Healthcare USA #1

Politics & News
2172

Like think this through. We’re going to do a 2 year extension of the new ACA subsidies. So they’ll expire in 2024. Anyone expect Dems to have the power to extend them again? So they’re toast. Meanwhile, our healthcare system is so short on nurses that they’re being paid doctor money. What’s that going to do to premiums?

I’m seeing estimates on Twitter of 15-20% increases, and that’s probably on top of the subsidy loss. And it probably doesn’t factor in long covid, which isn’t really burdening the system a ton yet.

As the demand for healthcare increases, we’re going to see a shortage in the supply of healthcare. I think it’s clear how that is going to manifest. The poor get fucked. Hospitals in lower class areas won’t have enough nurses or doctors. Those in wealthy areas will find a way.

And as all that plays out, the GOP likely takes a trifecta and repeals the ACA. We go back to scam coverage, no coverage for pre-existing conditions, low caps on benefits, etc.

That means we’re probably going to see a K shaped recovery in life expectancy. The wealthy will do about as well as they did pre-pandemic, but the poor and middle class will lose decades and decades of gains.

2173

And high fructose corn syrup and increasing use of processed foods generally.

2174

I’ve watched most of the episodes of this series called Medical Stories which is produced for PBS. It profiles individuals living with certain diseases, especially some rarer ones. The show isn’t perfect by any means, just more tasteful than similar ones I’ve seen on cable that are overproduced to maximize drama and plot twists. I’d scrap the cheesy music and uplifting endings though for sure. There’s also little emphasis here on the insurance battles and financial ruin some of these people must be facing, but that’s not the focus of the show (kind of weird not to include that angle but w/e).

Of course, I’ve selected a particularly horrifying episode to share here. I was familiar with NF1/2 from reading medical journals and knew this was gonna be bad. However, actually seeing a family dealing with it in an award-winning video series is on another level.

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2175

I have been dealing with the most frustrating health care/insurance issue ever over the past 4-5 months or so.

The prelude to this is that I have definitely been drinking too much for years. Especially since covid started. I would tell myself over the last couple years that I was going to take a week or a month off. I would make it 2-4 days and eventually fall back into it because my body hurt. Mostly back and neck. But also some more normal withdrawal stuff like headaches. So I spent the last couple years going through that cycle over and over. This year I got more serious about it and made it past the harder part back in March and was about 2 weeks in and I realized my neck and upper back hurt pretty much 24/7. Something is not right.

So I go to the doctor. I get an exam. He recommends a MRI and suspects I might have a disc problem. It is denied by my insurance. I being the weakling that I am fall back into the same cycle of self medicating. Fast forward to June. I have a normally scheduled doctors appointment and again my doctor sends the pre-auth for the MRI stating that things have not improved over time and it is again denied. This time they appeal and it is denied again. The insurance then recommends i get put on painkillers and go to physical therapy for 6 months. Which no chance in hell I should be taking opiates and my doctor is pretty firmly convinced physical therapy won’t help much. Although we never get to that last part because of what happens next.

Anyways at the point I realize nothing is going to happen with this again I decide maybe I am just being a wimp or something. I have been curling since late 2017 and hadn’t curled since March. But whatever, i guess I am just going to have to learn to deal with this. So i go to Dallas for a curling tournament the 2nd weekend in July.

Everything is going fine, we are doing well. In the quarters of our flight(4th game in 24hrs) we are losing. I get frustrated after missing a fairly easy shot. I am skating back on my curling shoes for my 2nd rock and i skate by the door into the ice which is broken so has been allowing hotter air onto the ice right there making it extra slick. I know this but am not thinking about it. A thing about curling shoes is that you have one that is insanely slick. That’s the shoe you slide on while delivering. The other has some grip to it. So to skate you hold the slick one flat on the ice and the other one is used for balance and momentum. Anyways I go through the slick spot. My gripper foot slips. I try and save it with my slider foot which just makes things worse and I take what I will call the old man in bathtub fall onto the ice. Right onto my upper back/neck. It knocked the wind out of me pretty good and my first thought was oh fuck I’ve really hurt myself.

But 30 seconds or so later i got my wind back, sort of got my wits back. Obviously I hurt but didn’t want to quit even though one of the people from the curling club thought maybe I should. We ended up making a big comeback and winning. Our big prize was to come back first thing the next morning at 830am and play in the semis. I was sore the next day but good enough to play. We were all tired and although tied late lose. Ok whatever. Probably best to not overdo it.

The next stage of the trip was to the DR. Ok perfect. A week to lay around and relax and recouperate. The first few days were fairly normal. Soreness. General discomfort in the usual areas. About day 4 I wake up and my entire left arm is numb, has weakness and has severe radiating pain. The numbness mostly fades but the other two symptoms are 24h a day. I go a day of this hoping things improve but they don’t. By the 2nd day of this i am trying to figure out what to do. Find a flight home, seek medical care or tough it out. Flights are insane expensive with bad long connections so that does not help me. My wife (the nurse) tells me that if I need surgery going to the doctor in the DR will not help me. Of course in the back of my mind I’m wondering if i had a stroke or heart attack or something even though i am 41.

So I tough it out. Things get worse and not better. Thankfully we had a nonstop flight home but the 4.5 hr flight was excrutiating. Because we flew from Texas after curling we have to drive home. It was literal hell on earth.

Now I left out one detail. After the fall but before we left for the DR I called my doc to tell them about the fall and to see if that would help the insurance situation. They said they would get back to me but had not called so I assumed denied again. I called first thing the next morning and they confirmed this and made me an appointment to come in to get examined and a EKG to try and rule out a heart attack.

