They can basically make up anything they want. It is the biggest feature of zero cost transparency.
But they donât have good insurance. They simply have untested insurance.
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They think itâs good, though, so thatâs all that matters. After all, the company would never lie to them and tell them they have very good insurance as an excuse for why theyâre not getting raises this yearâŚ
American insurance kind of reminds me of how Russiaâs strategy for keeping its people in line was to tell them âYes, things here suck but they also suck everywhere else, so weâre the smart ones who know things suck unlike those dumb Americans who think theyâre freeâ. Just hammer the idea of long waits for basic care for decades and youâll have dopes lining up to defend their insurance from SOCIALISM.
Yep, those stupid people at every other developed nation in the world think they have good healthcare. But not you, clever people. You know it is all a lie.
Could be. I have two kids. For the first I had insurance from an employer and we didnât pay anything at all. For the second I bought my own insurance and I think it cost about $4k in addition to premiums.
I actually think that a lot of people like their insurance because they think itâs good because theyâve never had to use it and found out just how shitty it is.
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Word. Amazes me when people go, âI only paid $2,000 for my new pacemaker because insurance covered half of it!â like thatâs a good thing.
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Right, because I seriously doubt they are reading the policies closely to figure out what might happen in the ton of oddball scenarios they arenât even aware of. Iâm being glib because you canât actually figure that out anyway no matter how much research you do. Hobbesâs case is a great example. You generally wonât figure out how much your great insurance actually wants to play ball until you have the brain tumor that will kill you.
Oh look! Those jeans on display are 50% off MSRP, down to $250! How can I pass that up?
Kohlâs
I buy a pair of socks at Kohlâs and somehow save $42. Itâs incredible how good their sales are!
Itâs shocking what people think constitutes good healthcare in America. My motherâs content paying a $400 copay if she has to go to the ER. Yeah, she can afford it. But the idea that healthcare should be a marketplace is whatâs so damning not whether or she can afford it.
What it tells me about her is how little sheâs aware of her own plan. In America, healthcare is one of those things you only begin to understand once you really need it. I spent more time talking about healthcare here than hers in America. But even so, itâs easy to get hit with costs you donât see coming. Yet, she still doesnât see that. She assumes that wherever she goes to ER, sheâll just have to pay her copay and thatâs it. As far as sheâs concerned, everything else is covered.
She brought up maternity leave and was shocked when I told her that CR has 20 weeks of maternity leave (itâs actually 28 but whatever) and she thought that was bad for business. Like she didnât really get it. When it comes to workerâs rights, sheâs thinking about it from the ownerâs perpsective, not the workers. People in America have become so heavily indoctrinated by capitalism and business that they are willing to patronize countries that actually give workers benefits.
It is amazing how bamboozled the average American is into giving up their own welfare for the sake of business owners that donât give a fuck about them.
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Propaganda works.
Yeah itâs unfortunate. My passion on the healthcare issue comes from massive first hand experience.
If you go to the ER for something minor and get discharged you will probably just pay the deductible. However once you are admitted thatâs when the entire game does a quick change and everything gets thrown out the window. I have a pretty good knack for only going to the ER when I have something really wrong or something I didnât even know about compounding a more minor visit.
Once you are admitted the charges go haywire and you are not getting out of there with no costs unless you are on some specific Medicaid programs for the poor.
I need to rant.
Fuck the healthcare system in this country. Iâve been dealing with insurance issues for 18 years, albeit I was a minor for 6 of them and pretty blissfully unaware of the struggle. It truly is a part time job to fight for your healthcare to be covered, and it costs more than a part time jobs salary to pay for everything every single year. It disgusts me to think how many tens of thousands of dollars my family has spent in out of pocket costs on healthcare. I see my peers buying houses, saving for their future, starting families, etc. while I sink thousands of dollars into just staying healthy.
My latest grievance has to do with post surgery bullshit and physical therapy. I needed surgery to repair an injury on my left hip two weeks ago. First the surgery was denied, of course, because the insurance company said it wasnât necessary. Luckily the surgeon did a peer to peer review and resolved that issue quickly. For the two weeks after surgery I was prescribed a CPM machine to help regain mobility and to prevent scar tissue from forming. That machine is not covered by Cigna because it is âexperimentalâ. $320 for me to rent it for two weeks. Now I have 4 months of PT prescribed, started at once a week for two weeks, then twice a week, and ideally eventually three times a week once I can really work the joint. Iâm a sponsored athlete and am missing 6 months of playing my sport, but if i rehab properly I will be back to playing and better off than where I previously was. The issue now is that i only get 20 PT visits covered per year. Oh yea, Iâll also need the same surgery on my other hip in 3 months. And Iâll need the CPM machine again. And more PT that I wont be able to afford. All of this is just super fucking stressful and annoying. And this is on top of the chronic health issues that are always a separate battle with insurance. We need M4A.
/end rant
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These Canadian healthcare horror stories are up there with Canadian girlfriends in high school.
