It’s wild that Americans accept this idiotic healthcare system.
Unfortunately there are people here in Canada who think it’s a better system. 😕
From an American: I’m so sorry our idiocy is bleeding into our neighbors up North. Learn from our mistakes!
Tell everyone you know that our healthcare literally bankrupts our working class, and that we still have crazy wait times for appointments due to our staffing shortages! Tell them there is absolutely zero upside to using anything remotely like our system!
Lobbyists in Canada (and northren European countries as well) will always try to dismember any social privelages their citizens have. The payoff is huge and the risks for trying to do so are negligible. Also, they can just blame the immigrants (which is hilarious in the US and Canada since all of us are immigrants or descendents of immigrants).
What are their complaints about the Canadian system out of curiosity? Just the taxes?
Complaining about the taxes would be the dumbest since the US spends a lot more tax money for a lot less per capita.
we don’t get a say, it’s up to how much money they can make off us. system is rigged hard unless you have money or a ghost gun apparentlym
We don’t get a say, but half the country will defend this shit and excuse it before they’ll accept any socialized medicine. And they vote accordingly.
Medicare for All is broadly popular. We’re just stuck with a two-party system that has been captured by corporate interests. We can’t vote third party until we get proportional representation like SPAV.
There’s too much to get into but the short version is we literally aren’t given a choice. People here idiotically vote against their own self interests and nothing anyone has tried to fix the problem has worked.
The sad part is that it doesn’t seem to matter who’s voting for who. I was a lead HIPAA security engineer at Blue Cross Blue Shield, and I architected some of the new EMR access auth systems. But I also got to see how ugly the inside of the insurance industry is. It was so depressing that even though they offered me a generous 6 figure salary, I had to quit for my own mental and emotional health. Their lobbyists have way more money than votes matter to begin with, that’s why I had to leave the industry for my own sanity.
The first card fell last week
We don’t accept it. We were born into it, and the powers that be are bought and paid for. Tis bullshit.
Hey now, we have some of the best healthcare in the world if you can afford it, and healthcare stats that demonstrate just how few people that actually is.
It must be exhausting to be an american
it most certainly is.
Gestures Broadly at Everything
Man, you got that right.
Anyone taking refugees yet?
I need to immigrate
I need to emigrate.
They (Americans) deserve it honestly.
- They worship capitalism
- Gleefuly joke about killing communists (via helicopters)
- Do not bat an eye when US govt invades 3rd world countries
- Rig international organizations in their favor
- Impose their will & turn other countries into a puppet states
- Fund Coups & Terrorists & bomb & sanctions on other emerging (As in developing) countries to destabilize them
- Stage Regime-change operations
- Greedy & Resource-Hoarding Nation with a mostly Selfish & Solipsistic Population
- & you rescued Nazis
- Not to mention how willing people are in joining the Military-industrial complex
I could go on & on
We 100% do.
My christian mother can’t wait for society to burn and Jesus to come back.
Let it. Fucking hell. I’m so tired of protecting these fucking idiots. Good riddance.
I do not. Many of my friends don’t either. Do we still “deserve it”?
I do not. Many of my friends don’t either. Do we still “deserve it”?
cause of death: not knowing the cheat code to getting treated like a human being that exists for some reason
I guess I get hung up on the whole:
Everyone knows this is true; it’s not a secret in any way. But it’s a violation of a number of regulations
bit.
So it seems like we could very easily stop these corporations from literally killing people with already existing regulations we are just choosing not to. COOL.
Bold assumption that “we” (meaning the government) includes anyone actually reading this, because as far as I can tell the only “we” the government considers is capital owners. Unless you’re proposing some alternate method of behavior alteration.
Can’t I just get care? I got a whole grown ass person’s life to live, and i can’t be an expert in everything.
Are you rich? Then yes. If you’re not rich, then you need to suffer and struggle for needing to use valuable resources that could be used on people more deserving; like the wealthy.
It’s not that they’re hoarding scarce healthcare resources so they’re available for the wealthy. They could provide care for everyone, but then the system wouldn’t run at the desired profit level.
There is also a giant undercurrent of wealth ministry in the American upper classes. Since about the 1960’s they’ve been pushing the idea that God blesses good people with money and punishes bad people by making them poor. It’s mixed with the Protestant Work Ethic so they also see poor people as lazy and undeserving.
It’s a completely self serving and self fulfilling ideology but it makes them feel good so we all have to suffer because we lost the lottery at birth.
