Can’t say you weren’t warned Were you on student insurance? That’s exactly what happened to us. Angrymob had student insurance, which bills itself as “hey, this isn’t for your routine doctor’s appointments, this is for catastrophic illness, like when you have appendicitis.” So we called their bluff, and WHOOPS, they didn’t want to pay that, neither.

Email me if you want to commiserrate, or however that’s spelled.

Good luck with this.  My mother and I dealt with Aetna and a collection agency because Aetna kept losing the documentation that I had continuous coverage, despite it being faxed and sent to them several times.  I paid the $1500 ER bill myself just to close the problem and Aetna made profit because of bad business practices. 

There will undoubtedly be worse stories in further comments on this post.

Ursula—this shit is all too common. Class-action-lawsuit common, if you ask me.

Yeah, but Jesse, you had the FREEDOM to clasp your hands tightly over your bursting appendix and go to four different emergency rooms so that you could find one that would take care of you for only $15,000! Maybe even only $14,000!

Don’t you understand the awesomeness? Or to you just hate America?

I’m really sorry, Jesse.

And somehow “socialized medicine” is supposed to be a big scary phrase?

I have problems wrapping my mind around the concept of just how fucked the American system of healthcare is. The only large medical spendings I’ve had was 460$ total for eye exams and new glasses (covered by employer’s insurance, but I have to pay upfront), had to pay a 150$ for a removable cast when I busted my ankle (covered by employer’s insurance, had to pay upfront, a non-removable cast that would have made it impossible to continue working would have been covered by the state though), and we have some upcoming dentist bills because that’s not covered by the state (but again, covered by employer’s insurance, except for orthodoncy, which is expensive as hell).

And this is CANADA. We’re not even at the top of the socialized medicine heap. This is just a free market with a single payer system layered on top.

I wish you good luck in your upcoming trials, and I hope I don’t come across as bragging here. I’m just incensed that this *minimal amount of coverage* is not granted to people in the wealthiest nation on Earth. Healthcare is a right.

Jesse, if you were a good, honest, decent, Godly Christian American, you wouldn’t have gotten appendicitis to begin with.  Whatever happens after that in the New Socialist America is only what you deserve after voting for Obama…

(and yes, technically Obama wasn’t yet president - we had to go through that sham election first - but if the stock market was already reacting to Obama, and from all I hear IT WAS!, then the socialism thing still applies.  Besides, you got the bill on Obama’s watch, which proves that it’s Obama’s fault…except for the part that’s Bill Klinton’s fault…)

Jesse, it’ll be annoying as all get out, but don’t give up.  Also, as someone who’s gone through this sort of thing myself, I have to remind you that your insurer probably has an adminstrative process for contesting their benefits decisions.  The process will have deadlines, and going through the process is, I guarantee, a prerequisite for seeking any further remedies (like in court).  DO NOT BLOW THIS OFF.

. . . not that i think you would, but you’d be amazed what sorts of things even highly educated people forget or go into denial about . . .

Every time some wingnut congressman starts talking about how your medical decisions should be “between you and your doctor, not some bureaucrat,” my reaction is “there goes a guy who has never had to deal with a health insurance company.” (Or more likely, can just say “don’t you know who I am?” and get a great response.)

All health insurance companies are evil. Their entire business is figuring out ways to deny payment. There are varying degrees of evil, but I’ve never dealt with one that wasn’t.

I was in this kind of nightmare once.  Insurance claimed they paid the doctors.  Doctors insisted they hadn’t been paid.  The doctors wanted me to submit a copy of the cancelled check.  A copy of a the insurance company’s check from a bank account I didn’t own.

I conference called the motherfuckers together.

You tell the insurance company you didn’t get paid.
You tell the doctors you have a cancelled check.

Get me the fuck out of the middle.

In my experience with bureaucrats. You must cause them pain. The approach the normal functionary uses to avoid work/dealing with things is by just saying no. In most cases the problem then goes away. To get what you want you must make dealing with your issue less annoying that not dealing with it. That means calling them, harassing them. Then when they make excuses, invalidate their excuses. If they claim their rule is the way find the rule, see if they are right, and then show them they are breaking their own policy.  Never give up, never surrender.

I learned this living in France. The answer to every single question there is no at first, then you push.

Great advice Caren, and Jesse, most of the insurance companies have the confernece call option on their phones.  Insist and remember these phrases - Who am I speaking to - and write it down
and can I speak to your manager (if not available - what is manager’s name and when will s/he be available?)

I have found that it is amazing how threatening (tacitly) to have the person you are speaking to become a problem in the eyes of the manager will often get action.

I know this is probably redundant for you, but, a script when stressed is helpful.

All health insurance companies are evil. Their entire business is figuring out ways to deny payment.

This.  The only way insurance companies make money is by sucking it out of healthcare.  All of the profit and all of the money needed to operate the insurance agencies needs to be taken away from them and either given back to the people or put toward properly funding national health.

Denying healthcare is fucking evil.

The latest Republican lie I’ve heard?  Soylent Green.  Health care will be available, but only until about age 78, b/c old people are too expensive.  What?!!  Just b/c no other nation with socialized medicine does that doesn’t mean that Obama’s people aren’t running the numbers and accepting the fact that that’s the only way it can work.!!!11!!  The fact that every other socialized health care nation has a life expectancy longer than 78 doesn’t seem to make much of an impression.

Sure, the bureaucracy of insurance companies is like a real life version of Office Space, but I bet every TPS report has the new coversheet on it…

“The latest Republican lie I’ve heard?  Soylent Green.  Health care will be available, but only until about age 78, b/c old people are too expensive.”

...I always liked the Logan’s Run solution better.  “Carousel” just seems more interesting, although probably not as disturbing as Soylent Green.  Your life clock turns red and the Sand Men come after you.  Besides, it had Farrah Fawcett(-Majors) and Jenny Agutter in it…

Good luck with this.  My mother and I dealt with Aetna and a collection agency because Aetna kept losing the documentation that I had continuous coverage, despite it being faxed and sent to them several times.

Agh.  Aetna.  My credit is still fucked up thanks to them and my own stubbornness because I refused categorically to pay money I didn’t owe.  It dragged on for three years, but suddenly the $2,000 bill that the hospital was sending me every couple of months magically turned into a $300 bill because Aetna finally coughed up the money to the hospital.

I had Independent Health which I paid for myself when I was gong through chemo.
Every week, I went through what you’re going through. I had to fight for practically every procedure. Try arguing on the phone with a faceless bureaucracy while you feel like shit.

Oh, and by “magically” I mean, “About four weeks after I sent a long certified letter to Aetna documenting every step of what I’d discussed with them over the previous three years and why all of their excuses were bullshit.”

I am highly insured - I just switched to an identical plan offered by my husband’s employer, but with no direct monthly payout from us.

So my number changed, and I handed over my card when I had a physical and told my PCP that it changed.  Madame LoWatt behind the desk dutifully photocopied it and handed it back.

Then they billed it under the old number.  FAIL.

It has taken an absurd number of calls to straighten this out - and this is when the insurer has been very helpful, cooperative, and has called the various labs themselves to straighten it out.  Why?  Two of the hospitals who did the pap smear and the blood work don’t want to rebill the insurer under the correct number - they would rather hassle me, because they know that I can afford it and they don’t want the lower reimbursement payment if they can get away with it.

“Oh, well, you can just pay that now and we will refund you.”

I pointed out my birthdate and compared it to yesterday’s date for them.  Only when I threatened legal action if they tried to go to collections did they bother to finally use the new insurance number and rebill it - even though the insurance company rep had already contacted them to do just that!

Trivial - but still an example of the kind of nuisance harassment that goes on with the healthcare system even when you have really good insurance!

Caren-Sun-blocking Creator of Animorphic Pancakes has the right idea.

The right way to do this is to reduce the number of parties in the conversation to two. If you are in a position to physically go to the hospital, go to the hospital, find whoever’s in charge of billing, and get the insurance company on speakerphone. Otherwise, set up a three-way call and listen in while the two of them argue.

Last time I went to the hospital, it was to an emergency department.  I had gotten stung in the neck, and since I’m allergic to wasps, this was a bit worrying.

They stuck me on a bed, observed me for a bit, shot me with some sort of anti-histamine, sent me home.

Four days later I got a note from the Accident Compensation Commission (paid for by wage and employee levies) saying “Yeah, we paid for it.”

That was it.

Every time some wingnut congressman starts talking about how your medical decisions should be “between you and your doctor, not some bureaucrat

I prefer to record their diatribes and play them back in their faces when they get all misty-eyed about poor widdle feti.

Jesse, I work for one of these massive insurance companies (okay, okay, it’s Medicaid) and I can tell you for a fact that it’s total B.S. that the hospital won’t resubmit the claim. That’s what hospitals do, all day, every day—I can’t tell you how many claims we process every day, but a huge chunk of them are claims that were re-submitted after we denied them. The hospitals’ accountants review the claim, discover that something is wrong—the client is listed as male, but the claim is for a maternity service, for example—and resubmit. It happens all the time.

