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 Post subject: Frustration with Healthcare Systems.
PostPosted: Fri Apr 13, 2012 5:14 pm 
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I know that Barack Obama was elected on the promise of hope and change and sweeping healthcare reform. This is NOT intended to be a political rant of any nature. I want to keep the focus on healthcare, in America and elsewhere.

As America continues to wade through the quagmire of this healthcare reform stuff, I shudder to think about how detrimental this will be if it all goes through. I appreciate the sentiment behind the idealized version of "social welfare" or "socialised medicine" where everyone can have access to healthcare.

I really do. I would like EVERYONE in America to have good, quality, affordable healthcare. Honestly.

Yet, it's a simple matter of economics. It can't be done. It just CAN'T.

To give EVERYONE access to any level of healthcare, means that the whole thing gets diluted and no one gets quality healthcare and it becomes more expensive for many folks.

There's a saying in the business world: Good, fast or cheap - pick two. You can have two, but you can never have all three. And that's where we are with social healthcare.
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It's torture watching as my friend of ten years disintegrates before my very eyes. Oh sure, she has access to national healthcare. But it's a two year wait to get a block of ten-pdoc visits. That's not terribly helpful when your meds aren't working and you continually spiral in and out of suicidal attempts.

For as sucky as it is in America to have to pay for insurance if you want it, there’s something to be said for the vast differences in care. With – what 9% – unemployment, that means 91% of Americans are employed. A solid chunk of them are full-time with benefits which means they’re able to sign-up for health insurance through their employer. The employer bears a portion of the monthly premiums and it’s different for everyone. I work at a company that offers three different medical plans (HMO, PPO-in-network, PPO-out-of-network) with four different coverage levels (EE, EE+1, EE+kids, Family) and each of those options runs the company and the employee a different amount each month – and provides a different level of coverage with each plan.
I’m paying about $120 per month for my medical insurance through my paychecks. With that, I get my mail order meds at very reasonable prices (3 mos generic Wellbutrin XL 300 mg for $28) and I can use my Health Savings Account (my own money, pre-tax reimbursements) for my over-the-counter meds (2 mos Allegra D-24 for $79). I can make an appointment with any doctor I want and get in to see them right away, depending on availability. Seeing my family practice doctor is a $30 fee. Seeing my ENT specialist is a $40 fee. When I see the chiropractor, it’s on my dime up until I’ve expended $350 within the year and then it’s a $12 fee to get my back cracked or $18 for an hour-long massage.

I know – “it must be nice.” And you’re right – it IS nice. And I didn’t always have this insurance. I’ve had it for the last nine years and it’s part of what keeps me at this same employer – I know it’s a good plan and I don’t trust other companies to have such decent benefits. (There’s something to be said for working for a company with 40,000+ employees – they get a helluva deal on insurance that can be and does get passed along to us.)

But even when I didn’t have insurance – before I got this job – and I needed to see a doctor, I could still go. I didn’t have to get on any waiting list. I wasn’t limited to the number of times I could see the doctor. I saw my therapist for a good 18 mos – on my own dime – at $100 per session out of my pocket. And it was well worth it. I scrubbed the toilets of teenage boys (talk about GROSS!) to earn money during that time and I knew I could’ve skipped a client or two if I didn’t have to see the therapist but it was important to me so I did it. And yeah, that was ten years ago so it probably wouldn’t be $100 anymore but you get my point.

My access to my therapist wasn’t regulated by the government. There wasn’t a huge demand to see her because she was one of the few therapists who would see me because none of her counterparts wanted to deal with my brand of crazy and get the pittance (by comparison to American doctors’ pay). I enjoyed the freedom to continue my care despite my absence of insurance.

And it wasn’t just the therapist. I also saw my family practice doc a couple of times, asked for samples, generics, cash discounts, etc. and did whatever it took. I saw my dermatologist as well and had a minor surgical procedure done as well, also without insurance. Again, asking for the discounts helped a great deal and there wasn’t a wait to get in.

It’s killing me inside to watch my friend battle these demons – knowing full well that a medication adjustment (or six) along with intensive therapy two or three times a week – would really help her get back on track. It’s killing me to watch her overdose, self-harm, act out, and basically go nuts when I KNOW she’s been in a better place before AND COULD BE AGAIN. The difference is she doesn’t have the access to the doctors or medications. If she were American, she would have access through her husband’s insurance through work. She’d be seeing a therapist multiple times a week; she’d be under the close supervision of a pdoc. She’d have access to the tools and support she desperately needs and would be getting better now instead of becoming suicidal again.

No matter what your political affiliation, I have to say that I really, really don’t think that socialized medicine is the answer for America. I’ve seen it first-hand. My friend is a beautiful woman, a terrific friend, a fabulous mother and could be all those things again. It breaks my heart to see the system failing her and causing this needless suffering. (Certainly there are things that would be causing her pain regardless; but at least she’d have the tools & support to get through them in one piece.)

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 Post subject: Re: Frustration with Healthcare Systems.
PostPosted: Fri Apr 13, 2012 8:22 pm 
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I don't know how you can possibly keep politics out of this because the whole debate is so politicized and each side is devoted to its talking points.

