Why Is Health Care In America So Fucked Up?

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https://www.insurancejournal.com/news/national/2018/10/08/503575.htm

Employees’ Share of Health Costs Continues Rising Faster Than Wages
October 8, 2018 by John Tozzi
Annual family premiums for employer-sponsored health insurance rose five percent to an average $19,616 this year, extending a seven-year run of moderate increases.The average single deductible now stands at $1,573 for those workers who have one, similar to last year’s $1,505 average. On average, workers this year are contributing $5,547 toward the cost of family coverage, with employers paying the rest.
Those findings are from the 2018 benchmark Kaiser Family Foundation Employer Health Benefits Survey. About 152 million Americans rely on employer-sponsored coverage.

Annual premiums for single coverage increased three percent to $6,896 this year, with workers contributing an average of $1,186 according to the same survey.
This year’s premium increases are comparable to the rise in workers’ wages (2.6%) and inflation (2.5%) during the same period. Over time, the increases continue to outpace wages and inflation. Since 2008, average family premiums have increased 55 percent, twice as fast as workers’ earnings (26%) and three times as fast as inflation (17%).
Deductibles paid by workers continue to climb over time in two ways: a growing share of covered workers face a general annual deductible, and the average deductible is rising for those who face one.
“Health costs don’t rise in a vacuum. As long as out-of-pocket costs for deductibles, drugs, surprise bills and more continue to outpace wage growth, people will be frustrated by their medical bills and see health costs as huge pocketbook and political issues,” KFF President and CEO Drew Altman said.

Currently 85 percent of covered workers have a deductible in their plan, up from 81 percent last year and 59 percent a decade ago. The average single deductible now stands at $1,573 for those workers who have one, similar to last year’s $1,505 average but up sharply from $735 in 2008. These two trends result in a 212 percent total increase in the burden of deductibles across all covered workers.
Looked at another way, a quarter (26%) of all covered workers are now in plans with a deductible of at least $2,000, up from 22 percent last year and 15 percent five years ago. Among covered workers at small firms (fewer than 200 workers), 42 percent face a deductible of at least $2,000.
“Deductibles of $2,000 or more are increasingly common in employer plans, which means the bills can pile up quickly for workers who require significant medical care,” said study lead author Gary Claxton, a KFF vice president and director of the Health Care Marketplace Project.
Employers Offering
The survey finds 57 percent of employers offer health benefits, similar to the share last year (53%) and five years ago (57%). Employers that do not offer health benefits to any workers tend to be small, and nearly half (47%) cite cost as the main reason they do not offer health benefits.
Some employers that offer health benefits provide financial incentives to workers who don’t enroll –either for enrolling in a spouse’s plan (13%) or otherwise opting out of their employer plan (16%).
The survey also probes employers’ expectations about how the 2017 tax law, which eliminated the Affordable Care Act’s tax penalty for people who do not have health insurance, would affect enrollment in employer coverage in future years. Overall 10 percent of all offering firms – and 24 percent of large ones – expect fewer workers and dependents to enroll because of the elimination of the tax penalty.
Among large firms that offer health benefits, one in five (21%) report they collect some information from workers’ mobile apps or wearable devices such as a FitBit or Apple Watch as part of their wellness or health promotion programs. That’s up from 14 percent last year.
Most large offering employers (70%) provide workers with opportunities to complete health risk assessments, which are questionnaires about enrollees’ medical history, health status, and lifestyle, or biometric screenings, which are health examinations conducted by a medical professional, or both. Thirty-eight percent of large offering firms provide incentives for workers to participate in these programs. The maximum financial incentives for these and other wellness programs often total $500 or more.
Other survey findings include:
  • High-deductible health plans with savings option. The survey finds 29 percent of firms that offer health benefits offer a high-deductible health plan with a savings option – a plan that either can work with a Health Savings Account or is linked to an employer-created Health Reimbursement Arrangement. Most (61%) of those firms offer only this type of plan to at least some of their workers. Overall, 29 percent of covered workers are enrolled in such plans.
  • Telemedicine. About three quarters (74%) of large offering firms (at least 200 workers) cover services provided through telemedicine, such as video chat and remote monitoring, which allow a patient to get care from a provider at a remote location. That’s up from 63 percent last year and 27% in 2015. A separate analysis also released today suggests very few workers are using telemedicine services in place of traditional in-person physicians visits, as less than 1 percent of all enrollees in large employer health plans used any telemedicine services in 2016.
  • Retail health clinics. Similarly, three quarters (76%) of large offering firms cover services received in retail clinics, such as those located in pharmacies, supermarkets and other retail stores. A small share also provide financial incentives for workers to use these clinics.
The annual survey was conducted between January and July of 2018 and included 4,070 randomly selected, non-federal public and private firms with three or more employees (including 2,160 that responded to the full survey and 1,910 others that responded to a single question about offering coverage)
Source: Kaiser Family Foundation
 