What’s far more likely is that they passed the filing deadline. In Medicaid, the hospital has 95 days after the last date of service to submit a claim. If that’s the case, then it’s still not your responsibility.

Call the hospital back, and talk to a supervisor. If they balk, ask for the R&S;(that’s Remittance and Status) that prove that your claim was denied. (This may also be known as a Claim Status Inquiry, depending on your state. Or perhaps some other term I don’t know.) If there’s more than one, you want all of them. And you want to know what the Denial Reasons are (not the Denial Reason Code—that won’t mean anything to you.)

Call your insurance company and ask them to verify that the claim was submitted for payment. If the claim was ever submitted, the insurance company has a record somewhere. Doesn’t matter if it was Paid, Denied, Suspended, or We Screwed Up—every claim is recorded once it’s submitted. If they have such a record, ask for a copy. While you’ve got them on the phone, ask if they have a filing deadline, and what it is.

What’s more likely is that the hospital either forgot to submit the claim in time, submitted it with errors that they then refused to correct, or (worst-case scenario) they DID submit it and get paid, but have “lost” the proof of that payment and now expect you to cough it up rather than correct their own accounting system.

Don’t give up.

Don’t brag, Phoenician.

Americans already feel shitty enough about our health care “system”...

Besides, isn’t NZ a CommunoFascist nightmare?...

If you ask me, the hospital is full of shit.  You get a bill several months after the date of service that’s already threatening collections and they won’t resubmit the claim?  I’ll bet the original claim was screwed up by their billing department, the same people telling you they won’t correct their mistake.  In this case, the hospital is the one trying to extort $16k from you.

There is never, ever a valid excuse for a hospital or doctor’s office refusing to resubmit a claim.

Incidentally, when the insurance company finally coughs up the money, it’ll be significantly less than $16,000.  Try $8,000-$13,000.

Sounds like Jesse’s hospital is pulling the same bullshit that the two hospital labs I was dealing with were pulling - only on a much more massive scale, and without friendly customer service!

They don’t want to bill the insurance because they are hoping to get more money out of Jesse.

Oh, and Jesse - is there anything the Dean’s Office at your Law School can do ... give them a friendly call on your behalf or something?

Besides, isn’t NZ a CommunoFascist nightmare?…

Guilty as charged.  We’ve just pulled down the huge bronze statue to Dear Leader Helen and tonight I’m being forced to put on a uniform and goosestep around Parliament grounds as part of a Peter Jackson directed propaganda piece honouring OverLeader Key.  I don’t mind much; it gets me out of the mandatory self-criticism session, where I would be required to explain why I didn’t cheer for the New Socialist All Black team fervently enough.

We’re gonna annex Brisbane on the grounds that those bastard Aussies are oppressing the Kiwi minority by selling Vegemite instead of Marmite in their supermarkets.  Bastards.

I’m a state employee. I already have the dreaded Socialized Medicine.

Guess what? It’s really cheap and good.

Feh. Any trouble you endure over this is your own damn fault. You should know better than to be…

1) Sick and/or in need Emergency Medical Care.

2) Poor and/or a Student.

3) Female and/or Single.

4) Liberal.

5) Living in THE GREATEST GODDAMN COUNTRY ON EARTH… provided, of course, that you’re healthy, wealthy, a good ol’ boy & privileged.

And even then, guys like Dubya are having issues. He needs to make a LOT MORE $3000+ a table dinner speeches to pay for that new mansion of his in Dallas, Texas. And you think YOU have problems!??

Wanna know the kicker?  Both of those faceless overlords were probably told by their supervisor faceless overlords they could never ever call each other and actually fix the problem.  Or at least I was when I worked for Medicare.  When I think about all the ridiculous issues that could’ve been over in a 20 minute conversation, instead of months of hassle, it reminds me what I hate about customer service most.

I love how WA just passed a triple-damages penalty for falsely denying coverage.

I love how WA just passed a triple-damages penalty for falsely denying coverage.

Which I’m guessing will never, or very rarely and only in cases that become really high-profile, be used.

This is what I’ve never understood about privatised healthcare. Isn’t it supposed to be more efficient than the government? Isn’t that the whole point?

My brother and his wife recently moved to the US from Australia (he’s a research scientist and he’s been employed at a university). I was talking to my sister in law the other day and I asked her about healthcare, having heard all your horror stories. She said that she’s been told that my brother’s coverage (which includes her) is one of the better ones but she also told me this tale of absurd bureacratic inefficiency. It took about 3 months for her and my brother to be issued with their membership cards (or whatever you call them) from the insurer. When her card arrived they’d screwed up her name quite badly. Having been told that these little details are quite important she thought she’d better fix it up. So she goes online and registers on the insurer’s website. Turns out registering allows her to do exactly nothing even something relatively straightforward like requesting a name change. She then rings them up. The people in the local office are quite nice but tell her that her request for name change will take about 3 months to go through and then another 3 months for them to issue her with a new card. Why? Because it all has to be done at head office which is on the other side of the country and everything has to be mailed. Because apparently the internet is this new fangled thing which you couldn’t possibly use to facilitate business in any way.

I gotta tell you that if there were those kind of delays in simple administrative processes with the government healthcare agency here there’d be howls of outrage about government inefficiency. Why aren’t there howls of outrage in the US?

As an aside she also tells me that you guys pay everything by cheque (which is weird to us because nobody uses cheques here anymore) and that your internet banking services are very limited compared to Australia. So perhaps some of the dramas described above are compounded by the fact that payment seems to occur in a very manual way. Almost all such transactions in Australia would be carried out via B2B systems facilitated by internet banking. All automatically coded and recorded. Even small businesses here use internet banking for payment (as in I can, via the internet, directly credit an amount into any bank account in Australia).

And remember, Jesse actually has coverage, and the insurance company has acknowledged that he’s covered for this event. He wasn’t a member of a group that contracted with a fraudulent insurance company that just collected premiums and absconded, he didn’t have hidden fine print disallowing claims for abdominal surgery when the moon was waxing gibbous, he doesn’t have an insurance company with a special task force devoted to retroactively canceling policies because of pre-existing conditions like being born with an appendix (really should have thought twice about that when you were in the womb, Jesse).

His story is, relatively speaking, one of the successes of private coverage.

I must admit that I was filled with glee in recent litigation, in which a large insurer was suing my clients (and me) for reimbursement of medical expenses it had allegedly paid twice, that the insurer had lost all record that it had paid anything at all. 

“Why aren’t there howls of outrage in the US? “

Because they have been told that private industry can do it cheaper and more effectively despite all logic to the contrary. They hear horror stories that in countries with goverment medicine people have to wait weeks or hours for an appoinment while not realizing that those countries make a point of recording the waiting times while there is no such recording in the US.

It’s wiilfull ignorance. My mother worked as an RN for decades. She refused to believe that Cuba was just three spots below the US in terms of healthcare efficancy. You have this nonsense fostered in US citizens by their churches, media that the US is the best in all things so they think that well if things are bad and we are supposed to be number 1 the world is a huge absolete shithole.

As a retired federal and postal (not the same thing, but we get the same benefits) employee, I have the coveted FEHB.  Yes, socialized medicine is good, and relatively cheap, and coming to understand that it really must cover dental and vision (what’s your quality of life if you can’t chew and you can’t see?)

But what’s this?  “they tell me that they won’t resubmit the claim, as resubmitted claims are almost always denied”??? 

That’s not what I hear from my doctor.  My husband is a massage therapist, and has simply stopped dealing with insurance because he was so often told “the fact that your client has this coverage doesn’t mean that she is covered.”  I mentioned this to my family practitioner and he said that they get that kind of run-around too.  That’s why there are so few sole practitioners anymore.  They are all in groups or clinics where there is one (or more) employee who does nothing but submit and resubmit claims.  Most of them, he said, are denied the first time around, so they need someone whose entire job is to tweak them a little and resubmit.

Our chiropractor has elected not to bother with that run-around and just to bill what she estimates she’d net anyway, and I’ve heard of a few other medical people who do the same.  If more of them would do this, the insurance companies would lose a lot of the power they have over all of us, doctors and patients alike.

But to be perfectly fair, hospitalization would probably be fairly expensive anyway, because of the advances in medicine that involve large expensive machinery, among other expensive things.

One of my friends from college had an appendectomy a few years ago, and the doctors wouldn’t even operate on her until she emergency applied for Medicaid. My best friend got a letter a couple years ago that basically told her that the government would no longer be paying for the immuno-suppressant drugs that she needs to take for the rest of her life because of the kidney transplant she had 11 years ago. Pro-life indeed, eh?

It’s pretty ridiculous that you have to play phone tag between the hospital and the insurance company. Maybe they should fight it out. They should know each other’s policies. They have to.

” because of the advances in medicine that involve large expensive machinery, among other expensive things.
“

A lot of that is just jacked up costs that aren’t reflected in reality. A lot of it is due to the procurement procedures that dictate where to get the equipment from. Also a lot of the cost is just obscene a respirator unit the tubing is eighty bucks and it’s no different materials or regulations then what goes into an aquarium tubing. Honeslty without the overhead costs that insurance incurs hospitals wouldn’t have that much of a problem getting the equipment they need since they would be slashing costs by half or more.