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Iâve struggled with a debilitating mystery illness for almost 30 years now. The first symptoms appeared in childhood and are apparent in photographs and my pediatric medical records. I saw dozens of local doctors over that time and made no progress with no answers including long uninsured stretches where I paid entirely out of pocket. At one point I was paying for PCP and several specialists who were all treating individual symptoms unsuccessfully.
Really felt like I was getting played. I have a graduate STEM degree but was generally clueless about medicine and wasnât sure what to do. So I read medical journals, textbooks, case reports, etc. for several years, identified a candidate illness, then traveled 2,000 miles to see a rare disease expert. Now I have a full chart of abnormal diagnostic tests and visible tumor consistent with the disease. Thatâs when the insurance stopped paying. I still need more (expensive) testing and possibly surgery. I donât like to think about how many thousands of hours or dollars Iâve spent on this. Itâs really similar to the article I posted before except Iâm not dying or $2M in debt. Not yet anyway.
Ugh Iâm sorry man. I hope you are able to navigate the healthcare hellhole and get the care you need without too much struggle.
Insurance companies are the real death panels.
I have a few backdoor outs that donât involve moving to different time zones but a lot of the damage is done. I talk to (educated, affluent white) people about my experience somewhat frequently and their responses are usually âwell we like our insurance.â Like you said, itâs peers buying houses and having kids that havenât had to deal with this shit.
While you are correct, I think thereâs also another phenomenon in play. Specifically, itâs that we want to believe that skill in medicine is more homogeneous than it actually is. That might be the case for common conditions that are seen and studied frequently. Rare diseases are a different ball game. Theyâre the long tail of medicine. This from NIH GARD who maintains the list of recognized rare diseases and disorders:
How many rare diseases are there?
There may be as many as 7,000 rare diseases. The total number of Americans living with a rare disease is estimated at between 25-30 million. This estimate has been used by the rare disease community for several decades to highlight that while individual diseases may be rare, the total number of people with a rare disease is large.
Thatâs 7% to 9% of the U.S. population. But these estimates are probably biased downward. Some disorders are actually very rare, some are relatively common but under- and misdiagnosed, some are changing in true prevalence over time.
In the United States, only a few types of rare diseases are tracked when a person is diagnosed. These include certain infectious diseases, birth defects, and cancers. It also includes the diseases on state newborn screening tests. Because most rare diseases are not tracked, it is hard to determine the exact number of rare diseases or how many people are affected.
For example, Celiac disease was once considered rare:
Celiac disease was initially thought to be relatively rare with prevalence rates of approximately 1:5000 (23). These rates were based on the classic presentation of the disease and the classical presentation is now viewed [as] only one form of celiac disease. It has become clear that these prevalence rates represent the tip of the celiac disease iceberg and the majority of people with celiac disease present with a milder, more insidious onset of symptoms.
You could swap Celiac with other ârareâ diseases in that paragraph. I think itâs a special problem for some rare diseases, i.e., a primacy effect on rarity and extreme phenotypes that likely requires some kind of breakthrough to overturn those perceptions. For instance, the autoantigen in Celiac diseaseâwhich can be screened in serum in large populations unlike intestinal biopsyâwas only discovered in 1997:
Screening of blood donors for antibodies associated with celiac disease have shown rates of positive antibodies of approximately 1:133 in non at-risk individuals (3), and certain populations as high as 1:100 (24,25). Other studies using celiac disease related antibodies followed up with small intestinal biopsy have also revealed an overall prevalence of 1% across many different populations. Most of the subjects have mild if any symptoms and would not have been identified without screening.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775561/pdf/nihms75319.pdf
Patients with other diseases may not have access to treatments or expert doctors. Imagine you are one of the nearly 1 in 10 unlucky people that stops on the whammy. How confident would you be beforehand that your HMO provides access to the specialized doctors, drugs, testing, or treatment centers for any one of the ~7,000 on the list? How well does your PPO reimburse if you need Mayo Clinic? It can be challenging just figuring out which disease you have and where to go next.
Many of the people Iâve talked to think itâs as simple as picking the largest metro area or best hospital theyâve heard of (Mayo, CC) and seem far too confident that their condition would be quickly and accurately diagnosed and treated. If theyâd browse this list
and pick a few to read about in depth, I think their confidence would plummet and the premise of House MD would seem even more preposterous to them than it already did. On another forum about a disease on that list, many of the people who were eventually cured elsewhere were incorrectly dismissed by Mayo Clinic, Cleveland Clinic, NIH, and other reputable centers and the average time to diagnose from onset is measured in years in the literature. The guy living in Los Angeles was able to find the leading expert on multicentric Castleman disease in the widely-known medical mecca of [checks notes] Little Rock, Arkansas.
Frits van Rhee, M.D., Ph.D., a myeloma researcher and clinician at the University of Arkansas for Medical Sciences (UAMS), was lead author on a recently published paper that for the first time establishes treatment guidelines for patients with a form of Castleman disease, a rare disorder of the lymph nodes and related tissues.
That said, happy Rare Disease Day.
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