The EKG was fine. The doc examines my neck and starts giving me all kinds of dire warnings. Do not go to a chiropractor with this kind of an injury out of desperation or you could be paralyzed. If the weakness in your left arm gets worse go directly to the ER you might need emergency surgery to save the use of your left arm. I’m pretty scared. He says they will keep fighting for the MRI. Gives me a script for some arthritis meds and a steroid. That was last Thursday.

I’m still in enormous pain and still have no MRI scheduled. He did send me for an xray last week to try and gather more evidence this is serious but so far my insurance company won’t budge. Meanwhile I am scared this situation will be permanent. I am scared of neck surgery.

And yes I was probably dumb to go play a sport on an ice rink when I already had the injury. But the injury was already there, it was getting worse not better, this probably just sped up the timeline. Not that I would know because I can’t get a diagnostic test. This is the one time post ACA I have needed anything serious. We have a Silver plan that is $973/month in premiums. Had I originally gotten the diagnostic test 4 months ago I would have done whatever was suggested. No chance I am doing 10 hours of curling over 36 with a disc problem. So I’m very angry at the insurance company both for denying me then. And obviously now it is terrifying.

TLDR: I have had a fairly serious neck injury for months recently made worse by a curling fall and my insurance wont pay to do the diagnostic test.

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2176

Christ, what’s the point of being a doctor if you’re going to be the insurance industry’s bitch?

No idea how a doctor could claim that they got into medicine to help people when they are rendered incapable of doing so by some tools in suits who have never seen the patients they’re making decisions for.

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2177

The part that is really puzzling to me is that 6 months of PT and pills can’t possibly be that much less than a MRI at whatever reduced in network rate they pay.

My guess is they don’t want to pay for the surgery. I just realized what they are doing actually. I got a letter from my insurance company a month ago saying they weren’t servicing my state after this year.

So they are running out the clock. Hopefully I get to go through all of this again with a new insurance company in 6 months!

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2178

Plus, opioids fucking suck. Ignoring the matter of side effects that come from being on them (dehydration, constipation etc), they leave you feeling less pain but also feeling completely ineffectual as a person. Last time I took them, they made me feel worse rather than better.

And withdrawal, even when weaning oneself off them slowly, sucks balls.

I guess that you have no choice but to keep fighting the good fight.

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2179

how much is an MRI if you just pay cash? I have heard a pretty wild range of numbers so I have no idea what the actual street price is.

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I honestly don’t know. The main reason I haven’t bothered to find out is my understanding of getting this covered is basically:

-get insurance to approve MRI
-get referral to appropriate surgeon if needed
-get surgery

I’m a bit scared that if i go rogue and skip step 1 that might make things worse. I’ve already called my insurance company and they told me my policy only allows them to discuss denials with my health care provider.

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yeah that’s a good point

USA#1

2182

What an insane system.

If a well off attorney married to a nurse can’t get a fucking DIAGNOSTIC MRI, what hope do the rest of us have?

Congrats on getting sober though. Will be a life changer if you can get through the neck injury.

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2183

My friend just had surgery for her breast cancer. The first 6 hours of surgery cost $170k. Doesn’t include the remaining 5 hours or the hospital stay. Pure insanity.

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Not sober yet although making small steps towards it. Definitely drinking way less now than months back. Ibuprofen can’t touch the pain though. I’ve tried not to overindulge since it got worse but a few glasses of red wine does help some though. Hopefully I can get past this and quit for good.

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2185

@WichitaDM , do you work for a firm or are you independent? If you’re independent, can you shop for insurance as a business and ditch the ACA insurance, especially seeing as you have to find a new provider next year anyways?

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Independent. I am not sure about that but when I looked years back it wasn’t going to save me much or maybe any money. My office is basically two attorneys and one assistant and the other attorney has good insurance through his wife’s job and the assistant is part time so even a small group plan or whatever is not feasible. I was on my wife’s insurance which was pretty good through her job but she quit nursing in October and hasn’t worked since so I now have this (what I thought was good prior to this) terrible insurance coverage that is insanely expensive through Bright Health.

You are right that I should look into it again though.

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Yeah, I wasn’t thinking of the savings, more that you might be able to get a better plan for a similar cost.

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2189

I just got off the phone with my doctor’s nurse and they denied the MRI again. Apparently my doctor has some peer to peer thing scheduled for later today to try and talk to one of their doctors about it but I am not hopeful.

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I get that this pain sucks balls, but the reason why they’re recommending these things (and it doesn’t have to be opiates either, you can take Tylenol and NSAIDs) is because it’s backed by evidence as the general right thing to do.

If you did a MRI on everyone’s spine in this thread, you’d fine all sorts of bulges and whatnot, but that doesn’t make you a good surgical candidate. Generally speaking, emergent MRIs are recommended for these symptoms kind of symptoms only:

  • Neuro deficit like weakness, numbness generally doesn’t qualify
  • Saddle anesthesia (basically you can’t feel the area under your balls)
  • Urinary retention/incontinence
  • Fecal retention/incontinence
  • Some sort of huge infection risk factor (IV drugs, immunocompromised)
  • Some sort of bone density issue (history of compression fractures, etc)

Also generally speaking, the only reason to get an MRI is to evaluate and plan for surgery. There’s nothing else that it adds to your actual clinical outcome.

Spine surgery fucking sucks. IIRC the most common indication for spinal surgery is failed previous spinal surgery. The reason why people get referred to PT first is that surgery is an awful first line option.

So while the pain is awful and sucks, aggressive PT is generally the right thing to do instead of MRIs. There’s lots of very high quality evidence to back it up.

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2191

I’ve been taking them for months. They don’t work. I do have significant weakness in my left arm now for over a week. I can barely hold a cup of water.

2192

OK that changes things, you need an MRI. Specifically a cervical mri

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