“They should know each other’s policies. They have to.
“
They don’t care to know that is the problem. It’s often the insurance company that proclaims to be ignorant while the hospitals and doctors at least have an excuse because they deal with dozens of insurance companies and literaly hundreds of health plans.

I had an operation in an Australian hospital whilst I was technically unemployed (although actually just underemployed).  I never saw a bill.  My husband had the same experience.  I’m really not sure that those who are on private health cover would have got better treatment.  Certainly, they could have asked to have their own private room, if they had paid insurance for that.  Apart from that, the medical care was probably equivalent.

I love how WA just passed a triple-damages penalty for falsely denying coverage.

Which I’m guessing will never, or very rarely and only in cases that become really high-profile, be used.

I’m guessing that every politician associated with it is bragging about its teeth to the public and (more accurately) assuring every health care lobbyist, “don’t worry, it’s all gums”.

My suggestion is to get some pro bono help from the law school clinic or from a prof. willing to help. Just the knowledge that you have a lawyer makes the hospital and insurance company take you more seriously. It might also help for them to know that you are a law student in good standing at university X, expected to graduate in year Y. That way the parties would know that you have genuine pro bono help as professional courtesy extended to a future colleague.

All this nonsense that insurance companies run their clients through has its best descriptor in a British Army term: a “sickener”. 

The Army has a number of elite units: Paras, SAS, and so forth.  Many people apply for comparatively few slots.  How to get rid of large numbers of otherwise worthy people?  You run them through degrading, humiliating, messy and oft dangerous procedures, messes and tests that actually test nothing but how much you want to be there: jump in that puddle of shit!  Assemble and disassemble this rifle two hundred times!  Jump naked into that cold lake then stagger out to have your shrunken privates mocked! and so on.  Large numbers of people drop out in disgust and frustration.  Insurance companies do their version of it simply because every genuine claimant who walks away is a pure profit.

There’s a reason why Brad Bird chose an insurance company and insurance executive for those compelling scenes in The Incredibles.

There’s a reason why Brad Bird chose an insurance company and insurance executive for those compelling scenes in The Incredibles.

Something conservatives choose to ignore (or at least ignore the ramifications of) when lauding its Randian narrative.

Yeah, it sucks paying for insurance and having a capitalist medical system.  But trust me, it sucks even more when friends of yours die needlessly because my Canadian socialized system makes them wait six months to see and oncologist, and then another six months after that to get an MRI, etc.  Imagine your entire state on the worst HMO possible, with said worst HMO having an absolute monopoly, and you have an idea what the Canadian health care system is like. 

My friend got a knee injury when she was mugged.  She waited for an MRI for TWO FUCKING YEARS before her knee got better and she gave up her spot on the waiting list. 

But don’t take my word for it:
“Newfoundland and Labrador’s largest health authority failed hundreds of breast cancer patients with shoddy laboratory work and “practically non-existent” quality controls, a hard-hitting judicial inquiry has found.
Cameron heard evidence over a seven-month period on how almost 400 breast cancer patients received the wrong test results. A year ago, the government disclosed that 108 of those patients had died, although it will never be known if different treatments could have extended or saved any lives.”

But hey, the health care those women received was “free”.

Oh I’d agree that they ignored it.

I’m just not sure that The Incredibles fits into a Randian model; permitting everybody to have a chance at their potential isn’t necessarily a libertarian notion: it’s arguable that artificial constraints on people’s lives and their ability to achieve are matters equally loathsome to liberals and progressives.  It’s just that progressives want no restrictions on the wealthy and established and tons of restrictions on everybody else.  Randians choose to ignore that any attempt to achieve their dream world of no restrictions on anybody means that the already-strong will prey on the weak and ensure that they never get a chance. The fact that the Supers accept that a government has a right to make laws applicable to them (even though they think the law is grossly wrong) is a distinctly un-Randian notion. 

/Threadjack.

We went through something similar with my partner’s back surgery.  Her insurance company paid some of the bill, but we were hit with a bill for almost $30K in expenses that insurance didn’t cover.  My partner wrote to the hospital and insisted on an itemized bill for the expenses.  Just that request resulted in a lower bill.  She then researched some of the expenses on the bill.  She discovered, for example, that her $60 pair of “slipper socks” could be purchased online (identical colour, same manufacturer) for $2.50 from a medical supply store.  She took a few examples of over-charges and wrote back to the hospital, asking for an explanation.  Again, her bill was lowered, and we ultimately ended up with a bill of about $9K.  The hospital happily accepted a payment of $100 per month, in lieu of not getting any payment at all, and it’s since been paid off.  The hospital billing department actually suggested a payment of $20/month, so it seems they’d be thrilled to speak to anyone with a genuine interest in giving them any amount of money.

Long story short, insist on an itemized bill, and don’t hesitate to argue about the stuff you find on it.  The hospital shouldn’t send you to collections (I don’t think they legally can), if you’re still arguing the validity of charges.  If you think you want to try to pay the bill, suggest an amount you think you can pay (say, $6500), and then tell them you can afford only $25/month because you’re a student.  If your bill goes to collections the hospital probably gets 10% of what you owe, and maybe even less.  I’m sure they’d love to help you with a payment plan if you’ll pay them more than a collection company will.

Man, I’m so sick of people taking the worst examples of the Canadian system and saying “that’s the system”.

Wanna play anecdote?  I kept getting persistent headaches and inability to focus and concentrate.  I was able to have a full brain scan done within a few weeks here in Southwestern Ontario even though I don’t have a family doctor.  But my excellent example isn’t conclusive proof of the perfection of the system any more than the two-year gap for your friend is proof of its complete failure is because neither of our anecdotes equal evidence.

The position isn’t that the Canadian system is perfect.  It’s that it’s infinitely better than the American system for almost everything.  The Newfoundland cancer scandal is horrific and many tragedies.  But bear in mind that those women died because (a) the system screwed up and (b) the government in question is moving heaven and earth to find out how and (c) it’s being well-covered in the news even in other parts of Canada.  In the American system, (a) insurance companies let people sicken and die on purpose because that’s more profitable, (b) their insurance-lobbyist-bought governments have moved heaven and earth to ensure that the public doesn’t get anything better and (c) the mainstream American media devotes almost no energy to these matters or to macroanalysis of the problem.

I’m a health care provider in private practice.  It was about a year before I figured out how to submit a claim to Blue Cross without it getting denied for no apparent reason.  The system is not at all designed to be user friendly—quite the contrary.  It’s as if they deliberately put obstacles in the way of getting reimbursed (all right, they do deliberately up obstacles).  It’s a racket—a license to steal.  Until we make enough of a stink they will go on and on stealing.

Fuck ‘em; it’s time for a single payer system.

“Newfoundland and Labrador’s largest health authority failed hundreds of breast cancer patients with shoddy laboratory work and “practically non-existent” quality controls, a hard-hitting judicial inquiry has found.
Cameron heard evidence over a seven-month period on how almost 400 breast cancer patients received the wrong test results. A year ago, the government disclosed that 108 of those patients had died, although it will never be known if different treatments could have extended or saved any lives.”

Umm…this has fuck-all to do with how the services got paid for; it’s a problem with the provider, not the payer.  But thanks for playing.

There’s a family that’s in the best business here in my area.  There’s a GP, a general surgeon, a gynecologist, and a lawyer that specializes in insurance and personal injury.  They all share the same building and some of the same office staff.  They’re all siblings.  It’s a fucking brilliant business model.

But trust me, it sucks even more when friends of yours die needlessly because my Canadian socialized system makes them wait six months to see and oncologist, and then another six months after that to get an MRI, etc.

yes, much better that your friends and family die needlessly because they can’t even get on the list because they don’t have enough money. that’s much better.

I wish there was a word that explains the contempt I hold for you.

In case anyone is wondering, if you’re uninsured and are severely dehydrated from a stomach bug, it costs about three thousand dollars for a poke in the arm and one bag of salt water.  Bargain!

“But trust me, it sucks even more when friends of yours die needlessly because my Canadian socialized system makes them wait six months to see and oncologist, and then another six months after that to get an MRI, etc.  Imagine your entire state on the worst HMO possible, with said worst HMO having an absolute monopoly, and you have an idea what the Canadian health care system is like. 

My friend got a knee injury when she was mugged.  She waited for an MRI for TWO FUCKING YEARS before her knee got better and she gave up her spot on the waiting list.
“

People who oppose socalized medicine bring out just a handfull of examples each year of people who had to wait six months or a year in those countries to see a doctor when there are tens of thousands of people each year in the US who die because they cannot afford to see the doctor or afford the treatment. Then there are thousands of people who die each year in the US who are on insurance who get denied the treatments claiming they are unproven even these treatments have been done for decades and don’t cost that much. Then you also have the people on insurance who number in the thousands who take six months to a year to finally get it approved for them to have a test done their doctor recommeneded.

Funny how these supposed inefficant socalized medicine disasters that cost lives wind up costing just a few hundred million dollars to run each year and just a handfull of deaths as opposed to the several trillion dollar insurance disaster that costs tens of thousands of lives each year and often charges people their lifes savings.

