Health care

[gunnarthor]

This seems scary.

https://www.asahq.org/about-asa/newsroom/news-releases/2024/11/anthem-blue-cross-blue-shield-will-not-pay-complete-duration-of-anesthesia-for-surgical-procedures

[Mike Sixel]

I used to work with the leadership at UHG .... healthcare in the US is a disaster

[gunnarthor]

Where were yesterday? 

[Mike Sixel]

1 hour ago, gunnarthor said:

Where were yesterday? 

Wondering why the stock went up

[TheLeviathan]

15 hours ago, gunnarthor said:

This seems scary.

https://www.asahq.org/about-asa/newsroom/news-releases/2024/11/anthem-blue-cross-blue-shield-will-not-pay-complete-duration-of-anesthesia-for-surgical-procedures

Stock prices driving health decisions......what could go wrong?

[Vanimal46]

16 minutes ago, TheLeviathan said:

Stock prices driving health decisions......what could go wrong?

Don’t forget private equity who always operates with the best intentions for the common folk. I love paying 5-10% of my total income every year to a service that will toss me aside the second I become too expensive to insure 

[Mike Sixel]

46 minutes ago, TheLeviathan said:

Stock prices driving health decisions......what could go wrong?

I'm reminded of the helicopter scene in die hard where the agents are ok with twenty to twenty five percent hostage loss....

[TheLeviathan]

6 hours ago, Mike Sixel said:

I'm reminded of the helicopter scene in die hard where the agents are ok with twenty to twenty five percent hostage loss....

We only wish that number was as low as 20% in this scenario....

[gunnarthor]

[Mike Sixel]

19 minutes ago, gunnarthor said:

Ouch 

[tony&rodney]

Among high income countries the U.S. spends the most by far but is dead last in outcome. The U.S. is the only high income country in the world that does not guarantee health coverage. Revenge killing is barbaric but is sadly an expected outcome as the U.S. continues to spiral downward in inequality across its culture. Health care as a determinate of rising up economically (hard to progress if you cannot see well enough to read and cannot afford glasses which is particularly a prohibitive issue for children) is huge. Health is the number one cause of individual bankruptcy and also a major factor in homelessness. I was flabbergasted that healthcare was virtually nonexistent as a topic in the 2024 elections. What happened? Having lived for at least two years in eight different countries (zero times in Europe) I have some first hand experience (including surgeries) with differing health care systems. One can only hope that the United States can emerge from its current sad state because the promise and potential remains great even as the overall trends in health care decline.

[gunnarthor]

12 hours ago, tony&rodney said:

Among high income countries the U.S. spends the most by far but is dead last in outcome. The U.S. is the only high income country in the world that does not guarantee health coverage. Revenge killing is barbaric but is sadly an expected outcome as the U.S. continues to spiral downward in inequality across its culture. Health care as a determinate of rising up economically (hard to progress if you cannot see well enough to read and cannot afford glasses which is particularly a prohibitive issue for children) is huge. Health is the number one cause of individual bankruptcy and also a major factor in homelessness. I was flabbergasted that healthcare was virtually nonexistent as a topic in the 2024 elections. What happened? Having lived for at least two years in eight different countries (zero times in Europe) I have some first hand experience (including surgeries) with differing health care systems. One can only hope that the United States can emerge from its current sad state because the promise and potential remains great even as the overall trends in health care decline.

Without getting too specific, nearly 15 years ago - prior to Obamacare - my wife got stage 3 cancer. It was timed nicely, as my employer told me to go elsewhere three days later. We couldn't leave the state b/c cancer is a pre-existing condition and I wasn't licensed to practice law in that state (I moved there for a job where a local license wasn't a requirement). We were paying 1700/mth just to stay on cobra coverage. Our insurance didn't cover some of the tests my wife needed, including the genetic test to figure out the origin of the cancer itself. Without my wife's family being able to help us financially I honestly don't know what we would have done. Eventually things got better, I got hired by a job in MN that gave my wife immediate coverage and she has been cancer free ever since but restrictions like pre-existing conditions and refusal to pay for tests the doctors thought were necessary enraged me.

About a year later, I had a heart issue. A nurse thought I was having a heart attack, did some tests, etc. I was at the hospital all day but my arteries weren't clogged. I got a good heart doctor and, over two years of check-ups, tests, meds, etc, they couldn't pin point what happened. The doctor said that organs can get sick and it was likely my heart had a virus and got better. He said that normally something like this wouldn't have been caught (I was at the hospital for a routine check up when i mentioned the weird feeling to the nurse) because people don't normally go to the doctor when they feel slightly off because it costs money. He said that if more people came in early, things like this would likely be considered less rare. 