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https://www.amjmed.com/article/S0002-9343(18)30509-6/fulltext



Results
Across 9.5 million estimated new diagnoses of cancer from 2000–2012, individuals averaged 68.6±9.4 years with slight majorities being married (54.7%), not retired (51.1%), and Medicare beneficiaries (56.6%). At year+2, 42.4% depleted their entire life's assets, with higher adjusted odds associated with worsening cancer, requirement of continued treatment, demographic and socioeconomic factors (ie, female, Medicaid, uninsured, retired, increasing age, income, and household size), and clinical characteristics (ie, current smoker, worse self-reported health, hypertension, diabetes, lung disease) (P<.05); average losses were $92,098. At year+4, financial insolvency extended to 38.2%, with several consistent socioeconomic, cancer-related, and clinical characteristics remaining significant predictors of complete asset depletion.
 

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Drug Prices Just Keep Going Up

Happy New Year! Your meds might cost more this year, starting yesterday. According to the Wall Street Journal, pharmaceutical companies are raising the prices of “hundreds” of drugs, with an average increase of 6.3 percent.

While drug companies didn’t raise prices by as much as in previous years—in 2014, drug prices increased by 13 percent—the price of some drugs rose significantly. Allergan, the company that makes Botox, raised the prices of “more than half of its portfolio,” according to the paper, with 27 prices raised by 9.5 percent. That might sound low, but a 2017 Bloomberg piecelaid out how Allergan’s actions work to increase drug prices across the board: Through shady deals and gaming the patent system.


These games are how AbbVie’s Humira, which is used to treat inflammatory conditions such as rheumatoid arthritis and Crohn’s disease and is the world’s best-selling drug, can continue to be sold for $60,000 a year in the U.S. while Britain’s National Health Service gets to strike a deal to pay $384 million less per year for the new biosimilar (generic) version, available in the EU and Britain but not here.

Allergan, meanwhile, transferred the patent for its eye drug Restasis last year to a Native American tribe to protect its exclusivity:

Under the deal, which involves the dry-eye drug Restasis, Allergan will pay the tribe $13.75 million. In exchange, the tribe will claim sovereign immunity as grounds to dismiss a patent challenge through a unit of the United States Patent and Trademark Office. The tribe will lease the patents back to Allergan, and will receive $15 million in annual royalties as long as the patents remain valid.
Yet in 2016, Allergan’s CEO boasted that it would “keep [drug price] increases under 10% as part of a ‘social contract’ with patients,” according to the Journal. Does that social contract include legal trickery to keep an exclusive patent and prevent cheaper generics from reaching the market? Apparently so!

The Journal noted that many of this year’s price increases are “relatively modest this year, amid growing public and political pressure on the industry over prices.” It’s true that the pharmaceutical industry had perhaps its worst year ever in Washington; a major piece by Stat today outlined how PhRMA, the industry’s absurdly well-funded lobbying group, actually lost a major battle for the first time in 2018. (No wonder, then, that PhRMA was so desperate to reach Washington power-players with sponsorships of Politico’s health newsletter.)

