There must be a pony in here somewhere.

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Jasper
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Re: There must be a pony in here somewhere.

Post by Jasper » 19 Dec 2018, 10:49

I've completely lost the thread of this flap. Can you guys stake out and support your positions again?

Sorry to vent. I just want to zip this up.
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lunchstealer
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Re: There must be a pony in here somewhere.

Post by lunchstealer » 19 Dec 2018, 11:07

JasonL wrote:I mean I appreciate the poetry, and maybe it would be better to call it a tax, but, again - the alternative is the camel trampling all over the tent forever. Handing over all features of medicine to the government directly forever, apparently not nearly as offensive as nose in the tent?
Ah different camel different tent. I’m more of the ‘the government mandating purchases for all for a given private company or suite of companies is a bright line we do not cross.’ Not for healthcare specifically but for everything.

For socialized medicine the camels were on their way in when Medicare and Medicaid became a thing and it’s just a matter of finding the least damaging place for the camel to stand.

But one measure of damage is what we let govt do, and mandated private purchases seems like a damaging place for the camel to stand.
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Re: There must be a pony in here somewhere.

Post by Mo » 18 Mar 2019, 05:20

Related to my comment on the other thread regarding kids' fevers, I feel like all the horror stories you would read in libertarian/conservative publications about the horrors of NHS and socialized health care are bullshit. Granted, I haven't tried to get a hip replacement, but for all of the health stuff I or my family has needed, I've seen no difference in wait times between here and the US. Granted, I have private health insurance, but most big employers here provide private health insurance gap coverage.
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Re: There must be a pony in here somewhere.

Post by lunchstealer » 18 Mar 2019, 12:42

Mo wrote:
18 Mar 2019, 05:20
Related to my comment on the other thread regarding kids' fevers, I feel like all the horror stories you would read in libertarian/conservative publications about the horrors of NHS and socialized health care are bullshit. Granted, I haven't tried to get a hip replacement, but for all of the health stuff I or my family has needed, I've seen no difference in wait times between here and the US. Granted, I have private health insurance, but most big employers here provide private health insurance gap coverage.
So what doesn't NHS cover that gets covered by the gap coverage?
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Re: There must be a pony in here somewhere.

Post by JasonL » 18 Mar 2019, 13:00

My understanding from my more healthcare obsessed days is that about 10% (float between say 8% and 12%) of UK residents are covered by private insurance, that such coverage is 99% corporate benefits, and that it is employed primarily to ameliorate dissatisfaction with services the NHS won't cover or wait times in the NHS model. There was a bit of hubbub a while back about NHS having to subcontract private providers to take spillover from public providers.

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Re: There must be a pony in here somewhere.

Post by Mo » 18 Mar 2019, 13:01

My understanding is it lets you jump the queue, choose your surgeon/hospital, and allows you to get uncovered care/treatments like specialized sports medicine or treatments deemed too expensive by NHS. Also, it gives you access to private medical care and private hospital rooms (basically covers the cost difference between NHS and private).

It shows the complete lack of understanding on the left and right. Even under a government provided care model like the UK, there is still space for private care and insurance. Yeah there are bad stories that come out of here due to corner cases, but that's basically true in every medical system. This doesn't take into account any R&D free riding the UK and other socialized health care countries take advantage of, but it's hardly the socialist hellscape that's advertised back home.
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Re: There must be a pony in here somewhere.

Post by Kwix » 18 Mar 2019, 17:52

Mo wrote:
18 Mar 2019, 05:20
Granted, I haven't tried to get a hip replacement, but for all of the health stuff I or my family has needed, I've seen no difference in wait times between here and the US. Granted, I have private health insurance, but most big employers here provide private health insurance gap coverage.

My understanding is it lets you jump the queue, choose your surgeon/hospital, and allows you to get uncovered care/treatments like specialized sports medicine or treatments deemed too expensive by NHS.
Am I missing something here or did you just say that "being part of the 10% that has private insurance I'm not the 90% that likely sees wait time differences"?
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Re: There must be a pony in here somewhere.