Auguste: Something conservatives choose to ignore (or at least ignore the ramifications of) when lauding its Randian narrative.

I suspect in a proper Randian narrative, the only fault with the scene was the hero helping the claimants.

I am JUST sitting down to write a threatening appeal letter to an insurance company.

In October, my very young, very healthy soon-to-be ex-mother-in-law had an aneurysm burst.  She’s been in various hospitals ever since.  Her brain surgeries were very successful, but they’ve had trouble regulating her intracranial pressure.  The closer they get that to correct, the more cognizant she is.  The various care facilities have been fabulous.  The “management” company hired by the insurance company to “coordinate” (turn down) care, however, has been a nightmare.  They don’t know what they’re doing.  They have only the vaguest idea of state or federal law, either in terms of us managing her care or the administrative and privacy options.  They ordered us to do a number of things at the beginning, but when (in trying to comply) we received technical questions from our elder care lawyer, they wouldn’t talk to me to sort it out, because I’m a lawyer too, and they had a “policy” not to ever talk to lawyers.  (I’m an antitrust lawyer.  I wouldn’t know what to do about a guardianship on a bet).  The woman in charge of our case was a vindictive, nasty person who threatened to deny coverage every time my FIL questioned her.  Their latest denial of coverage listed the incorrect diagnosis (which also means that, according to their form, a “specialist” physician in the WRONG DISCIPLINE reviewed her file), and stated she doesn’t meet the clinical standards for continued care.  They don’t talk to us about coverage and care options, and for the longest time the insurance company was dictating care options to the hospitals.  They almost moved her out of state without notifying us, and then wanted to move her to Traverse City, thinking that wouldn’t be so far. When we started working with the caregivers ourselves and making our own arrangements (in network and covered, but our choices), she cut us off and denied care entirely, telling us to put her in a non-skilled custodial nursing home.

I’m spending close to twenty hours a week JUST on this stuff, so that my ex and his FIL can spend their time working with MIL cognitively to try to help her with the therapy and get her back.  Thank GOD I have the resources and the flexibility in my job to do that.  Otherwise?  They clearly just expected the FIL to roll over and not fight.  It’s ridiculous.

Hospital: I will not resubmit the bill.
Me: I guess I won’t resubmit myself into your hospital.  Deal?
Hospital: That’s not funny.
Me: Then don’t be stupid.  Resubmit the bill.
Hospital: (sheepishly) Okay.

Insurance: We won’t pay this.
Me: Why not?
Insurance: The paperwork is wrong.
Me: Then why not ignore it?
Insurance: That’s not funny.
Me: Stop being stupid.  Is it covered or not?
Insurance: (sheepishly) Most likely.

Saving thousands of dollars isn’t easy work, but it can be done.  Keep at them.

Yup. Your system is insane. I thank my lucky stars that when I had to spend four days in hospital, it didn’t happen when I lived in the US, but here in Britain where the only financial transaction I was aware of was spending £1.45 on chocolate and sudoku puzzles at the hospital newsagent.

(Potentially useful info for Brits: anyone can ask for the “ethnic meals” and they’re far better than the standard hospital food. Most urban hospitals offer Indian and Afro-Caribbean options.)

Also, collections isn’t a scary thing.  You get annoying phone calls, you ignore them.  You get calls saying they’ll get your money, but give them nothing.  Those people work on commission, are liars, and will screw you if given 1% of a chance.  Do not deal with them, they are crooks.  What I’d do right now is start to send the hospital money.  Write a check for $10 today, send in another one next month.  Then the hospital has to send you some notice that you are too far behind, but you are protected from the worst if you are paying something.  Don’t send in more than the copay, assuming there is one.

Collection agencies should never be given any information about you.  If you do decide to give them anything, do it with money orders, as you do not want to give them any access to your account.  None.  Zero.  Zilch.  Nada.  They are working on commission, assume you are stupid, and might take more than you approve.  I’m sure there are hardworking, honest people in that business, but I didn’t have the pleasure of their company before I said “Fuck you all” and declared bankruptcy.  Also, if all goes wrong, that’s not such a scary option either.

Because they have been told that private industry can do it cheaper and more effectively despite all logic to the contrary. They hear horror stories that in countries with goverment medicine people have to wait weeks or hours for an appoinment while not realizing that those countries make a point of recording the waiting times while there is no such recording in the US.

When angrymob had his appendicitis, he went to a free clinic and was told “we’re pretty sure you have appendicitis. We’ll call ahead to the hospital, go there now, you can probably have this treated medically but we can’t take care of it here.” So they went directly to the hospital and ended up waiting in the waiting room for EIGHT HOURS during which time the appendix ruptured and he started to go into peritonitis. It went from treated with antibiotics turned into his mother being asked to fill out organ donation cards and whether or not they wanted to revive him. He ended up being an inpatient for over a week, during which time they couldn’t even sew him up because they had to let him drain.

If someone ever tells me we can’t have single-payer system because the wait times will be too long, I’m going to fucking punch them in the neck.

“I’m a state employee. I already have the dreaded Socialized Medicine.”

So do those congress creatures who inveigh against said dreaded system and who won’t allow any but the most gradual steps toward universal coverage in this country and so does the president who we don’t know would even go there if he could. Nothing about the changes they’ve talked about sound like they’d solve Jesse’s problem or any of the problems other people brought up.

You’ll notice that the largest group of people in America with socialized medicine are active duty soldiers.  Until the Bushies and wwIraq they were treated well compared to the rest of the country.  I note also that the organization with the most pervasive and socialized medicine hasn’t become a cesspit of raving communists, so any notion that the rest of the country is going to go bolshie if they don’t die in the gutter is rather amusing.

I’d be most amused at watching the congresscritters try and take that care away from the services. 
“Wow!  You have this brilliant idea for privatizing my healthcare.  I have something cool, too!  It’s this tank, see.  Let me show you how it works .....”

Not as whimsical as it sounds.  Don’t forget that one of the things that destroyed the Roman Republic was the Senate and upper classes stealing everything that wasn’t nailed down, to point that they felt confident enough to steal the land that was going to soldiers, too.  Very bad move.

“Don’t forget that one of the things that destroyed the Roman Republic “

Are we forgetting Christanity becoming involved? Seems the real downfall occured when that Religion became involved and twisted the Roman ideals and morality.

Funny how these supposed inefficant socalized medicine disasters that cost lives wind up costing just a few hundred million dollars to run each year and just a handfull of deaths as opposed to the several trillion dollar insurance disaster that costs tens of thousands of lives each year and often charges people their lifes savings.

Not to mention that it is always exactly the same story with different waiting periods grafted in depending on the credulity and shockability of the audience.

The plural of a SINGLE anecdote is not data either!

What we need are market-based solutions relying on the power of choice and informed consumers. Jesse should be free to choose among a handful of gigantic corporate insurance providers by analyzing decades of research on reimbursement rates, conducting customer satisfaction polls, and going to medical school to learn enough about medicine to anticipate his future medical needs, then purchasing the best product. Everything works better when the consumer’s power of choice is protected.

I’m really sorry for your ordeal.

I wish there was a word that explains the contempt I hold for you.

Karpad, be nice.  He can’t help it if he’s a Newfie.

However, just because the Newfies messed things up for their OWN province because they combine the worst elements of New England and Quebec systematic administrative incompetence in a very isolated and rural province doesn’t mean that my nieces and SIL2B in rural Alberta don’t receive a top notch care system.  Not perfect, but vastly superior to the US - and also willing to clean up after their Newfies, too.

Are we forgetting Christanity becoming involved?

No, you are forgetting that The Roman Republic came before the Roman Empire - from around 500bce to 25ce or so.

Christianity hit a couple of centuries later and collapsed the Empire.  It had nothing to do with the collapse of the Republic.

Incidentally, when the insurance company finally coughs up the money, it’ll be significantly less than $16,000.  Try $8,000-$13,000.

This is a big part of the the problem.  I’ve seen plenty of my own statements where the insurance company offers about half the price, and the doctor, hospital, or lab just accepts it.  If an uninsured person just said, “Hey, why don’t I pay you half of what I owe and we’ll call it even?”, the doctor or hospital would never accept it.  In your case, $8,000 would still be too much, but for things that cost a few hundred dollars, it would make a big difference to many uninsured people.

“It had nothing to do with the collapse of the Republic.”

...that would be the responsibility of our friend Octavian, rival of Marc Antony, adopted son of Julius Caesar, better known as the First Emperor of Rome, Caesar Augustus...

This is a big part of the the problem.  I’ve seen plenty of my own statements where the insurance company offers about half the price, and the doctor, hospital, or lab just accepts it.  If an uninsured person just said, “Hey, why don’t I pay you half of what I owe and we’ll call it even?”, the doctor or hospital would never accept it.

That’s because the insurer has preexisting agreements on payments with these organizations.  The cost for the uninsured person is more than the cost to the hospital.