But the fact remains that any price increases are evidence that the pharmaceutical industry isn’t being regulated properly; that millions of Americans who are already struggling to pay for drugs will find themselves worse off this year; and that boy, our standards are low. Increasing drug prices by a few percent—when drug prices are already absurd, unaffordable, and the highest in the world—is not good news.


*bolding mine. i had to use restasis once. thank christ i had insurance. at the time it was $3000 out of pocket for a month's supply. i somehow only paid $100 for a month.
 

fxh

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Why are Americans, both as patients and taxpayers, paying billions of dollars for a drug whose efficacy is so questionable that it's not approved in the European Union, Australia or New Zealand? Restasis, a blockbuster drug sold by Allergan to treat chronic dry eye, has done $8.8 billion in U.S. sales between 2009 and 2015, including over $2.9 billion in public monies through Medicare Part D. Restasis and Allergan have been in the news lately due to the company's novel legal strategy of transferring their patents on the drug to the Saint Regis Mohawk Tribe in order to stave off competition posed by generic drugs.
 

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Oddly Enough, More Big Pharma Kickbacks for Docs Are Associated With More Opioid Deaths

It’s been an infuriating week on the opioid news front. Just days ago, the New York Times reported on court documents revealing how the Sackler family, which owns the company that makes OxyContin, pushed doctors to prescribe more and more dangerous opioids, urging “that sales representatives advise doctors to prescribe the highest dosage of the powerful opioid painkiller because it was the most profitable.” Today, a study published in JAMA Network Open reveals exactly how that kind of pressure works—and how well it works.
As the New York Timesreported, the study found that “for every three additional payments that companies made to doctors per 100,000 people in a county, overdose deaths involving prescription opioids there a year later were 18 percent higher.” Over two years, the study said, “$39.7 million in opioid marketing was targeted to 67 507 physicians across 2208 US counties,” with 434,754 total payments made. One of the counties with high levels of physician payments and opioid deaths was Cabell County, West Virginia, which the Times said has “one of the highest overdose death rates in the nation,” though its overdose totals dropped 40 percent in 2018, according to the Herald-Dispatch. Still, the 95,000-person county was seeing “an average of three emergency calls a day” for overdoses, the paper reported.

The data on these payments comes from the Open Payments database and includes things like “meals, travel costs, speaking fees, honoraria, consulting fees, or educational costs.” These kinds of payments are commonplace in the medical business (and it is a business, unfortunately): A 2017 study found that about half of doctors received payments from pharmaceutical companies. And these companies spend more on marketing than they do on research and development, despite critics’ claims that Medicare for All would kill pharmaceutical “innovation.”

These payments, as you’d expect, affect prescribing habits, meaning doctors might end up prescribing a drug that isn’t best for their patient or that costs more than an equally-effective alternative. A smaller-scale study from Boston Medical Center’s Grayken Center for Addiction in March 2018 found that doctors who received meals from pharma companies prescribed 9 percent more opioids. Another study found that meals with a rep from Pfizer increased prescriptions of their two cholesterol drugs, Lipitor and Crestor, by 73 percent. Yet another study, from 2016, found that doctors were “up to two times as likely to prescribe the promoted brand-name drugs as physicians who received no meals.” Brand-name drugs are much more expensive than generic drugs—and those drugs are how big pharma makes its massive profits.
Meanwhile, a JAMA study last year found that one in five young people who died in 2016 died from an opioid overdose, and the National Safety Council said this week that the odds of dying of an opioid overdose are now higher than the odds of dying in a road accident.
The Times noted that both opioid prescriptions and payments to doctors are falling, thanks in part to more public scrutiny of these companies’ actions. And it’s important to remember that 80 percent of opioid users were not prescribed the drugs themselves, instead obtaining them from others—though often from those with prescriptions.
The study is an indictment of America’s sick healthcare system more broadly. It’s appalling to think that these companies, with billions in sales each year, spend millions on pushing doctors to prescribe dangerous drugs. And it’s appalling to think about the position this practice in general puts patients in: not knowing whether their doctor is only thinking of what’s best for them medically or who bought them their last steak dinner. There’s no reason to allow pharmaceutical payments to doctors to continue, and today’s study makes clear: banning these payments could save lives.