Post by Pham Nuwen » 18 Mar 2019, 18:00

Kwix wrote:
18 Mar 2019, 17:52
Mo wrote:
18 Mar 2019, 05:20
Granted, I haven't tried to get a hip replacement, but for all of the health stuff I or my family has needed, I've seen no difference in wait times between here and the US. Granted, I have private health insurance, but most big employers here provide private health insurance gap coverage.

My understanding is it lets you jump the queue, choose your surgeon/hospital, and allows you to get uncovered care/treatments like specialized sports medicine or treatments deemed too expensive by NHS.
Am I missing something here or did you just say that "being part of the 10% that has private insurance I'm not the 90% that likely sees wait time differences"?
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Re: There must be a pony in here somewhere.

Post by Mo » 18 Mar 2019, 18:20

Private insurance in the UK isn’t expensive* though. Most people choose to go without not because they’re priced out, but, presumably, because the value isn’t perceived to be necessary.

* According to this, it’s £30-£120 a month, which is not nothing, but not exactly limited to the bemonocled
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Re: There must be a pony in here somewhere.

Post by Aresen » 18 Mar 2019, 18:55

Mo wrote:
18 Mar 2019, 05:20
Related to my comment on the other thread regarding kids' fevers, I feel like all the horror stories you would read in libertarian/conservative publications about the horrors of NHS and socialized health care are bullshit. Granted, I haven't tried to get a hip replacement, but for all of the health stuff I or my family has needed, I've seen no difference in wait times between here and the US. Granted, I have private health insurance, but most big employers here provide private health insurance gap coverage.
I am forced to use anecdotes here, but I experienced an 18 month delay in obtaining hernia surgery in Canada (would have been longer if a new surgeon hadn't joined the clinic and been allotted time-slots in the local hospital that he needed to fill). When I had my glaucoma surgery, I was determined to be a high-risk patient due to the rapid deterioration of my vision and my wait time was cut to ONLY two months from the usual fifteen months.

The typical wait time for knee or hip replacement surgery where I live is 18 months. (I have two friends who have had knee surgery; one of those also has had hip surgery.

There are a few clinics permitted to perform some minor surgeries, but eye and bone surgery may only be done in government hospitals.

When I was first examined for my hernia, the surgeon offered to do it in his office for $1,000 cash. Foolishly, I declined. Shortly after, the government banned the practice outright with the threat that any surgeon who did it would lose his/her hospital privileges.
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Re: There must be a pony in here somewhere.

Post by Pham Nuwen » 18 Mar 2019, 19:32

Hip surgery is dangerous. Cant slap a tourniquet up there. Lots of major and minor blood vessels so easy infection traverse and route. It's why breaking your hip at an advanced age can be a death sentence usually.
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Re: There must be a pony in here somewhere.

Post by JasonL » 18 Mar 2019, 22:56

Pham Nuwen wrote:Hip surgery is dangerous. Cant slap a tourniquet up there. Lots of major and minor blood vessels so easy infection traverse and route. It's why breaking your hip at an advanced age can be a death sentence usually.
I’ll try to remember that while getting both of mine replaced. Ugh.

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Re: There must be a pony in here somewhere.

Post by Pham Nuwen » 18 Mar 2019, 23:04

JasonL wrote:
18 Mar 2019, 22:56
Pham Nuwen wrote:Hip surgery is dangerous. Cant slap a tourniquet up there. Lots of major and minor blood vessels so easy infection traverse and route. It's why breaking your hip at an advanced age can be a death sentence usually.
I’ll try to remember that while getting both of mine replaced. Ugh.
Advanced age ...
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Re: There must be a pony in here somewhere.