I'm not even maybe going to get into another debate with you on this topic after what happened the last time.

I'm going to say only a couple of things, then I'm done.

The healthcare reform act as passed is not socialized medicine the way a more European single-payer system is. The vast majority would get their insurance through private companies, just like they do now, though probably fewer of them through their employers. The incentive for insurance companies to offer more affordable plans is the individual mandate, which hugely broadens the base -- by insuring more young and healthy people who are now playing the dice that they won't get sick or injured and are going without insurance, there is more money available to pay for the older and sicker. For people who cannot afford any of the private plans -- even though there will be bare-bones catastrophic plans with huge deductibles which would be relatively inexpensive -- there would be a Medicare-like plan, which I guess you can consider "socialized medicine." Your healthcare decisions would be no more controlled by "bureaucrats" than they currently are decided by paper pushers at the insurance companies, whose main goal, after all, is making a profit for their shareholders and executives and not even maybe being altruistic.

Everybody who pays premiums for insurance now -- and for years past before any of the reform talk started up -- pays more than they would if there was universal coverage either by mandate or single-payor, because we ALL pay for uninsured people who get sick or injured and show up at hospitals.

There is a push, and it's a good one, to move toward evidence-based, outcomes-related medicine. If there are two treatments for Condition A, call them X and Y, and X is older, cheaper, but reasonably effective, and Y is also reasonably effective but not moreso than X and also costs a whole bunch more (but it's shiny and new and the company is running a kajillion ads trying to convince you that you NEED it more than the old, less fancy one) your insurance will pay only for X, for starters -- though you could pay out of pocket (or buy a super-spiffy break-the-bank policy) if you and your doctor decide that you want Y -- and also, insurance will pay your doctor if you complete treatment for Condition A with a positive result, rather than paying him every time he orders a test or a scan or a drug. Because there will be things that insurance won't pay for that people want, there will inevitably be cries of healthcare rationing. Well, yeah. Maybe we just need to get used to that. It's not throwing granny under the bus. It's just trying to determine a level of cost-effectiveness which is more sane than our spendspendspend current modus operandi.

I recently attended a talk given by the CEO of one of the two hospital systems where I live. He was a doctor in private practice before getting into administration, took care of my ex-husband's rheumatoid arthritis and my mother-in-law, his wife (a PhD in math) taught my kids algebra and basic computer programming, and I've known him a long time. He's generally pretty conservative, and the venue for the lecture had probably a 60/40 conservative/liberal audience. He said from the outset that this is not a political, Republican vs. Democrat issue, it's an economic issue. We can't continue to do what we've been doing, and there have to be changes. He said quite clearly that whether we broaden the base for private insurance or move more to a single-payer system, which is only socialist to the extent that you consider Medicare socialist, if we do nothing we're screwed.

There is no possible way to make everybody happy.

That's all from me.

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 Post subject: Re: Frustration with Healthcare Systems.
PostPosted: Tue Apr 17, 2012 2:33 pm 
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In the UK with a national healthcare system things are still abismal for those with mental health problems.

I've had to be hospitalised several times and I still can't get healthcare.

I've literally been given a phone number for a call centre if I'm in crisis and left with no care, no medication, no support systam, no treatment. Last time I was hospitalised was early January and I'm still waiting. I probably will be for a long time.

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 Post subject: Re: Frustration with Healthcare Systems.
PostPosted: Tue Apr 17, 2012 4:57 pm 
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Storme, I am so sorry. At least you have BPDR. We're certainly no substitute for mental health professionals but we can certainly be a piece of your support system.

Sari, I thought I replied to this from my phone but apparently it didn't go through. It wasn't about politics. It was about a screwed up healthcare system that is failing my dear friend compared to the system that has worked quite well for me and countless others in America.

I wasn't talking about a European country so I wasn't referring to a single-payer system. I honestly have no clue what the ins-and-outs are for Europe, Canada, El Salvador or any other country outside of what is currently in place in America. The only thing on which you and I agree is that: There is no possible way to make everybody happy. And with that in mind, it's ludicrous to me to change something that has been working for so long - employers offer benefits, pay for some of it, employees get a way better plan than the open market (usually) and health care reaches 80-or-90-something percent of the population. If it's not economically feasible for things to continue the way they've been going, then the answer is actually to revise legislation for medical malpractice and reform the malpractice insurance which is what generally pushes doctor fees through the roof.

I simply and outright refuse to believe that "managed care" for ANYONE is a viable alternative. Kaiser is a private company (heck, it may be publicly traded for all I know - it's just not run by the government.) It's a g.d. JOKE of an insurance plan. I've been on medications for years and I've been with Aetna through my employer for most of that time. I made the god-awful mistake of trying to save a few bucks one year and signed up with my husband's work plan through Kaiser. Immediately, I was told I could no longer have the medications that actually WORKED. I would have to suffer, be miserable, buy OTC crap and go through about 8 different hoops just to BE miserable. I did everything I could to switch back so I could GET THE FRICKIN' PRESCRIPTION I needed. It's not just that they wouldn't PAY for the meds. They wouldn’t even FILL the prescription – even at full cost. It was utterly F-ing ridiculous. And I shudder to my very core to think what sort of hell-on-earth the “broader base” evidence-based outcomes-related stuff RUN BY THE INEPT GOVERNMENT would do to screw us all over.