*you notice its never the cocksucker doctors who take the payments that ever get shit on over this. just as complicit as the drug companies.
 

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The Spiking Cost of Insulin Is Highway Robbery

A new Health Care Cost Institute study to be released next week found the cost of insulin per patient almost doubled between 2012 and 2016, according to Reuters. The average annual insulin cost for a type 1 diabetes patient was $5,705 in 2016 compared to $2,864 in 2012. (The vast majority of people with diabetes have type 2.)

The figure includes the cost paid by insurance, but how much a patient pays varies greatly depending on their plan. If they have good insurance, great. If they have shitty insurance, they might have to meet a huge deductible before their plan pays anything. If they have no insurance, good luck! According to GoodRx, the most popular kind of insulin costs $286 at Walgreens for a 30-day supply. The bottom line: When costs double, insurance isn’t going to eat that whole increase. Patients will pay more, too.


And these prices aren’t going up because of some amazing, expensive developments in the market or because so many more people are using the drug. Per Reuters:

“It’s not that individuals are using more insulin or that new products are particularly innovative or provide immense benefits,” Jeannie Fuglesten Biniek, a senior researcher at HCCI and the report’s co-author said in a phone interview.
“Use is pretty flat, and the price changes are occurring in both older and newer products. That surprised me. The exact same products are costing double,” she said.​
The exact same products are now costing double. Why? Profit and greed. There’s no other explanation for doubling the price of the same drug; inflation is not 200 percent, nor are labor or production costs twice as high as they were five years ago.

These decisions kill people. People literally die because they can’t afford insulin (and other necessary drugs and medical care). As the Washington Post reported in a feature about patients who rely on insulin earlier this month:

What Alec soon learned was just how much his insulin would end up costing: more than $1,000 a month. The price of insulin — once modest — has skyrocketed in recent years, making the lifesaving medication a significant, even burdensome, expense, especially for the uninsured and underinsured. The costs are so heavy that they have driven some patients to ration their supplies of the drug in a dangerous gamble with life-threatening consequences.
At the time Alec discussed skipping insurance coverage, he told his mother, “It can’t be that bad.” Within a month of going off her policy, he would be dead.​
Let’s be clear: The proposition that the current healthcare system, in which pharmaceutical companies withhold drugs people need to live until patients pay hundreds of dollars, is extortion. “Give us the money or you’ll die” is not all that different from “give us the money or I’ll shoot you in the head.” The only difference between this and an armed robber holding your drugs unless you hand over your wallet is that an armed robber doesn’t have a $450 million lobbying group in Washington.
 

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this country should be razed to the ground

https://nypost.com/2019/01/24/schoo...ges-for-using-own-insurance-to-help-sick-kid/

School superintendent faces charges for using own insurance to help sick kid

An Indiana superintendent is facing charges for allegedly using her own insurance to help a sick student, according to officials.

Casey Smitherman, who is the head of Elwood Community Schools, turned herself in to police Wednesday after she allegedly sought medical treatment for the boy using her son’s name, news station WLS-TV reported.

The superintendent said the boy missed school on Jan. 9, so she checked on him at home, where he was suffering from symptoms of strep throat.

She took him to a clinic but he was denied care because he didn’t have insurance. Smitherman then took him to another medical center, where she admits she lied about the child being her son so he could get treatment, according to police.

The total bill was $223 and the student received a prescription for amoxicillin, documents said.

“I’m not saying it was right; I’m really sorry. I just was scared for him,” Smitherman said, according to WLS-TV. “I would love to go back to that moment and redo it.”

Prosecutors charged the superintendent with official misconduct, insurance fraud, insurance application fraud and identity deception.

“I understand it was her desire to help a young man that was in bad shape but probably not the best example to set for young people to assume other identities and make false statements,” Madison County Prosecutor Rodney Cummings told news station WXIN.

Following Smitherman’s arrest, the Elmwood school board issued a statement in support of her maintaining her position as superintendent.