Which is probably why I had my little problem and now Jesse has his big problem - they would rather get the profitable fee from the patient when they think they can get it, because it is a lot more than the agreement with the insurance company will net.  If they can pretend that it was rejected and repeatedly fail to resubmit under the appropriate circumstances, they will do it.

The whole system is both insane and corrupt, through and through. But hey, it’s The Best Health Care System In The World!™

Are there attorneys that offer any sort of pre-emptive medical billing services? So for example, I accidentally swallow the jagged metal Krusty-O in my cereal and have to go in for an appendectomy, and I call my lawyer and say “hey, Mike, I need to have my appendix out. Can you send someone over to sign documents?”

The hospital and insurance company then has to send forms to Mike. Mike then calls them up and does Scary Lawyer Thing to contest any messed-up wording, or sends a secretary or paralegal over to me to make sure that I sign any documents. I’m still legally responsible for paying, obviously, but the lawyer acts as a sort of Billing Agent, and if the insurance company comes back with “well gosh we’re not going to cover” then Mike can go into Scary Lawyer Mode and say “we filed this paperwork on 1/2/09 and received confirmation of its processing on 1/5/09, according to subsection 5 of paragraph 8 of State Law Blingadingdong your company is required to give notice within 48 hours of filing if there is to be a contest to the bill…” etc, etc. Because really, once the lawyers are involved, most hospitals and insurance companies and collections agencies lose their fangs right quick.

I’m just thinking that if I had to pay $500/$1000 in lawyer’s fees for him to just keep his eye on this stuff ahead of time and go into Scary Lawyer Mode once or twice, it sure beats getting a $16,000 bill because the insurance company or hospital decided to play these shenanigans on me. Because this happens an awful lot.

Good advice, Not a Morning Person. Also since I have worked in a doctor’s office doing NOTHING BUT resubmitting denied claims from Medicaid, Medicare and private insurance companies (oh the stories I could tell..but won’t) I can add one more bit of advice. When you call the claim submission department at the hospital ask them to look on the back of the HIPAA form or in the Medicaid coding book where it will tell them that BY LAW they have to submit a denied claim 2 more times for a total of 3 times before stopping the process. Tell them they also have only 180 days to submit those claims. So if they failed to do so in a timely manner they have to take the financial loss.
You might want to tell your insurance company that you are going to be interviewed by Michael Moore in a few days. That might scare them a little…it’s worked for people before. Seriously. It has.

Having lived under and experienced both a universal healthcare scheme and the American system, there’s no doubt which one I’d choose. And that’s as a patient, as an independent businessman and as a citizen. I’m sorry that you have to deal with this BS, Jesse.

Don’t forget that one of the things that destroyed the Roman Republic was the Senate and upper classes stealing everything that wasn’t nailed down, to point that they felt confident enough to steal the land that was going to soldiers, too.

Don’t get me started!

Newfoundland and Labrador’s largest health authority failed

That is a rather impoverished province, and Canadam unfortunately, gives too much autonomy to individual provinces rather than allowing individuals to benefit from the overall wealth of the entire nation. As others have pointed out, Ontario gets better results, in part because it’s richer.

We are either the richest country in the world, or we’re not. If we’re not… if we’re an impoverished, 2nd-world country, then fine, we can expect second-world results…. but then you have to shut up about how America is such a great country and instead accept its mediocrity.

Because they have been told that private industry can do it cheaper and more effectively despite all logic to the contrary.

Well, perhaps private industry could do it cheaper and more effectively, if the goal were to do it more effectively and cheaper. 

Unfortunately, the goal of private industry in our capitalist system is to increase profits.  The best way to increase profits in the insurance game is to take premiums and never pay claims.  Insurance agencies are extremely effective at making patients’ lives a living hell by denying claims.  It increases their profits.

—————-

Just for the record, YOU ASSHOLES WHO WHINE ABOUT SOCIALIZED MEDICINE, none of your horror stories are worse than what Americans already deal with.  Your anecdotes are similar to McCain whining about not wanting bureaucrats to come between him and his doctor, when the rest of us, without his government run socialized care already have bureaucrats between us and our doctors.

Our situation is a nightmare.  We have waiting periods already that allow diseases to kill us.  We already have people who cannot see any doctor b/c they don’t have coverage.  We already have people with coverage who are being destroyed financially.

The rich survive in any system.  We need a system that will care for all of us.

—————-

I think they should be sued for practicing medicine without a license, b/c that’s what they do.  It’s what they’re doing to the poor ex-MIL above—they are denying care her in-network doctors prescribe.

Do people here honestly not think that single payer systems do not systematically deny care, as well?

The costs of these systems have to be controlled somehow. That usually boils down to limiting the amount of care that gets disbursed, in some way, shape or form. It doesn’t typically result in a big “CLAIM DENIED: DIAF” stamped on something. Sometimes it means that a new piece of expensive equipment doesn’t get purchased, because its operational costs per patient are very high. Or that a new “exotic” therapy doesn’t get approved, because lots of patients availing themselves of it would cost the system too much.

The practical result is the same: denial of care. It’s just that in the latter, it’s not available at any price.

Gah, double negative acknowledged, before the grammar police show up.

Once again it is proven that Kafka was a realist writer after all. Of course he worked in insurance…

Besides, isn’t NZ a CommunoFascist nightmare?…

Guilty as charged.  We’ve just pulled down the huge bronze statue to Dear Leader Helen and tonight I’m being forced to put on a uniform and goosestep around Parliament grounds as part of a Peter Jackson directed propaganda piece honouring OverLeader Key.  I don’t mind much; it gets me out of the mandatory self-criticism session, where I would be required to explain why I didn’t cheer for the New Socialist All Black team fervently enough.

Isn’t Fred Dagg the replacement statue? Towering over Wellington… terrifying the sheep.

It’s just that in the latter, it’s not available at any price.

Not true at all. Canada and the UK, among other countries, have a thriving private payment system, if you REALLY want a treatment without waiting for it or insist on a treatment that doesn’t have a lot of benefits.

However, CTD, in the event that a treatment is approved (such as in the case of appendicitis), unlike in the USA, the bills actually get paid.

Do people here honestly not think that single payer systems do not systematically deny care, as well?

It’s generally a delay of care rather than denial. Which is sometimes the same thing. In either case, the delay/denial is based on a mission of serving the health of all potential recipients of the service, rather than serving a group of shareholders who are interested in personal financial profit.

Either way, efficiencies have to be found, and either way you’re dealing with a big ugly bureaucracy. The difference is, one bureaucracy is ultimately accountable only to a small group of shareholders who may or may not use it, and one is ultimately accountable to a large group of stakeholders who will use it.

But trust me, it sucks even more when friends of yours die needlessly because my Canadian socialized system makes them wait six months to see and oncologist, and then another six months after that to get an MRI, etc.

We have an even better system here in the US—we cancel your insurance in the middle of chemotherapy and tell you that you’re going to have to pay out of pocket if you want to continue treatment.  Oh, and you’ll never be able to get insured again once you have cancer, so you’ll be paying out of pocket for all of your health care for the rest of your life.

That’s assuming that the lab doesn’t deliberately misread your test so you don’t get treated until it’s too late.  Or that emergency room personnel don’t leave you laying in a pool of your own blood so you can die on the floor without ever seeing a doctor. 

You’re right, that’s a much better system than making people wait for health care.

Do people here honestly not think that single payer systems do not systematically deny care, as well?

Of course they deny care ... just not in ways that usually kill you.

Care is denied according to BEST PRACTICES, sure.  You don’t get aromatherapy on the national dime, unless it has been shown to work.

In other words, you still have an extremely good chance of getting care that you NEED and that will likely WORK and help doctors make a diagnosis, while not paying for care that does NOT work and is NOT needed and will NOT assist in a diagnosis - like an entitlement MRI for every little boo boo that will be better on its own.

Unlike the US system, which is a total feast-or-famine crapshoot that kills people daily with denial of care based on wallet thickness rather than efficacy and diagnostic specificity given symptoms.

No system is perfect.  To me, it’s a choice between selecting a system whose mission it is to actually provide the best possible health care to the greatest number of people (albeit imperfectly) and a system designed to benefit and support private health insurance companies. 

It’s kind of a no brainer to me, but your mileage may vary….

Oh, and CTD, nice repetitive talking points based on oft-whined but never published anecdotes.  The Newfie situation was a crime, sure, but that was stupidity and not because the concept is bad. 

Try comparing Newfoundland’s situation to equivalent impoverished and rural places in Maine, as a control, and you will see people who are found dead of cancer having never seen a doctor because there are none to be seen.  Only the problem with Newfoundland’s incompetence is being addressed while the problems in Maine are not even news.

Try some actual statistics next time.

I can guarantee you one thing:  if we do get a single-payer system, some people will bitch and moan about it.  That’s because—surprise!—a single-payer system is not perfect and will not cause unicorns to come to your door to convey you to the doctor’s office.  Some of the problems that exist with our current system (like rationing and wait times) will not be magically solved by a single-payer system.