Post by Jennifer » 21 Mar 2019, 15:25

Aresen wrote:
18 Mar 2019, 18:55
Mo wrote:
18 Mar 2019, 05:20
Related to my comment on the other thread regarding kids' fevers, I feel like all the horror stories you would read in libertarian/conservative publications about the horrors of NHS and socialized health care are bullshit. Granted, I haven't tried to get a hip replacement, but for all of the health stuff I or my family has needed, I've seen no difference in wait times between here and the US. Granted, I have private health insurance, but most big employers here provide private health insurance gap coverage.
I am forced to use anecdotes here, but I experienced an 18 month delay in obtaining hernia surgery in Canada (would have been longer if a new surgeon hadn't joined the clinic and been allotted time-slots in the local hospital that he needed to fill). When I had my glaucoma surgery, I was determined to be a high-risk patient due to the rapid deterioration of my vision and my wait time was cut to ONLY two months from the usual fifteen months.

The typical wait time for knee or hip replacement surgery where I live is 18 months. (I have two friends who have had knee surgery; one of those also has had hip surgery.

There are a few clinics permitted to perform some minor surgeries, but eye and bone surgery may only be done in government hospitals.

When I was first examined for my hernia, the surgeon offered to do it in his office for $1,000 cash. Foolishly, I declined. Shortly after, the government banned the practice outright with the threat that any surgeon who did it would lose his/her hospital privileges.
Bullshit-ridiculous wait times happen in the US, too. I remember one of the first time I ever used my then-new health insurance I got for being a teacher: I came down with some mysterious skin rash/eczema (cause unknown to this day). It was so bad that, with the merciful exceptions of my face and neck, I literally did not have a square inch of skin anywhere on my body that didn't have at least two of those ugly scaly red patches. So I call my primary care doc, had an appointment on July 1, and was told "This is bad, YOU need to see a specialist/dermatologist as soon as possible." [Pause] "There's an opening on Oct. 1." Meanwhile my PCP prescribed me some steroid cream, which made the eczema go away, and by the time Oct. 1 rolled around I was fine -- I took time off work and shelled out my co-pay to be given the incredibly useful medical advice "Huh, wel, whatever you had, it's gone now."

Or, for that matter, the terrifying freakout I had on the very first forum: long story short, I'd already had two hospitalizations for kidney stones, suddenly I started pissing so much blood the water in the toilet bowl turned opaque red .... had to wait something like two or three goddamned MONTHS before being allowed to see a urologist.
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Re: There must be a pony in here somewhere.

Post by Kwix » 22 Mar 2019, 18:37

Jennifer wrote:
21 Mar 2019, 15:25
Or, for that matter, the terrifying freakout I had on the very first forum: long story short, I'd already had two hospitalizations for kidney stones, suddenly I started pissing so much blood the water in the toilet bowl turned opaque red .... had to wait something like two or three goddamned MONTHS before being allowed to see a urologist.
Since that forum is no longer accessible, would you mind elaborating on this statement. By "allowed" do you mean that your insurance prohibited you from visiting a urologist or that the one you elected to see was unavailable?
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Re: There must be a pony in here somewhere.

Post by Jennifer » 22 Mar 2019, 19:49

Kwix wrote:
22 Mar 2019, 18:37
Jennifer wrote:
21 Mar 2019, 15:25
Or, for that matter, the terrifying freakout I had on the very first forum: long story short, I'd already had two hospitalizations for kidney stones, suddenly I started pissing so much blood the water in the toilet bowl turned opaque red .... had to wait something like two or three goddamned MONTHS before being allowed to see a urologist.
Since that forum is no longer accessible, would you mind elaborating on this statement. By "allowed" do you mean that your insurance prohibited you from visiting a urologist or that the one you elected to see was unavailable?
The former, but also, my attempts to find one on my own came to naught because when I found one accepting new patients it was impossible for me to get a quoted price in advance and, as I repeatedly stated at the time (to those who accused me of "wanting other people to pay my medical bills for me/wanting a free ride/whatever"), it's not that I oppose having to pay my own way, but I damned well oppose having to pay with a blank check.
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Re: There must be a pony in here somewhere.