The mentality goes back much farther than the 1960s. In a traditional Christian family the father is the giver of rules and justice. “Wait til your father gets home!” Kids learn that doing what daddy says leads to rewards and disobedience leads to punishment. Follow the rules and you prosper, break them and you suffer. This translates very directly into thinking poor people must be bad people. They must have broken the rules somewhere along the line because look how they’re being punished. Wealthy people must have done all the right things in all the right ways, because they’re getting rewarded with prosperity and that’s what’s supposed to happen. f you’re conditioned into that mindset, class differences make perfect sense.
i didn’t say healthcare resources. money is a resource and you must give it to your betters if you want access to affordable healthcare. they are hoarding one resource by denying access to another.
You can get whatever you want, but you have a $37,849.45 bill because you used the wrong door.
See, that door you used was operated by Attenya Healathus, not the Hospital, which is operated by Wellmeat (formerly Agape Plalauthis) so your care was not covered. If you had entered through the door (as outlined in your EOB) to the right, it would’ve only been an $800 copay for your splinter removal.
In most countries you can, yes.
You could but half the country voted for the guy who hates poor people
To be fair, neither party was going to pull the trigger on Medicare For All. We’re not getting universal healthcare until the working class stops letting wedge issues divide it.
75+ million fascists voted for a fascist.
The Democrats have fought nationalized healthcare tooth and as well
You say that, but when the Dems had a filibuster proof super majority in Congress for a handful of weeks over a decade ago, we got the ACA.
Hey why did we get the shitty ACA instead of actual universal healthcare if the Dems had power and were committed to getting universal healthcare?
Because there were other people in Congress who talked about death panels and tried to kill it at every turn. Reps hate the populace, and try their best to neuter everything good for the people. Also, some pretty right-leaning Dems were there. Have you paid ANY attention to politics?
Maybe don’t tout a half-measure that comprimised with literal ghouls as a defining unequivocal win for the party then?
You some champion of missing the point? That’s what we got despite all odds.
It’s like you people don’t understand politics or history. No wonder we elected a fucking fascist into office. JFC
They literally brought the health insurance executives in to write that bill. It was a step forward. But it was also a captive market that was supposed to be subsidized by state and federal governments. So the health insurance companies would just make a profit no matter what.
You say that, but when the Dems had a filibuster proof super majority in Congress for a handful of weeks over a decade ago, we got the ACA.
The ACA barely passed in its original form (219-212) with a bunch of democrats voting against it too. A few aligned themselves with big business however many other democrats voted against the ACA because they believe it didn’t go far enough.
The ACA was still the biggest win for the American people on healthcare in decades.
Yeah, there were some pretty conservative Congress people back then. There no way we were gonna get enshrined abortion rights, since many Dems were staunchly pro-life, hence ACA as an alternative.
Oh ya, you can get care. And then you fight with insurance about whether or not that was the right doctor to use or if it was really necessary in the first place. But insurance won’t talk to the hospital and the hospital won’t talk to insurance so you have to talk to each of them in turn while waiting on hold every time. It’s a wonderful system.
Thank you. This is directly relevant to me. And yeah, I’m an American.
I don’t think persuasion Checks are a good way to determine who lives and who dies in real life 🥲
Go ahead and roll for persuasion on your motion to abolish persuasion checks in healthcare.
The tragedy, in my opinion, is that Americans have to do this stuff at all. You need a tactic to get the service you’re literally paying for out of your own pocket.
Good luck getting them to give you an answer at all to any of those questions. You’re going to need to get a lawyer and spend a lot of money and time getting any response at all from anyone who actually works for the company, since the customer service doesn’t have access to any of that information and they wouldn’t be allowed to reveal it even of they did. It’s an insurance system, not a social service system where you have some kind of rights.
Insurance companies are designed to find any reason possible not to pay a claim, whether it’s homeowner’s insurance, liability insurance, or any other type of insurance. And they have plenty of lawyers on staff so they’re happy to make the lawsuit take long enough to cost you more than the claim is worth to you and it barely costs them anything.
The reason why this would work is because it makes it appear as though you may get lawyers involved. Yeah, they don’t want to pay out claims, but they also don’t want to get sued and lose. This is an intimidation check to make them either back down and pay out or risk potentially going to court with someone who appears to know what’s up. They’d rather just pay the bill at that point, at least as long as this doesn’t become common.
That might be the case if you got to talk to someone with the ability to do anything about it. Customer service is just able to tell you what happened, not really make any change. You can file an appeal, but you can’t really ask for much during that process. It’s mostly automated and the people who process those have very specific criteria for overriding an initial decision and have a very short period of time they’re allowed to spend on each appeal.
So the only way you’d get to someone who might be able to access any of this information is through a lawsuit. Trying to intimidate a worker with no power, no access to information, and a very high quotas is unlikely to have much effect. And these companies all have more lawyers on staff and/or retainer than any of us could afford in a hundred lifetimes. And those people aren’t going to give that information anyway. Nor would they give it to any lawyer you might hire in most cases. Proprietary information has way more legal protections than consumer rights, even in healthcare. You’d need to get a judge to order that release of confidential information about an employee or proprietary algorithm in most states, unless you convince someone to sacrifice their job, their freedom, and possibly their life to become a whistleblower.