And yeah, I get it – I am ALL for the evidence-based, outcomes-related concept. Where things will fall apart – mark my words – is that it will take entirely too long for some redtape dillwads to slog through all sorts of studies and debates and hearings and everything else just to determine if treatment Y is finally approved as an evidence-based outcomes-related approved treatment. Meanwhile, we’re all going to be shunted into the crappy treatment X stuff that may work marginally well for most – BUT NOT ALL – and even with a doctor’s authorization stating “this patient is required to be on Treatment Y” – they won’t approve jack-squat.

I have another friend who has serious issues with seizures and her doctor absolutely INSISTS that she be on the brand-name medication because of the wide variation (up to 20%, I believe) in formulations of generics. That variation can make the difference between her being just fine, a normal productive member of society and loving wife & mother and having a massive seizure while driving and killing innocent people, including herself. But yeah, god forbid that 85 bureaucrats in Washington with no medical background or understanding of sensitive & serious medical issues actually dare to approve that treatment for anyone.

Oh, and just how did I extricate myself from the hell-that-is-Kaiser? I bought a month of insurance through Blue Cross or some such to constitute a life-change to get out of Kaiser and when that ended, I had another life-change which allowed me to resume my beloved Aetna coverage. Saying that the consumer base needs to be widened is actually kind of funny to me. Because there are literally HUNDREDS of websites, television and radio advertisements for individuals to purchase their own insurance plans. I just pulled up NINETY different plans through ehealthinsurance.com for myself – ranging from $115 per month to $477 per month. So how – exactly – can the base be broadened more than it already is since what’s already in place is “ANYONE IN AMERICA CAN BUY MEDICAL INSURANCE!”? (By the way, I’m paying $117 per month in addition to what my employer’s paying and I was able to get a mostly-comparable plan through some other company, rated B++, with prescription coverage (brand names capped at $250) for $375/mo.)

True – none of them are nearly as good as what most employers are able to offer. And the reason for that is simple: employers are buying in bulk and amortizing (?) the risk. A single sickly person will be more easily absorbed into the mix of a 1,000 person policy and it’s more likely that there will be 50 other people on the same plan who are fit as a fiddle, rarely requiring anything beyond preventive care, the occasional sniffle, a booster shot here or there. That same sickly individual would have to pay a small fortune to afford a plan one-tenth as good as they’d get through the group plan of an employer. But the fact remains that insurance is available for those who can pay for it. There are always going to be people who say “I can’t afford it” and, from what I understand, these reforms would then impose a $750/yr fee or tax or $62.50/mo to offset their ER visits. So yeah, maybe it’s a good idea to force this tax onto the people who say they can least afford it – good luck collecting it, government; those are the same people who pay $0 in taxes a year anyway.

But saying that “we need to broaden the base” is meaningless rhetoric. The sickly person is still a sickly person. Someone’s got to pay for it. The money’s not going to come out of nowhere. Perhaps you’re right – perhaps the answer is “Tax the crap out of the kids just entering the workforce to get them to cover for the sickly ones or the quick-trips-to-the-ER types of people.” If that’s what you mean by “broaden the base” … well, whatever. Somehow, some way, this whole thing is going to implode. Somehow, some way these changes are going to seriously screw with what’s been working quite well for me – and millions of others in the workforce for decades.

Either way, it’s STILL a shame that my friend – who is in agony right now – and Storme too are suffering from healthcare systems that are outright FAILING them. Government-intervention in healthcare is a proven recipe for disaster, it seems – at least from experience and as witnessed over the years from the visitors to BPDR in non-America countries, struggling to get the care they desperately need.

You can’t please all the people all the time. Getting the government involved to please a fraction of the currently-displeased is going to end up pissing off the majority. Mark my words.

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 Post subject: Re: Frustration with Healthcare Systems.
PostPosted: Tue Apr 17, 2012 10:45 pm 
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I said I wasn't going to say any more on this subject, and I meant it. We have such fundamental disagreements that there's absolutely no point in pursuing it. If others agree with you (or not) and want to weigh in, go for it. But I've said my piece and am through with this.

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I can take it in small doses, but as a lifestyle I found it too confining. -- Jane Wagner


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 Post subject: Re: Frustration with Healthcare Systems.
PostPosted: Fri May 11, 2012 4:34 pm 
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Eek. This is an older post, but I have something I want to say. Ash you said:
Quote:
So how – exactly – can the base be broadened more than it already is since what’s already in place is “ANYONE IN AMERICA CAN BUY MEDICAL INSURANCE!”?

Yeah... about that. I get 90 web sites all with great offers... until they find out I have mental health issues. And thyroid issues. And a seizure problem. And.... I am uninsurable outside of an employer-provided plan. Trust me. No one will touch me and if they do, they won't cover any of my pre-existing conditions. So, the main reason I'm happy about the upcoming changes is that they'll have to cover me. It might cost me more than I'd like, but it will be less than not having any coverage.

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