Post by Jennifer » 22 Mar 2019, 23:11

Jennifer wrote:
22 Mar 2019, 19:49
Kwix wrote:
22 Mar 2019, 18:37
Jennifer wrote:
21 Mar 2019, 15:25
Or, for that matter, the terrifying freakout I had on the very first forum: long story short, I'd already had two hospitalizations for kidney stones, suddenly I started pissing so much blood the water in the toilet bowl turned opaque red .... had to wait something like two or three goddamned MONTHS before being allowed to see a urologist.
Since that forum is no longer accessible, would you mind elaborating on this statement. By "allowed" do you mean that your insurance prohibited you from visiting a urologist or that the one you elected to see was unavailable?
The former, but also, my attempts to find one on my own came to naught because when I found one accepting new patients it was impossible for me to get a quoted price in advance and, as I repeatedly stated at the time (to those who accused me of "wanting other people to pay my medical bills for me/wanting a free ride/whatever"), it's not that I oppose having to pay my own way, but I damned well oppose having to pay with a blank check.
No, wait ... actually, it was "I couldn't see any urologist under any circumstances without a referral from my primary care provider." The inability to get a prior price estimate is why I did not go to an emergency room. (Fortunately, I experienced no physical pain; I "only" had the symptom "Every single time I go to the bathroom, I piss away so much blood that I cannot see the bottom of the toilet bowl through the red opacity." Which I self-treated via drinking FAR more water than usual, and also cran-grape juice... and as with that mysterious eczema breakout [which luckily never appeared again], by the time I visited the specialist the problem had cleared up, so I took time off work and shelled out a co-pay to be told I'm fine now.)

That was also when I made the permanent and lasting lifestyle change of drinking water all the time, not just when I'm thirsty.
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Re: There must be a pony in here somewhere.

Post by Mo » 01 May 2019, 04:27

This is quite the recusal letter by a judge.

https://pbs.twimg.com/media/D5WxTbvWwAA81mE.jpg
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Re: There must be a pony in here somewhere.

Post by Jennifer » 06 May 2019, 16:53

Transcribed for those who can't read Twitter: in response to a tweeted question "When did you become radicalized by the U.S. health care non-system? Julia Galef answered with a brief thread saying (dashes indicate spaces between tweets) "When I was in the burn unit for 3 weeks and kept begging everyone at the hospital to tell me how much the stay was costing me. Everyone claimed not to know. One person said "Not sure, but definitely less than $1,000/night." When the bill came it was $10,000 per night. -- Tbc, my complaint isn't about the high price per se - I have no idea how much medical care "should" cost. It's that I couldn't make an informed choice about how much care to purchase. -- ... oh and the $10,000 per night was just for one night in the hospital bed -- that does not include the cost of the treatments, ambulance ride, etc. I just thought at *least* the hospital should be able to tell me the cost of a hospital bed per night? But no."

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Re: There must be a pony in here somewhere.

Post by Pham Nuwen » 06 May 2019, 17:03

Because they don't know what she'll be charged. None of us do. It's an accounting shell game with insurance. No one has any idea. Even the people handling those claims don't know. They know how much the services charge for wages. That's about it.

I'm convinced that what is actually "charged" is a weighted algorithm that has nothing to do with the care given. This thought was not my own. It's something I've heard among staff for the last 2 years in varying forms.
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Re: There must be a pony in here somewhere.

Post by Painboy » 06 May 2019, 17:13

Jennifer wrote:
06 May 2019, 16:53
Transcribed for those who can't read Twitter: in response to a tweeted question "When did you become radicalized by the U.S. health care non-system? Julia Galef answered with a brief thread saying (dashes indicate spaces between tweets) "When I was in the burn unit for 3 weeks and kept begging everyone at the hospital to tell me how much the stay was costing me. Everyone claimed not to know. One person said "Not sure, but definitely less than $1,000/night." When the bill came it was $10,000 per night. -- Tbc, my complaint isn't about the high price per se - I have no idea how much medical care "should" cost. It's that I couldn't make an informed choice about how much care to purchase. -- ... oh and the $10,000 per night was just for one night in the hospital bed -- that does not include the cost of the treatments, ambulance ride, etc. I just thought at *least* the hospital should be able to tell me the cost of a hospital bed per night? But no."