[bean5302]

Healthcare in the US has a few underlying issues. Obama did his best to demonize the insurance industry, and it's easy to point fingers at them because they're the most visible frustration in the process.

Health insurance isn't profitable. Most major carriers have bailed out of health insurance in the past 20 years to focus on financial products (life insurance, retirement services, long term care insurance, etc). Health insurance profit rates have typically been in that 5-8% range. Life insurance 10-12%, Retirement services 12-14%. It's led to a lack of competition and innovation in the industry, and the ability to create terrible policies. The Affordable Health Care Act gutted health insurance plans for larger companies as well as it gutted ERISA. The lack of simple policies still prevents a lot of people in the US from carrying/qualifying for health insurance. The AHCA didn't truly address any of the problems, but it did create new ones while partially mitigating some of the underlying problems.

Doctors and nurses in the US make 50-200% more than their counterparts in leading European countries. The compensation rate for medical staff in the US is astronomical, and that cost gets passed on to consumers, regardless of whether or not the payor is an insurance company or an individual.

Malpractice insurance. Colossal rewards for every "mistake" a jury decides was actually made has led to surgical coverage approaching $250,000 of premium annually for a single provider. Americans are pretty lousy at understanding the money doesn't just fall out of the sky when they award damages. There is no workers comp fee schedule table for malpractice, and it leads to tons of frivolous lawsuits and outrageous rewards.

Medical equipment. The US has the best. Period. No questions or debate about it. The technology used in the United States is simply better, more cutting edge and more capable than anywhere else on Earth. It's also more expensive. A private (out of pocket) scan will typically be 5-10x more expensive here than for our peer nations. That cost gets passed on to consumers.

Pharmacy. Yeah, this one is downright crooked. The FDA is ploddingly slow, and thus brutally expensive to obtain approvals, and the licensing and the market is rigged to favor big pharma.

A huge underlying issue of the cost of medical care in the United States is... education. Want to be a doctor? 4 years at a for profit college for the BS. 4 years of medical school at a for profit college for the Doctor of Medicine. 2 years of internship (residency) where you get paid slave labor working 80hrs a week while also preparing for the state medical exam/license. Then onto the fellowship path which can take years longer. Ludicrous. It leads to doctors graduating with $250-500k of student loan debt. That has to be paid back somehow... which leads to compensation rates being so high, and procedures costing way more as institutions promise to repay student loans as golden handcuffs which lock a doctor into a residency with the threat of immediate financial ruin if they leave.

[Juliett87]

On 4/24/2025 at 6:47 PM, bean5302 said:

Healthcare in the US has a few underlying issues. Obama did his best to demonize the insurance industry, and it's easy to point fingers at them because they're the most visible frustration in the process.

Health insurance isn't profitable. Most major carriers have bailed out of health insurance in the past 20 years to focus on financial products (life insurance, retirement services, long term care insurance, etc). Health insurance profit rates have typically been in that 5-8% range. Life insurance 10-12%, Retirement services 12-14%. It's led to a lack of competition and innovation in the industry, and the ability to create terrible policies. The Affordable Health Care Act gutted health insurance plans for larger companies as well as it gutted ERISA. The lack of simple policies still prevents a lot of people in the US from carrying/qualifying for health insurance. The AHCA didn't truly address any of the problems, but it did create new ones while partially mitigating some of the underlying problems.

Doctors and nurses in the US make 50-200% more than their counterparts in leading European countries. The compensation rate for medical staff in the US is astronomical, and that cost gets passed on to consumers, regardless of whether or not the payor is an insurance company or an individual.

Malpractice insurance. Colossal rewards for every "mistake" a jury decides was actually made has led to surgical coverage approaching $250,000 of premium annually for a single provider. Americans are pretty lousy at understanding the money doesn't just fall out of the sky when they award damages. There is no workers comp fee schedule table for malpractice, and it leads to tons of frivolous lawsuits and outrageous rewards.

Medical equipment. The US has the best. Period. No questions or debate about it. The technology used in the United States is simply better, more cutting edge and more capable than anywhere else on Earth. It's also more expensive. A private (out of pocket) scan will typically be 5-10x more expensive here than for our peer nations. That cost gets passed on to consumers.

Pharmacy. Yeah, this one is downright crooked. The FDA is ploddingly slow, and thus brutally expensive to obtain approvals, and the licensing and the market is rigged to favor big pharma.