However, under a single-payer system, those people will at least still have a roof over their heads instead of having to sell their house and go into bankruptcy to pay their medical bills.  They won’t have to go through years or decades of lawsuits to try and get treatment if they were injured by malpractice and now can’t get health insurance at any price.  They won’t have to spend an hour on the phone with their insurance company while they’re laying on a gurney in the emergency room trying to get permission to be treated.

Telling people that there are problems with single-payer systems so they should stick with the shitty system we have now is like telling a starving person that they can’t have a hamburger because it’s not quite nutritious enough, so they’ll just have to wait for the free market to produce a perfectly nutritious meal.

“Umm…this has fuck-all to do with how the services got paid for; it’s a problem with the provider, not the payer.  But thanks for playing. “

Respectfully, I disagree.  When you have a single-payer socialized medical system, there only IS one provider, usually government owned.  When that one provider screws up, people die. 

“Not true at all. Canada and the UK, among other countries, have a thriving private payment system, if you REALLY want a treatment without waiting for it or insist on a treatment that doesn’t have a lot of benefits. “

Not true for Canada.  By Canadian law, private, for-profit health care is illegal.  Private health care corporations are allowed to exist only to serve the Canadian public system.

” Or that a new “exotic” therapy doesn’t get approved, because lots of patients availing themselves of it would cost the system too much. “

Yep.  Another breast cancer example (they’re the most talked about in Canada) is a drug that’s taken post-chemo, it helps reduce the chance of breast cancer recurrence by up to 50%.  The public health care system doesn’t want to pay for it, because it’s too expensive.  So noone can get it, even if they want to scrape together some money and pay.  Yeah, it’s more fair, but people still die.

As for someone saying that it’s a “handful of examples” that lead to a bad reputation of socialized health care, it’s not.  Every person in Canada has a handful of personal stories.  That works out to tens of millions of bad health care stories.

As for people not getting the treatment they need, well, prescription drug costs, which are one of the biggest burdens in health care, are not covered under Canadian medical care.  So even in Canada, you’re SOL if you need an prescription medicine and you don’t have a job.

The Roman Republic was never any damn good—it was a polity run by and for the patrician elites; and social customs ran on the model of client-patron relations (that is, where it counted, they were crushingly, oppressively patriarchal). Sure, the plebeians got an assembly and tribunes by the 3rd c. BCE. But after the Punic Wars it was a sorry story of the rich getting richer (off of cheap, plentiful slave labor from abroad) and the poor losing their farms and joining the underemployed mob in the capital. By the end of the 2nd c. BCE you’ve got CLIENT ARMIES (the poor and desperate pledging allegiance to whatever general who offers them the best spoils to become his private political force) and civil wars and dictatorships well before Octavian. His civil war with Pompey was just the final kick of already very stiff corpse.

Please, the Romans are no sane person’s idea of a model society at any point in their history.

And the role of Christianity runs counter to the imaginings of Pandagon’s more rigidly ideological atheists.

To its credit, Christianity did at least put an end to infant exposure (and the consequent “harvesting” of abandoned girl infants for eventual sale as sex slaves) and promote the manumission of slaves. And no one on this feminist blog seems to understand the importance of women in the early Church. Part of the appeal of the Church (pre-Constantine, pre-Nicea) was the possibilities for active participation and even leadership in religion; leadership and participation that other mystery religions (like Mithraism, which was for men only, or Sol Invictus, which was a soldiers’ cult) denied them.

History will always frustrate the ideologue.

When you have a single-payer socialized medical system, there only IS one provider, usually government owned.

Uh,  no.  That would be single-provider health care.  Single payer means that you have multiple providers, all of whom submit their bills to a single payer, ie the government.  Doctors in France are not government employees.  Neither are doctors in Germany.  Both of those countries would be a better model for the US since our population is so large—a single-provider system like they have in England would not work for our large and diverse population.

Not true for Canada.  By Canadian law, private, for-profit health care is illegal.  Private health care corporations are allowed to exist only to serve the Canadian public system.

I think you’re confusing “for profit” and “private.”  They are not the same thing.  Kaiser Permanente is a private health care provider here in the US, but they are non-profit.  Many of our hospitals are private but non-profit.  “Private” and “for profit” are not synonyms.

Every person in Canada has a handful of personal stories.  That works out to tens of millions of bad health care stories.

Did you miss the part in this thread where everyone has a horror story about dealing with the health care system here in the US?  If that’s your metric, then clearly our health system is completely broken and needs a major overhaul.

Wapsie, what does the Roman Empire have to do with socialized health care?

Send them $10 dollars and inform them that you will continue to pay $10 a month until you have more that you can afford to pay. You might also want to talk to a social worker either at the hospital or your local department of social services to see if you would qualify for short term Medicaid with a “spend down” since your income is as low as it is.  It might be a pain in the butt but it may just word out. My blog has some financial resources but they are mostly cancer related. Feel free to take a peek though and see if there’s one I’m not thinking of. Kate @ http://aftercancernowwhat.blogspot.com

When you have a single-payer socialized medical system, there only IS one provider, usually government owned.  When that one provider screws up, people die.

I heard about a lot fewer screw-ups of that nature under single-payer insurance than I did under the U.S. system. It’s one of the side benefits of having standardised systems and S.O.P.s from the start.

Of course, when the standardised system is severely flawed, as in the Newfoundland case, the screw-up is major. But that’s the benefit of administering benefits on a state-by-state level: it balances things out. And goodness knows there are many existing and long-running examples of best practises around the world, as well as lessons to be learned from flawed system.

So even in Canada, you’re SOL if you need an prescription medicine and you don’t have a job.

Not as SOL in the U.S., where the identical scrip is far more expensive, and where you can’t afford a physician to tell you that you need the med in the first place.

Please, the Romans are no sane person’s idea of a model society at any point in their history.

Really, Waspie, no-one (even I, Timmy Gracchus) is arguing that. You’re correct about the appeal and effects and appeal of the mystery religions (which borrowed from each-other liberally), but let’s not derail too much here. The original (and more relevant) point was about how rampant and short-sighted greed helped change a republic to a more authoritarian empire.

“Wapsie, what does the Roman Empire have to do with socialized health care?”

...there was a reference higher up something about the fall of the Roman Republic…that somehow connected to the topic…

When you have a single-payer socialized medical system, there only IS one provider, usually government owned.

That is not true, and not the way that Canada works or how most any other national health care system works, outside of the UK.

By Canadian law, private, for-profit health care is illegal.

You really don’t know what you’re talking about.

“Every person in Canada has a handful of personal stories.  That works out to tens of millions of bad health care stories.”

Gee, the 30 something million of us really appreciate your effort, but, hey, we can actually speak for ourselves, ok?

This Canadian’s personal story involves cancer treatment in both the US and Canada, and I’ll tell you, it was my Canadian care that allowed me to survive my US care.

“As for people not getting the treatment they need, well, prescription drug costs, which are one of the biggest burdens in health care, are not covered under Canadian medical care.  So even in Canada, you’re SOL if you need an prescription medicine and you don’t have a job.”

Are you insane? Or just completely unaware of the vast difference in cost between drugs in Canada and the US, entirely due to the Canadian government’s a) buying in bulk and b) placing price controls on prescription drug. Again, anecdotal but… when I was out of work and being treated for a thyroid condition related to my cancer, I had no problems paying the $3 a month cost of the drug.

Again, anecdotal but… when I was out of work and being treated for a thyroid condition related to my cancer, I had no problems paying the $3 a month cost of the drug.

My boss here at work had one of her medications switched to the generic by the insurance company, and it turns out the generic makes her sick.  She spent 45 minutes on the phone with them yesterday, only to be told that if she wants the name-brand drug (as in, the one that doesn’t make her vomit every 2 hours), she’ll have to pay for it herself at $95 a month.

Did I mention that she is insured and will still have to pay full price out of pocket for the drug that doesn’t make her sick?  And we have pretty darn good insurance at our company, much better than most places.

” the generic by the insurance company, and it turns out the generic makes her sick”

Weird a generic drug is the same as the prescription drug in chemical composition and often uses the same exact production methods. It’s the same exact drug just with the chemical name rather then the brand name on it.

Usually if you get sick to the generic you will also get sick to the brand name version. They have to put you on another drug.

Weird a generic drug is the same as the prescription drug in chemical composition and often uses the same exact production methods.

Sometimes the production methods are different. Sometimes while the “active ingredients” are the same, the generic version is made differently which causes it to dissolve and get absorbed by the body in a different way at a different rate. Sounds strange, I know, but the body is a complicated thing, and subtle differences in drug delivery affect people in different ways.

Just ask any woman about her experience with different brands of birth control pills that supposedly have the same formula.

Weird a generic drug is the same as the prescription drug in chemical composition and often uses the same exact production methods. It’s the same exact drug just with the chemical name rather then the brand name on it.

It’s supposed to be, but I’ve also had the experience that I will get sick from the generic but have no problem with the name brand.  In those cases, it’s usually not the active ingredient that gets you—it’s the inactive ingredients like the stuff they use for the base, the coating, etc. that you turn out to be sensitive to.