So unless your claim is in the hundreds of thousands at least, it’s unlikely you’ll spend less on lawyers just to get your case in front of someone who can answer these questions much less compelled them to give it. Otherwise, they’d have an incentive to pay claims in good faith in the first place. So there’s no intimidation felt on their end by things like this. It just makes them get I to a defensive posture if anything, and likely reduces your likelihood of getting an appeal approved in a timely manner.
Your best bet if your claim is denied and appeal fails and you actually have a case is to hope you live in a somewhat progressive state that funds their insurance commission and has more consumer-friendly laws, and go to them for help. Federal laws aren’t going to help much unless you have evidence of fraud or you understand all the details of the case and can point to specific contract language or laws they violated already. But in that case the appeal should be all that’s needed.
I would add a caveat to your statement. It might not be just through a lawsuit but the threat of a lawsuit. A lawsuit will cost big money, but having a lawyer right the company a letter shouldn’t cost more than a couple of hundred bucks. Most people give up immediately and that’s what they are counting on. Worst case scenario is what? Tack a couple of hundred on to the thousands you will already owe? Basically a drop in a bucket.
Also, as scummy as the profession and some lawyers are, there are plenty who just want to do right by people. I have only paid a lawyer once, but I have talked to around half a dozen in my life time with questions about the law and some of the issues I was having. One or two probably spent at least a couple of hours on me over the course of a month or two when you factor in the initial 20-30 minute conversation, reading the documents I put together, and answering some of my follow up emails, and despite my insisting they charge me, they were insistent on not doing so.
(I suspect because in many of the situations what was happening to me was morally wrong, but legally more or less fine just barely grazing the gray area, and taking payment for their time could be construed as them acting as legal counsel as opposed to just answering some questions)
And your doctor will have to fight with the insurance company over the phone for an hour to do a pre-auth. When my doctor wants to perform something or give a certain treatment not covered, he assures me he will make this long and stressful call. I really wonder what they are discussing and what goes on in these conversations…
What doctor has time to do that? I’m in Canada and I can never trust my doctor to have any conversation with anyone, at any time longer than five minutes at a time for anything.
The best tactic I’ve found if you want to get anything done for yourself or someone close to you is for you to do the legwork and make calls, contacts and literally hound people to do their job. If no one is there to push things along, no one is going to magically appear to help you … that is a fantasy that seldom and rarely happens, even in our publicly funded system.
You or someone who is capable should advocate for you every step of the way, otherwise you will just get lost and forgotten in the system … whether you are in the US or Canada.
What you are saying is generally true. The only real oversight in ensuring things are moving forward is us ourselves as patients. It’s our responsibility as patients to take charge of our health.
That being said, P2P is sadly a standard aspect of American medical practice. Essentially anyone in a direct patient contact position position has done them. In the clinic or hospital, it may be your primary clinician handling it but it doesn’t necessarily have to be. It can be handled by other clinical staff or a group of nonclinical doctors also.
You dont have to worry about P2P since it will get taken care of (whether the service will be covered by insurance is another story). Instead I’d focus on keeping disconnected parts of the system abreast of your medical conditions and current list of medications. Because health information is protected there really isn’t a great solution for centralizing this data yet so if you go to a clinic that’s on a different EMR, they’re not going to have all of the necessary information available to them.
I’m in Canada and I can never trust my doctor to have any conversation with anyone, at any time longer than five minutes at a time for anything
The best tactic I’ve found if you want to get anything done for yourself or someone close to you is for you to do the legwork and make calls, contacts and literally hound people to do their job.
This is my experience in the US as well. Also nobody knows anything about anything.
Doctor A puts you on a medication, doctor B doesn’t know until you tell them and then he says “he put you on that!? You shouldn’t be on that, I’m taking you off it.”
You go to have a surgery and say “hey guys, did you know that I’m difficult to intubate? Because I could die if you don’t take that into account”, they didn’t know.
“Hey guys, I have reason to believe that the insurance card I was issued in the mail isn’t completely correct, can anyone help me with this?”, 4 different people at the company that issued the card have no idea what’s going on, don’t even know about the policy tied to the card in question and think you must have accidentally called the wrong company (you didn’t).
“Hey guys how much is this going to cost?” it is literally impossible to say.
Do you think your health record got that black mark before you took control of your health journey, or after?
(Mine is “surgery seeking”, apparently, as my old region has the mitigation history and the new region doesn’t; and one surgery every 15 years seems to be too many for them!)
