit margins on insurance aren't that big, and the reason they involve so much paperwork and defensive medicine all ties into various other issues--PBMs, our country's overload of lawyers, and a general desperate attempt to counteract profiteering.  Which, yes, does drive up costs, but not as much as, say, paying for the latest and hottest wonderdrug that's functionally identical to the last three released in its general class.  Doctors just love prescribing Nasonex, since the drug reps talk it up and give out samples (and possibly sexual favors, God knows).  Never mind that common fluticasone and budesonide work just as well for most people.  And that's a trivial example, compared to some others.  Once you get even a little way inside the industry, you quickly learn that there are thousands and thousands of little tricks to jack up prices, acquire monopolistic leverage, and dispense kickbacks to all cooperative parties.

Insurance gets the hate because they're everybody's common point of access, the apparent gatekeepers, and everyone figures that they have far more power than they actually do.  Also we associate the actual provision of medical care with doctors and nurses, whom we trust, and we have no direct contact with hospital administrators or drug company CEOs.  In reality, insurance companies are the only non-consumer party with a functioning incentive to keep the cost of service down.  Them, and pharmacy discount cards.

[Geo]

At some political decision level here on the old continent (beats me if its Belgian federal or European legislation), there's been a sort of law to prescribe generic medicines over the latest/hottest medicine in the sector, which should bring down the cost when purchasing at the pharmacy.

About insurances. About a year ago I had a labour accident when on cleaning duty in the old warehouse (some tool hit me on the elbow while manipulating it). I was home 2 or 3 (working) days for that. Afterwards, during reconstruction interview of the event with the safety advisor at work, a second-tier manager came in during the interview and had to tell me the cost of this whole event for the company: €900.
Mind you, at least half of that cost was the bill of the insurance provider for the company. The medical care itself and my salary being paid for those days on sick leave was somewhere between onethird and twofifth of the bill (that's my own estimate, based on my wage).

[Yitzi]

At some political decision level here on the old continent (beats me if its Belgian federal or European legislation), there's been a sort of law to prescribe generic medicines over the latest/hottest medicine in the sector, which should bring down the cost when purchasing at the pharmacy.

Although there are cases where someone has a reaction to all but one particular brand, and the law should probably have an exclusion for such cases.

[Rusty Edge]

It's Deadline Day for choosing an insurance plan.

I can't stay with my existing insurer, because they are leaving my state as of the end of the year. It seems like this every year, it's always something. It started with ACA outlawing the kind of high deductible plan we had and were happy with. Then we were in and out of high risk pools and state sponsored Medicaid equivalent. Then we were with our current provider as an only option. I can't say I've been happy with them. They insist that we only use CVS Pharmacy. I preferred Walgreens, but my legitimate complaint is that when the insurance declines a prescription for whatever reason or error, CVS never contacts me or my doctor. I have to call around to find out why I don't have what I needed two days ago. Oh well.

ACA was actually more affordable for us for years, but it was a lot of stress, paperwork and lapsed coverage. We were considering giving up health insurance next year. $1800/month minimum had us thinking about assuming our own risks and paying cash for services and the tax penalty. A higher tax rate doesn't mean much to people like me with more savings than income.

We're trying to go with Health Sharing,  sort of a loophole plan used by the Mennonites.
 https://www.calhealth.net/Aliera-care-health-sharing-plan-review-rates-plans.htm  It sort of turns the clock back to the kind of high deductible plan we had before ACA came along.  There seems to be a glitch with the on-line enrollment.

O

[Rusty Edge]

To follow up, it did go through, I guess things were just a bit laggy from heavy usage at the time. As I recall, you can still sign up for it any time of year, not just during the December window. ( in case anybody is looking for insurance later this year )

[Geo]

So, it appearantly is 'shut down' time again in federal land.

Things that were mentioned in the morning news is how it affects National Park staff and in the midlong run payment of allowances for the people in need.

Since president [Sleezebag] last year renounced the Paris climate accords for his country, we on the old continent learned by the news here that some of the states continue or surpass the obligations stated in the climate accord, meaning they have in general alot of leeway in how they handle what is considered 'internal affairs' in the United States.

So I wondered if this shutdown also affected staff at State Parks (if such a separate branch exists in the USA) and perhaps allowances payed out on the state level, not the federal level.

Anyone in the knows?

[Spacy]

State parks do exist.  No impact to them.

The biggest impact is to the people who do things like answer the phones - as they are all told to not go in.  If it lasts a while, it will have other impacts, such as military who are working, but not getting a check (but will get a back pay check when things start back up) - but if it goes on long enough, their spouses and dependants, who need things like groceries & rely upon that money to purchase them, will start to suffer. 

[Geo]

A thought just struck me: during a government shutdown, is the presidential 'stipend' blocked as well? In short, is the office considered critical for the functioning of the country?