I’ve gotten the same generic drug made by different manufacturers and it looks pretty different (like, one will be purple and the size of an Advil and the other will be white and the size of a children’s aspirin) so I don’t think it’s true that they always manufacture it the same way that the name brand is manufactured.

Just ask any woman about her experience with different brands of birth control pills that supposedly have the same formula.

Ha!  That’s exactly what I was referencing above.  I had no problems with the name brand version of Alesse but I had extra side effects with the generic.  Now I’m on generic Mircette with no problems.

CTD: Do people here honestly not think that single payer systems do not systematically deny care, as well?

Well, if I don’t get a SciFi laser device to operate on my appendix without a single cut and without the surgeon even needing to don gloves, I can still get my appendix taken out before it bursts with 20yo methods, and get it for free. Which beats both a burst appendix and paying 16K dollar for a routine surgery.

Unless you are in the business of selling SciFi-y medical devices, of course.

Binding agents are another area where generics and name brands can differ. Generics are required to be “bioequivalent”, not identical in every formulation/ingredient.

Every person in Canada has a handful of personal stories.  That works out to tens of millions of bad health care stories.

Not every one of the people I know who live in Canada.  The remainder of the stories go something like this: I didn’t get what I wanted because it cost a lot and there was no evidence that it was any better than what I was offered ... wahhhh.  Or “I had to wait a whole month to ...” get a treatment that would take at least that long to get in the US, if it was even covered and could be approved for payment that fast.

Thanks for playing ... “wahhh, I didn’t get the newest purple pills” is not the same as “” because the person who might whine died and is now silent because they couldn’t get treatment.

So even in Canada, you’re SOL if you need an prescription medicine and you don’t have a job.

That must be why hoards of unemployed, retired, and disabled Canadians are flooding across the border by the busload, searching for bargain-priced refills.

Oh, sorry, wrong direction.

Ms Kate,

Care is denied according to BEST PRACTICES, sure.  You don’t get aromatherapy on the national dime, unless it has been shown to work.

In other words, you still have an extremely good chance of getting care that you NEED and that will likely WORK and help doctors make a diagnosis, while not paying for care that does NOT work and is NOT needed and will NOT assist in a diagnosis

That’s begging the question.

Implicit in this argument is that the level of care “needed” under “best practices” is exactly the same as the level that will (and can) be disbursed. Why make that assumption? Why take it as a given that the level of resources available will, out of pure coincidence, meet at some equilibrium point with quantity demanded (even when demand has been “optimized” by being restricted to “best practices”) ?

The only way that makes sense is if the people providing the resource are the same people who are determining the quantity demanded (i.e. determining what care is really “needed”). In this case, the two will always meet, because the actor controlling both supply and demand can simply define down “needed care” to the level of what it can realistically provide. And huzzah!  All “needs” for care that “works” have been fulfilled.

Again, begging the question.

I ask once more how you expect to control costs for such a system without routine denial of care (Yes, real medical care, not hoodoo like aromatherapy and chiropractic).

Also since I have worked in a doctor’s office doing NOTHING BUT resubmitting denied claims from Medicaid, Medicare and private insurance companies

“When you spend your day fighting alligators, it’s important to remember that you originally came to drain the swamp…”

Do people here honestly not think that single payer systems do not systematically deny care, as well?</i.

<i>The practical result is the same: denial of care. It’s just that in the latter, it’s not available at any price.

This is false.

A while back, I had ingrown toenails (two of em!) requiring surgery.  When I finally got a specialist’s appt at the local hospital, he wrote me a presription for some antibiotics and said “the first time I can fit you in is six months from now, because you’re low priority.  And if that happens, it’s likely that you’ll be infected again and I won’t be able to operate anyway.”

So I opted to pay $600 out of my own pocket, and got the surgery from that same specialist within a week., privately.

And, of course, I can also buy private insurance as well.  My grandmother got her hip replacement on private.

You are speaking crap, and I am telling you that as someone who lives under those systems.

I ask once more how you expect to control costs for such a system without routine denial of care (Yes, real medical care, not hoodoo like aromatherapy and chiropractic).

Define “routine denial of care.”  Are you arguing that X number of cancer patients will be routinely denied care every year?  A set number of patients will not get their prescriptions?  What is your metric for “routine denial of care”?

Implicit in this argument is that the level of care “needed” under “best practices” is exactly the same as the level that will (and can) be disbursed. Why make that assumption? Why take it as a given that the level of resources available will, out of pure coincidence, meet at some equilibrium point with quantity demanded (even when demand has been “optimized” by being restricted to “best practices”) ?

Nope.  It’s called “prioritising”.

For example, a district health board will be funded to perform X number of heart transplants a year.  If they need more, they have to throw some discretionary funds at it, which compete with any other demands on those funds.  So the central government sets a minimum amount of care for the population, but there’s room to adjust for local conditions. BASED ON HEALTH PRIORITIES.

Which is why there was a long waiting list for my toenails - such operations had some funding from the central governemtn (so they *would* be performed) but not much, and the DHB wasn’t kicking any more in.  The end result is that I wound up suffering.

But - and here’s the big but - it was cheaper for me to get that minor surgery privately than it would have been in the States.  And when I needed emergency care, it cost me nothing.  And if I had really needed to, I could have waited.

Define “routine denial of care.”

Resources are limited. Demand, especially absent any kind of price signal, is not.

Denial of care is the difference between the two.

Or for the math inclined:

D - R = Care Denied

All equations have to zero.

Resources are limited. Demand, especially absent any kind of price signal, is not.

I have ample savings as well as a full-featured insurance plan. If demand is not “limited”, then by your theory I should be demanding a lot of health care right now at this moment, yet I am not!

My father has chronic heart disease. He recently received a bill for his latest surgery and hospital stay—to the tune of eighty thousand dollars.

He can no longer work, and my mother’s insurance is strained to the limit, as she is a cancer survivor herself.

They are having to declare bankruptcy, they are heartbroken that they will have nothing to leave to my brother and I, they can’t afford food, and still they swallow the Repub crap about how proper civilized health care is OMGSOCIALISM and OMGLOOKATCANADA. My mother even works for a sliding-scale federally-funded outreach clinic, works almost full time with these insurance assholes, and still she swallows it. I got married two years ago and moved two hours away. In that time, they have been able to afford the gas money to come see me ONCE. All because of medical bills.

Needless to say, anyone on this thread or anywhere else who really believes that the American health care system is the best of all possible health care systems is cordially invited to lick me. I don’t believe for a second that if we had a system, including preventative care, that working-class people could afford, my father would be on his eleventh heart attack and on the cusp of heart failure now.

Also fuck anyone who really believes that “routine denial of care” is a super-cool way to keep costs down. Lower the cost of malpractice insurance, kick pharmaceutical companies in the pants until they charge what their product is actually worth (My father takes Nexium, which is $4 PER PILL). Provide good preventative care. Watch as costs fall.

Resources are limited. Demand, especially absent any kind of price signal, is not.

Denial of care is the difference between the two.

In other words, you have no actual metric.  All you know is that someone, somewhere will be denied some kind of care at some point in the vague future.  You can’t even point to a specific procedure or treatment that you think would be denied in a single payer system.

That’s what I thought.

Denial of care = not giving me an MRI on demand for every boo boo, because my symptoms don’t meet the criteria.

Denial of Care = not handing out antibiotics like candy just to make people feel like you did something for them

Denial of care = not getting expensive drugs advertised on TV that don’t work much if any better than those that are already out of patent

Denial of care = limiting access to heroic and likely to fail measures for people facing the ends of their lives because that money could be used to pay for prenatal care for thousands of women and their infants.

So ... is it denial of care if my doctor says “you are doing very well on this medication” and doesn’t immediately switch me to one that is being advertised on TV that costs twenty times as much and has more side effects just because I wanted him to do so?

Denial of care = not getting expensive drugs advertised on TV that don’t work much if any better than those that are already out of patent

THIS. Seriously, how weird is it that prescription drugs are marketed on TV? I can get behind that denial of care.

Know what?  My husband had to see a podiatrist for a very painful plantars wart.  We had to pay out of pocket to have that wart treated and removed.

So much for a difference between the US and New Zealand - in NZ you wait or pay out of pocket, in the US you pay out of pocket.

I am perfectly willing to entertain the notion that under a single-payer system in the US, there will be rationing beyond cutting out the easy things that Ms Kate talks about.  (I don’t think this has to happen, but we don’t have a great track record in this country of fully funding worthwhile and necessary programs, so it’s plausible.)  What I have a harder time believing is that a cost-based rationing system (where you prioritize based on cost per quality-adjusted life-year) would have worse or less equitable effects than our current price-based rationing system (where you only get the care that you can pay for.)  Does anyone else remember the little boy who died from an abcessed tooth?

Does anyone else remember the little boy who died from an abscessed tooth?

Yep.  But, hey, according to CTD, that kid had to die so those of us with private insurance would still have the right to walk into our doctor’s office and demand whichever medication we’d seen on “House” the night before.  It’s the American Way for poor children to die so a 95-year-old cancer patient can survive three extra days on life support.

“Nope.  It’s called “prioritising”.”

...um, no it’s not.  It’s only called that in Britain, and Australia, and New Zealand, and other weird places.