When I was a clinic assistant in a cancer-focused plastic surgery clinic, it was my job to fight with the insurance companies. I did prior authorizations for every surgery and they would do shit like approve the removal of a melanoma without requiring prior authorization, but performing the skin graft to repair the 10cm diameter hole required a prior authorization because the procedure code falls under the “Plastic Surgery” heading and they wanted to make sure you’re not getting skin grafts for cosmetic reasons.
I’ve had doctors lead me to make certain statements so they can more readily justify a given treatment that they know I need.
It’s a bit of a wink-and-a-nod situation.
It’s even worse if you’re part of an HMO, because the doctors are beholden to the business side, unlike independent doctors who don’t have a management overhead telling them how many times a year they can prescribe a treatment, becuase they’re doing it more frequently than other doctors in the system.
This demonstrates the major issue with socialized care, because it’s also managed this way. I’ve been in both HMO and PPO systems - overall they both cost about the same despite HMOs acting like they cover more day-to-day stuff. It’s just with PPO (independent doctors), I get care that’s more tailored to me and my wishes, I don’t get pushback from corporate, because there’s no corporate involved. I may have to discuss with my doctor how to present things so my insurance won’t push back, but at least the insurance company doesn’t directly control my doctor’s salary, bonus, etc.
All this crap started in the 80’s as business management orgs started taking over healthcare organizations and consolidating them, and turning them into profit centers.
Agree I feel fortunate to have found a doctor(and their PA, and their staff) who feels like my own personal swat team to get my treatments. I am not wealthy and don’t have gold plated coverage, I just found a winner.
It’s so much paperwork and phone tag.
I was the feisty little gremlin that fought with the insurance at a cancer-focused plastic surgery clinic. I got really good at stacking up all of the info in the first submission so that they couldn’t drag their heels on shit that was time-sensitive.
Preesh.
As an EMT I rode with too many people who were sobbing in the bus because they knew the financial hit that was coming when we got to the ER.
I’m in medical school now and looking at either emergency med or family med, and either way, I am going to be exceedingly careful about how I construct my notes, diagnoses, evaluations, and treatment plans to leave as few cracks as possible for the insurance companies to try to weasel their way into.
I would encourage you to CAREFULLY and WITH DETAIL listen to your senior tutors (senior grisled paramedics, charge nurses, etc). They have a very particular line to walk and you can blow the show if you don’t learn the language.
It’s performative…everyone in the equation wants the patient to get the best, but if you haul off and make it obvious, they may be screwed.
Not saying you’d do that, but it’s a new world of…bullshit nuance.
Edit and if they ever give you a knowing look, and ask you to check the blinker fluid, or if the vending machine is stocked with saline, nod, and go “check”. They want to talk to the patient with no witnesses, so they can coach them on how to fit a proper insurance code.
This is more than mildlyinteresting.
Tell me you’re American without telling me you’re American.
Ok let me try: bulletproof backpacks.
I remember when Michael Moore’s “Sicko” came out a long time ago and the country was just as riled up as they are now. History repeats. After a while they will arrest the shooter and this will all die back down.
There was a movie in the 2000s that pointed out how fucked up US healthcare is.
Very little changed.
John Q?
Kid gets denied a heart transplant so the dad takes the entire ER hostage until he gets one?
One of the best TV shows of all time is premised on our broken healthcare system.
Wrong answers only…
Fallout
House
Semi related, recently I was referred to what I thought was a “specialist” from my doctor for a thing but I couldn’t myself determine if they were in-network with my insurance. Turns out what was implied to be a specialist was actually just a company that determines where to send people for this specific service, so we’re at the point that a primary care provider is working with a 4th party to deal with the 1st party and the 5th party is running services at the 2nd party and I am 1) the person responsible to figure out this insanity and 2) will likely be billed an obscene amount of money for something that should’ve been a 1:1 convo with a doctor and a hospital because one or five of the likely 30 people across 8 companies missed an email. (And you know all those people are they themselves dealing with the same nightmare and probably being paid a paltry $15/hr.
Yeah, that sounds about right. After a heart attack scare, a night in the hospital and all the cardiac testing that went with it, I received a letter in the mail from some company I’ve never heard of that determined my tests were necessary and would be covered. Weeks later. Like, motherfucker, what was the other option? We all thought I was dieing… ER had me admitted in less than 2 hours. It was bad … And someone needed to contact a fifth fucking party to make sure I deserve to live?
Fuck me. I wish I could leave this place and get my family someplace sane, where they are safe.
The free market is so much more efficient than the government!
My wife’s neurologist has done this with her insurance more than once. Especially the practicing out of scope or without a license. Usually she got her way. Probably the best doctor my wife has ever had.
I jump straight to filing a complaint with the Department of Insurance. The insurance company immediately gives me the authorization every time.
Can they respond to the DOI that I haven’t followed proper escalation procedures? Sure. But they just fold because they know they’re in the wrong and I am clearly willing to escalate matters.