“She made an unfortunate mistake, but we understand that it was out of concern for this child’s welfare,” the statement said. “We know she understands what she did was wrong, but she continues to have our support.”
 

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I’m pretty sure diabeties treatment for type 1 here is about $39 script, but for concessional, eg pensioners, Disabilty etc $6.40 a script. I think a script is a months worth. So $500 a year. But there’s also a cap on pharmaceutical expenditure for each person/family I think once you reach $1500 or so in a year it’s free from there on.
 

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The 2019 PBS Safety Net threshold is: $1550.70 for general patients, or. $390 for concession card holders
 

Rambo

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I’m pretty sure diabeties treatment for type 1 here is about $39 script, but for concessional, eg pensioners, Disabilty etc $6.40 a script. I think a script is a months worth. So $500 a year. But there’s also a cap on pharmaceutical expenditure for each person/family I think once you reach $1500 or so in a year it’s free from there on.
that's cute
 

fxh

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Essentially it’s one payer - the state. They also negotiate the price of pharmaceuticals. Nationally. We spend less of GDP on healthcare than USA but for better outcomes. Dental is the only thing not on the scheme.
 

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Essentially it’s one payer - the state. They also negotiate the price of pharmaceuticals. Nationally. We spend less of GDP on healthcare than USA but for better outcomes. Dental is the only thing not on the scheme.
I'll be the devil's advocate AKA American - but if I pay more money I expect to be at the front of the queue.
 

Arnathor

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^ Can't argue with that. What are the odds that the Pharma companies lined the pockets of the reps that oversaw the funding?
 

Rambo

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That's only the tip of the iceberg, those who have been caught. It's well known get UK government/NHS/military contracts and away you go....scam city!
yes but the point isn't that fraud exists so the system can't be socialized. the point is that fraud exists in all systems so why not have one where everyone can get the care they need and not have to go bankrupt with medical bills?

to wit:


The Affordable Care Act Did Almost Nothing to Stop Medical Bankruptcies

A new study out Wednesday in the American Journal of Public Healthfound the Affordable Care Act had little impact on the number of bankruptcies caused by medical problems. It’s a sign of how much about our broken healthcare system and social safety net has remained the same, and how deep the rot is.
The study randomly sampled court records of bankruptcy filers between 2013 and 2016 and mailed them a questionnaire, asking whether medical reasons—like bills or losing a job because of illness—contributed to their bankruptcy. Before the 2014 implementation of the bill, 65 percent cited a medical reason for bankruptcy; after, it was 67 percent. Overall, 58 percent cited medical expenses as a reason for bankruptcy. According to a Thursday press release from Physicians for a National Health Program, whose founders are among the study’s authors, it also found that people who reported a medical reason for bankruptcy “were two to three times more likely to skip needed medical care and medications.”


The list of medical reasons people gave for bankruptcies includes medical conditions causing job loss, with 44 percent of people surveyed saying it contributed to their bankruptcy. This is a major reason why employment-based insurance—the kind that public option plans work so hard to preserve—is such a bad idea: People lose their jobs all the time, and if that happens to coincide with a major illness, you might be screwed. It also underscores how barren the social safety net is in the U.S. Many states provide less than six months’ unemployment insurance, with some providing much less, and the amount you can actually receive in insurance is desperately low in many states. And there’s no mandated paid sick leave, so if you have cancer, your boss can refuse to pay you for time off you need for treatment.
The ACA left a lot of dreadful, cruel things about American health insurance untouched, but there’s a lot it could never have fixed. Even Medicare for All wouldn’t provide better financial support for people who lose jobs due to illness; it wouldn’t force Louisiana to offer more than $247 a week in unemployment benefits. But 79 million people have medical debt because of our private insurance-based system, and it’d sure be a good idea to stop adding to that figure.
 

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fxh fxh this is a good one for you to help get some sense of what its like dealing with difficult problems

https://www.npr.org/sections/health...ills-maddening-errors-and-endless-phone-calls

Cancer Complications: Confusing Bills, Maddening Errors And Endless Phone Calls

Carol Marley wants everyone to know what a life-threatening cancer diagnosis looks like in America today.