Yeah this is probably my biggest complaint about the medical system. This allergy for anyone to actually tell you what something is going to cost.

Once I ended up in the emergency room for dehydration. It was significant but not life threatening. They asked if I wanted an IV and I agreed not thinking it would cost much. It turned out it was $100. Not crazy by health care standards but I was poor at the time and I could've just drank some water until I felt better. When I complained they looked indignant that price should've even been a consideration.

I'm not big on more health care legislation but I wouldn't gripe if they passed a law mandating upfront pricing for care.

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Re: There must be a pony in here somewhere.

Post by lunchstealer » 06 May 2019, 17:15

Painboy wrote:
06 May 2019, 17:13
When I complained they looked indignant that price should've even been a consideration.
This is why I'm starting to hate providers more than insurance companies.
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Re: There must be a pony in here somewhere.

Post by Jennifer » 06 May 2019, 17:16

Pham Nuwen wrote:
06 May 2019, 17:03
Because they don't know what she'll be charged. None of us do. It's an accounting shell game with insurance. No one has any idea. Even the people handling those claims don't know.
Which, IMO, further indicates that the system is SERIOUSLY broken and in need of major reform, if not outright rebuilding. Especially when it's so bad nobody can even give a reasonable ballpark estimate -- as Ms. Galef's being assured "less than $1,000 per night" and the reality was OVER TEN TIMES that much. (This also explains why the counter-argument "People just need to be responsible and have savings sufficient to cover possible medical emergencies, same way responsible car owners should have enough to cover possible emergency repairs" holds less water than a leaky colander.)
Last edited by Jennifer on 06 May 2019, 17:23, edited 1 time in total.
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Re: There must be a pony in here somewhere.

Post by Jennifer » 06 May 2019, 17:22

Remember this from Matt Welch?

Me: Hey doc, I really need to know how much this medical procedure is gonna cost me out of pocket before I pull the trigger!
Doc (after calling insurance co.): $800.
Doc (10 weeks later, after complication-free procedure): Actually ... $87,000.
Or the infamous blood-cholesterol test for which the customer could be billed anywhere from ten dollars to ten THOUSAND dollars?
Mo wrote:
15 Aug 2014, 11:55
A price range of 3 orders of magnitude for a lipid panel? Go home hospitals, you're drunk.
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Re: There must be a pony in here somewhere.

Post by lunchstealer » 06 May 2019, 17:28

Jennifer wrote:
06 May 2019, 17:16
Pham Nuwen wrote:
06 May 2019, 17:03
Because they don't know what she'll be charged. None of us do. It's an accounting shell game with insurance. No one has any idea. Even the people handling those claims don't know.
Which, IMO, further indicates that the system is SERIOUSLY broken and in need of major reform is not outright rebuilding. Especially when it's so bad nobody can even give a reasonable ballpark estimate -- as Ms. Galef's being assured "less than $1,000 per night" and the reality was OVER TEN TIMES that much. (This also explains why the counter-argument "People just need to be responsible and have savings sufficient to cover possible medical emergencies, same way responsible car owners should have enough to cover possible emergency repairs" holds less water than a leaky colander.)
Yeah, anyone who says, "Oh just have savings" in our current system as it has been for the last 20+ years, not just post-Obamacare, is just saying let them eat cake. Were we in a more market-driven system, sure we could expect people to pay for this stuff with savings. If we were in a more HMO style pre-approval for most things and fixed schedule for most of the rest, that'd be more appropriate. But the whole thing of pretending we're in a free market when we're really in a super-fucked-up torturously distorted market due to 80+ years of post-New-Deal interference and favoritism is about 90% of why single-payer is inevitable at this point.
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