Over here in the US of A, it’s called prioritizing…with a freaking ‘z’, the way God told us to spell it…

Respectfully, I disagree.  When you have a single-payer socialized medical system, there only IS one provider, usually government owned.  When that one provider screws up, people die.

Respectfully, your are wrong.

In Canada, the insurance is single payer; there are a multitude of providers (i.e., doctors, dentists, therapists, etc.) who accept the government run insurance (the payer). This system is distinct from the British system, where most (though not all) providers work for the National Health Service—in other words, where the provider and the payer are the same entity.  In both countries, there are private insurers for those who wish to opt out of the public insurance system.  Not surprisingly, few people opt for private insurance.

Here in the USA, I am a provider.  I accept the following payers: Medicaid—government issued health insurance, Blue Cross and, of course, cash payments from patients.  Everyone’s money is equally good, though they don’t all pay the same rate and it requires varying degrees of persistence to get paid.

If I were a provider in Canada, I would be seeing a lot more patients with the Canadian equivalent of Medicaid, a lot fewer patients with the Canadian equivalent of Blue Cross, and probably fewer private pay patients.  All in all, it would probably average out for me—other people’s mileage may vary.

In either the US or Canada, if I screw up on my treatment, its my fault, not the fault of the payer—and certainly not the fault of the government. 

Single payer is not “socialized medicine.”  If anything, it’s socialized insurance—big difference.

But hey, the health care those women received was “free”.

Well, if we are going to play the anecdotal evidence game, here are just three recent examples of the super-cala-fragalistic” fun to be had in American health care.  Let’s focus on “the wait.”

All of the people in my examples have insurance.

First a lady at the church where I work who has diabetes.  She developed a strange and painful growth on her leg, which may have been related to her diabetes.  Wait time before she actually got in to see a doctor?  About two and a half months.  Granted, not a life-threatening illness, but possible complicated by diabetes.

Next, a man at the church who has developed debilitating back problems.  He cannot, however, have surgery for his back until he has surgery for a thyroid condition.  And…he’ll be waiting three months for the thyroid surgery.

And finally, my husband’s co-worker, who during a routine exam, had such a low heart beat rate that his doctor wanted to call an ambulance, right then and there.  Well, the guy managed to avoid that (crappy insurance wouldn’t pay much for the ambulance ride), and the doctor consulted with his heart doctor.  He then got an appointment—for several weeks later—with the heart doctor.  I reiterate, his heart rate was so low, his primary care physician was afraid he was going to drop dead.  But no follow-up appoint until several weeks later.

I don’t have any health insurance, so I have the longest wait of all.  I doubt Canada’s system is perfect, but it’s certainly not worse than the American system.

What I have a harder time believing is that a cost-based rationing system (where you prioritize based on cost per quality-adjusted life-year) would have worse or less equitable effects than our current price-based rationing system (where you only get the care that you can pay for.)

It absolutely won’t.  Even if more expensive, esoteric procedures/medicines get cut back, there is no doubt that overall health outcomes will improve under a single-payer system.  Infant mortality will decrease, life expectancy will increase, more people will be more healthy.  Cuba has decent health outcomes, even if they don’t have the same access to fancy equipment and procedures, because the large majority of people don’t need that stuff.  They need preventive health and dental care, they need antibiotics and vaccines, they need generic medications to regulate blood pressure or alleviate arthritis.  Improve people’s access to those basic things and we’ll all be much healthier.

There would also be nothing preventing the middle class and rich from going into debt or paying out of pocket for expensive treatments that government health insurance won’t cover, kind of like what they do now if private insurance won’t cover something.

Over here in the US of A, it’s called prioritizing…with a freaking ‘z’, the way God told us to spell it…

Since when was Noah Webster declared God?

Captain Bathrobe said “If I were a provider in Canada, I would be seeing a lot more patients with the Canadian equivalent of Medicaid, a lot fewer patients with the Canadian equivalent of Blue Cross, and probably fewer private pay patients.  All in all, it would probably average out for me—other people’s mileage may vary.”

Actually, you’d be seeing nothing but people with provincial medical cards, unless you’re a cosmetic surgeon or a chiropractor. We all have provincial insurance, and in most places it’s paid for by taxes, not premiums.

I have only seen a hospital bill once in my life - when I had surgery before I’d gotten around to applying for my Ontario Health card, even though I’d been in Ontario for more than 6 months. I just needed to demonstrate that I had been resident in the province for 6 months, and Ontario Health paid it. If I hadn’t been, BC’s health plan would have paid it.

This is because up here you don’t pay out of pocket, and you can’t pay out of pocket, not for routine medical care. There isn’t an alternate private system paralleling the public system, and any province that tries to allow ‘private’ hospitals or ‘private’ clinics is in violation of the Canada Health Act.

The idea (and it’s a sound one) is that doctors would be motivated to work in the private system rather than the public one—so the waitlist problem would be worse, not better. Of course, it is possible to go to the US and pay for your own care out of pocket, and people do.

PeterZeroOne is right about what’s not covered, though. Dental work, eyeglasses and medications are not covered. My teeth were terrible while I was in grad school.

” They need preventive health and dental care, they need antibiotics and vaccines, they need generic medications to regulate blood pressure or alleviate arthritis. “

They need to see the doctor when the problems first start rather then delaying it for months or years because it is cost prohibitive just for a single visit. Regular visits to the doctor often solve a lot of problems before they get costly but in the US people are discouraged from doing that while in Cuba they have tons of doctors that do housecalls and can be easily found every few blocks.

” kick pharmaceutical companies in the pants until they charge what their product is actually worth “

Yeah it’s strange that the pharma companies haven’t moved out or denied their products to countries like Canada or Cuba or the UK where they are gasp limited in how much profit they can make in a year. Strange how the pharma companies that only deal with certain countries that do this never have massive layoffs of workers and thrive even at several hundred million dollars profit a year and yet still manage to come up with new drugs to sell.

I find it extremely strange that so many people are terrified by the rationing of care based on actual medical metrics, and yet completely blase about rationing of care by something so arbitrary as which insurance provider your company chooses to carry, or how rich one is.

As to demand being infinite? Most people don’t go about running to the doctor when they feel good. Nor can they choose to have a less expensive disease (or even a less expensive procedure) because they can’t afford what they’ve got. Doctor shopping is difficult, and can end with substandard care because doctors are suspicious of patients who bounce from doctor to doctor, so saving money that way isn’t really a go either.

My mother needed a parathyroidectomy. Being exceedingly well insured and privately well off, she had surgery within a month by a top surgeon halfway across the country. My mother-in-law needed a bowel resection. She & her husband could only afford to insure one person, and FIL has diabetes so he was it. She died slowly and painfully by having her digestive system stop up over the course of a year.

I think I could have lived with my mother having to have surgery locally or wait a few months if it means I got to skip watching my mother-in-law waste away for want of a straight-forward procedure.

in NZ you wait or pay out of pocket, in the US you wait and pay out of pocket.

FTFY.

By Canadian law, private, for-profit health care is illegal.

That private clinic I go to will be surprised to see the government goons bashing their door in, I assure you.

You’re not even from Canada, are you?

I find it extremely strange that so many people are terrified by the rationing of care based on actual medical metrics, and yet completely blase about rationing of care by something so arbitrary as which insurance provider your company chooses to carry, or how rich one is.

Well, the rich would like to jump the line, becase hey! what’s the point of being wealthy if you can’t get massive privileges from it?

My mom used to work for the state government before she retired, and her insurance was great.  If a generic drug didn’t work as well or had worse side effects, it was up to the patient and doctor together to decide if the brand name drug would be better.  In that case, the doctor had to specify it on the prescription, and you could the name brand drug if you need it relatively easy by simply discussing it with your doctor.  Also, all prescriptions cost the patient the same price.  Now I’m on my own and have insurance through my company, and it’s much worse than what I’m used to.  Prescriptions are much more expensive, and I have to get them through mail-order which has very slow processing and sometimes leaves me without my medication for up to 2 weeks.  Thankfully my doctor will give me some samples while I’m waiting.  If I choose to get my prescription filled at a pharmacy, it costs 3 times as much.  I don’t know if universal health care would be like the health care given to state employees, but if it is, it would be great.

“what’s the point of being wealthy if you can’t get massive privileges from it?
“

Thing is the wealthy in countries with socalized medicine still can get massive privileges when they want medical care. They can get rooms that look like an expensive five star hotel room with all the extra amentites instead of your typical hospital room.

Caren-Sun-blocking Creator of Animorphic Pancakes:  “The only way insurance companies make money is by sucking it out of healthcare.”

That, and investments.  Which is why, even though insurance companies do like to avoid paying claims, they become much more ruthless about it when investing the money they’ve gotten from their members fails. 

As one law firm says, only a little tongue in cheek, “If you’re planning on getting in a car accident any time soon in which you or a loved one may be severely injured or killed, try to time it so that it coincides with a day when the economy is strong and Wall Street’s markets are on the rise. Your chances of getting a fair settlement from your insurance company are much better if their stock portfolios are doing well.”