A huge underlying issue of the cost of medical care in the United States is... education. Want to be a doctor? 4 years at a for profit college for the BS. 4 years of medical school at a for profit college for the Doctor of Medicine. 2 years of internship (residency) where you get paid slave labor working 80hrs a week while also preparing for the state medical exam/license. Then onto the fellowship path which can take years longer. Ludicrous. It leads to doctors graduating with $250-500k of student loan debt. That has to be paid back somehow... which leads to compensation rates being so high, and procedures costing way more as institutions promise to repay student loans as golden handcuffs which lock a doctor into a residency with the threat of immediate financial ruin if they leave. In addition to all these problems, there's also a big issue with how healthcare handles paperwork and information. Many hospitals and clinics still use old systems, which makes everything slower and more confusing. Digital tools can help fix this. For example, using a healthcare document management system can make organizing records, sharing information, and reducing mistakes much easier. A very interesting and useful case study on ddi-dev.com explains how to create one of these systems. It covers important parts, including how to follow privacy rules like HIPAA and how to connect them with other tools hospitals already use. While technology can’t solve everything, making these systems digital is a smart way to save money and help things run more smoothly.

I agree with a lot of the points. The part about insurance being unprofitable is something people don’t usually consider. It’s easy just to hate the insurance companies, but the reality is more complicated. The lack of competition definitely explains why plans are so terrible and confusing.

Also, the US has cutting-edge tech, but at what cost? A scan shouldn't cost 10x more than in other countries. Pharma being protected by the FDA’s slow and expensive process just feels like legalized monopoly behavior.

[bean5302]

1. Make it illegal to ask about pre-existing conditions so, essentially, universal guaranteed insurability.
2. Create a "government plan" which is universal and require private health insurers to offer the exact plan. Cap this plan's cost more aggressively than the 80/20 ratio currently required due to its simplicity.
3. Include automatic health insurance enrollment in the government plan in unemployment compensation if the unemployed person isn't already covered elsewhere.
4. Require employers to provide an employer sponsored health insurance plan or contributions to private insurance in addition to wages through some sort of insurance savings plan or whatever. Like an HSA.
5. If an person does not have health insurance and racks up medical debt, the government pays the debt to the provider using a medicaid fee schedule, then collects from the delinquent individual through the IRS/wage garnishment.

That's what the AHCA should have looked like IMHO.

[TheLeviathan]

Or just do universal health care like the rest of the damned world.

For a country of people that hates when middle-men and inefficiency get involved, we sure built an entire health-care system of maximizing both of those concepts.

[Mike Sixel]

19 hours ago, TheLeviathan said:

Or just do universal health care like the rest of the damned world.

For a country of people that hates when middle-men and inefficiency get involved, we sure built an entire health-care system of maximizing both of those concepts.

Nah, it is cheaper and better than what we have....Why would we want that?

[Hawkeye Bean Counter]

On 12/7/2024 at 9:32 AM, gunnarthor said:

Without getting too specific, nearly 15 years ago - prior to Obamacare - my wife got stage 3 cancer. It was timed nicely, as my employer told me to go elsewhere three days later. We couldn't leave the state b/c cancer is a pre-existing condition and I wasn't licensed to practice law in that state (I moved there for a job where a local license wasn't a requirement). We were paying 1700/mth just to stay on cobra coverage. Our insurance didn't cover some of the tests my wife needed, including the genetic test to figure out the origin of the cancer itself. Without my wife's family being able to help us financially I honestly don't know what we would have done. Eventually things got better, I got hired by a job in MN that gave my wife immediate coverage and she has been cancer free ever since but restrictions like pre-existing conditions and refusal to pay for tests the doctors thought were necessary enraged me.

About a year later, I had a heart issue. A nurse thought I was having a heart attack, did some tests, etc. I was at the hospital all day but my arteries weren't clogged. I got a good heart doctor and, over two years of check-ups, tests, meds, etc, they couldn't pin point what happened. The doctor said that organs can get sick and it was likely my heart had a virus and got better. He said that normally something like this wouldn't have been caught (I was at the hospital for a routine check up when i mentioned the weird feeling to the nurse) because people don't normally go to the doctor when they feel slightly off because it costs money. He said that if more people came in early, things like this would likely be considered less rare. 

I would have thought they would have caught myocarditis - inflamation of the heart from a virus.  If can overcome it,  goes away in a month or two, or possibly may need rehab.   That honestly sounds like what you had if I were to guess.