Yes, it's the chemotherapy that leaves you weak and unable to walk across the room. Yes, it's the litany of tests and treatments – the CT scans and MRIs and biopsies and endoscopies and surgeries and blood draws and radiation and doctor visits. Yes, it's envisioning your funeral, which torments you day and night.

But none of these is her most gnawing, ever present concern.

That would be the convoluted medical bills that fill multiple binders, depleted savings accounts that destroy early retirement plans and so, so many phone calls with insurers and medical providers.

"I have faith in God that my cancer is not going to kill me," says Marley, who lives in Round Rock, Texas. "I have a harder time believing that this is gonna get straightened out and isn't gonna harm us financially. That's the leap of faith that I'm struggling with."

Coping with the financial fallout of cancer is exhausting — and nerve-wracking. But the worst part, Marley says, is that it's unexpected.

Share Your Story And Bill With Us

If you've had a medical-billing experience that you think we should investigate, you can share the bill and describe what happened here.

When she was diagnosed with adenocarcinoma of the pancreas head in July, she didn't anticipate so many bills, or so many billing mistakes. After all, she is a hospital nurse with good private insurance that has allowed her access to high-quality doctors and hospitals.


Randall Marley, a computer systems engineer, says he frequently comes home from work to find his wife feeling unwell and frustrated about having spent a precious day of her recovery making phone calls to understand and dispute medical bills. One recent night she was in tears and "emotionally at a breaking point," he says. "The hardest part of this is seeing the toll it's taken on my wife."

Stress-inducing bills accumulate

More than 42 percent of the 9.5 million people diagnosed with cancer from 2000 to 2012 drained their life's assets within two years, according to a study published last year in the American Journal of Medicine. Cancer patients are 2.65 times more likely to file for bankruptcy than those without cancer, and bankruptcy puts them at a higher risk for early death, according to research.

But those statistics don't convey the daily misery of a patient with a life-threatening disease trying to navigate the convoluted financial demands of the U.S. health care system while simultaneously facing a roller coaster of treatment and healing.

Stephanie Wheeler, a professor at the University of North Carolina at Chapel Hill, said the number of bills coming from different providers can be overwhelming.

"It's oftentimes multiple different bills that are rolling in over a period of several months and sometimes years," says Wheeler, who has conducted survey research with metastatic cancer patients. "As those bills start to accumulate, it can be very stress inducing."

Given that many patients can't work during treatment, these bills may force even relatively well-to-do cancer patients to take out second mortgages, spend college savings or worry about leaving debt behind for their families, Wheeler says.

Carol Marley is a slight woman who dotes on her two dogs and is involved in her church. Her 88-year-old father, who has dementia, had moved in a few years earlier. She and her husband, Randall, pride themselves on living frugally. They pay their credit card off every month and don't have car payments.

Carol and her daughter, June Marley, who is a second-year college student, have health insurance through Carol's employer, Ascension Health, a large faith-based health care system with facilities across the nation. Carol's husband has separate insurance through his job.

They were hoping to retire early, buy an RV and drive around the country. Instead, they see their meticulous plans disappearing, even if Carol recovers.

Their high-deductible insurance policy meant they had to spend $6,000 before their insurance started covering her treatment expenses. They hit their annual out-of-pocket maximum of $10,000 well before the year was over.

But Carol says she was prepared for that. "What I didn't anticipate is the knock-down, drag-out fight that I would have to engage in to get people to see there were errors and address it."

Since she's unable to work, the family lost her nursing salary.

"Money is not coming in, and it's going out by the thousands," she says.

From nurse to patient

Carol had treated cancer patients before. She had seen them come in with unexplained aches and leave with devastating diagnoses. Now it was her turn.

Though she didn't recognize it at the time, her symptoms were textbook. Fatigue. Back pain. Weight loss. In July, doctors told her she had pancreatic cancer.

Her first thought was that she was going to die. One nurse friend asked if she had her affairs in order. That's because pancreatic cancer is usually discovered too late. Just 9 percent of patients are alive five years after diagnosis, compared with 90 percent of breast cancer patients.

Carol knew she was lucky. Hers hadn't spread. She might be able to undergo surgery. But first, four months of chemotherapy and five weeks of radiation.

The chemotherapy — seven or eight rounds, she can't quite remember — drained her. "I couldn't put words together in my head," she says. She had muscle spasms and developed fevers that landed her in the emergency room.

As she became weaker, Carol realized she could no longer care for her father at home. On a recent morning in early January, she sat down with a nurse from a memory-care facility where a space had become available. Holding back tears, Carol told the nurse she knew this day would come. "I didn't think it would be so soon, and I didn't know under these circumstances."

Different insurers lead to different bills

Later that same day, Carol's energy was up. She adjusted the colorful scarf on her head, turned on her computer and pulled out a pen. Some days she spends hours trying to clarify and fix medical bills. "But I don't do that frequently because it is so fruitless and it is stressful," she said.

Often, she is just trying to figure out what different bills mean. "Even as a nurse, I feel like it's impossible to understand," she said. "I can't make heads or tails of it."

Sometimes there are errors.

Part of the problem, she contends, is that one insurance company covers visits with Ascension providers and hospitals and another company covers pharmacy claims, specialty drugs and providers outside Ascension's network. Some of the bills, including a $1,400 one from an ER visit — were sent to the wrong insurer, she says.

Carol cites other issues. An $18,400 chemotherapy bill was submitted with missing information and then denied because it arrived late. An $870 MRI bill was denied because the provider said there was no pre-authorization.

"It's not any one individual. It's not any one system or provider," she says. "The whole system is messed up. ... There's no recourse for me except to just keep making phone calls."

On this particular afternoon, Carol has a long list of calls to make. One to figure out why she couldn't access her insurance claims online. Another to a medical provider that urged her to pay $380, even though it acknowledged that it owed her about $80 of that total.

Someone who answers the phone suggests again that Carol pay the entire amount. "Once it's posted to your account and it goes through, we would send you a check," the woman says.

Carol shakes her head. "I'm sure y'all are fine people over there, but I'm not trusting a refund to come," she responds, reflecting on her experience as a consumer of cancer care. "The problem is, they want their money and they are going to get it one way or the other."

As for her hospital bills, Ascension declined to comment, citing protected health information. But spokesman Nick Ragone said, "The matter at issue was favorably resolved."

He didn't say which issue was resolved.
 

fxh

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man - the horror stories I hear about healthcare in USA boggle my mind. Health care debt is the biggest single cause of bankruptcy in USA
 

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Interesting, and I think life expectancy may also include a heavy dose of healthy diets and lifestyles (if not genetics) in those countries with universal health care. As an anecdotal example, an ex-colleague of mine has recently retired to Italy and he informs me that the health service is significantly worse than in the Netherlands (the Netherlands does spend more on health care, but the cost of living is much cheaper in Italy), but the life expectancy is higher in Italy according to the graph. Another ex-colleague from Japan had his daughter come and live with him as the grandson had leukemia and the Japanese treatment was sub-par compared to the Netherlands and Japan is No.1 for life expectancy,

Also some of those countries have models closer to the USA system than one might expect based on the graph i.e. insurance schemes. Here in The Netherlands all adults must pay for Insurance, unless they are on the dole in which case the government pays. Up until a few years ago you had to pay for children, but this is free now, but it is expected that the parents have insurance. I had to take one of the kids to the hospital with one of those out-of-hours child hood accidents that turns out to be nothing at all, but on arrival at the emergency ward the first thing they wanted to know was my insurance details and if that couldn't be produced they wanted payment up front to treat my child.

In the case of America, without structural reform, a simple imposing of a Universal Healthcare without addressing cost, or why expenditure per capita is so high is doomed to failure. My USA colleagues all inform me that Obamacare was a failure and left them with less options than before.
 
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