Why Is Health Care In America So Fucked Up?

Journeyman

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i'm dying to see the two sides on this one
Those costs seem insane.

I've taken my children to the emergency room of a local, private hospital on a few occasions, mainly for potential broken bones. From memory, it's cost $190 each time and that included a physical examination, X-ray and bandaging or splinting. Admittedly, there were no complex issues such as concerns about medication or other complications that had to be considered.

I could have taken them to the emergency room of a public hospital but that's a few kilometres further away and we would have had to wait longer. However, if we'd done so, it would have been absolutely free.
 

Pimpernel Smith

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Rambo

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Hence, medical insurance should be compulsory for those who work and can afford it, for those who can't the insurance is provided by the state as safety net.
no, not hence. not hence! this is the absolute worst conclusion to take away from this article. mind you, we're in the middle of a pandemic wherein half of the population can't actually work.
 

Pimpernel Smith

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no, not hence. not hence! this is the absolute worst conclusion to take away from this article. mind you, we're in the middle of a pandemic wherein half of the population can't actually work.
Someone, somewhere needs to pay for the production of all the medicines, doctors, nurses and associated services at hospitals. The NHS demonstrates that the cradle to the grave system is not that great compared to comparable nations in mainland Europe.

As regards, the current situation, then of course, there should be massive government support and intervention. You will see that in the US and elsewhere as the death tallies mount.
 

fxh

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Pimpernel Smith Pimpernel Smith Journeyman Journeyman fxh fxh i'm dying to see the two sides on this one

I don't need to tell you that ALL of that here would be FREE to the patient.

I could do some research to estimate a cost of the episode here but it would take a while and I'm still busy.

I can tell you that in about a week The Australian (Federal)** Government will be setting up a Medicare Claim Item for COVID-19 GP run clinics. I know it will reimburse GPs about $125aud for one test. I've done a bit of work on it and its probably a fair bit above the actual cost to GPs as it likely to take less than 10 minutes. (But there extra costs, consumables, masks etc and security guards, + nurse who will do most work and possibly rooms extra away from usual waiting rooms etc.).
Edit:: I just remembered they will also grant up to $150,000 one off to the clinic for capital costs etc.

I don't have a figure but I'd estimate the lab test is in the order of somewhat less than $50aud a pop. Then there is mailing and ringing people with tests and some admin and data work.

So I'd guess that the true TOTAL cost to Gov - the single payer - is $200aud - $250aud. Not a lot more.

By next week - there will also be a Medicare reimbursement item for GPS for phone and video consults for ALL items - which doesn't exist at all now. So that will dramatically lower the number of people going to GP clinics. Thus freeing up clinics for testing etc.

** THE Australian Government here funds GPs through medicare, a time and episode based system of reimbursement) but the States fund hospitals. In my state on a Casemix - Unit Cost basis. With Capital costs separate.
 
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Rambo

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The new bullshit plan the democrats have come up with is to allow people who have lost their health insurance to be able to buy into the COBRA program.
 

Rambo

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remind me again which one of you assholes was attempting to argue with me about how the US system was good?


Seattle coronavirus survivor gets a $1.1 million, 181-page hospital bill

June 12, 2020 at 4:53 pm Updated June 12, 2020 at 6:55 pm

Health care workers applaud Michael Flor upon his release from Swedish Issaquah last month Pushing the wheelchair is Dr. Anne Lipke, Flor’s critical care doctor. (Ken Lambert / The Seattle Times)



Remember Michael Flor, the longest-hospitalized COVID-19 patient who, when he unexpectedly did not die, was jokingly dubbed “the miracle child?”
Now they can also call him the million-dollar baby.
Flor, 70, who came so close to death in the spring that a night-shift nurse held a phone to his ear while his wife and kids said their final goodbyes, is recovering nicely these days at his home in West Seattle. But he says his heart almost failed a second time when he got the bill from his health care odyssey the other day.
“I opened it and said ‘holy [bleep]!’ “ Flor says.
The total tab for his bout with the coronavirus: $1.1 million. $1,122,501.04, to be exact. All in one bill that’s more like a book because it runs to 181 pages.


Michael Flor battled with coronavirus for 62 days at Swedish Issaquah. His stay makes him the longest coronavirus patient at a Swedish hospital. (Ramon Dompor / The Seattle Times)
The bill is technically an explanation of charges, and because Flor has insurance including Medicare, he won’t have to pay the vast majority of it. In fact because he had COVID-19, and not a different disease, he might not have to pay anything — a quirk of this situation I’ll get to in a minute.
But for now it’s got him and his family and friends marveling at the extreme expense, and bizarre economics, of American health care.
Flor was in Swedish Medical Center in Issaquah with COVID-19 for 62 days, so he knew the bill would be a doozy. He was unconscious for much of his stay, but once near the beginning his wife Elisa Del Rosario remembers him waking up and saying: “You gotta get me out of here, we can’t afford this.”

Just the charge for his room in the intensive care unit was billed at $9,736 per day. Due to the contagious nature of the virus, the room was sealed and could only be entered by medical workers wearing plastic suits and headgear. For 42 days he was in this isolation chamber, for a total charged cost of $408,912.
He also was on a mechanical ventilator for 29 days, with the use of the machine billed at $2,835 per day, for a total of $82,215. About a quarter of the bill is drug costs.
The list of charges indirectly tells the story of Flor’s battle. For the two days when his heart, kidneys and lungs were all failing and he was nearest death, the bill runs for 20 pages and totals nearly $100,000 as doctors “were throwing everything at me they could think of,” Flor says.
In all, there are nearly 3,000 itemized charges, about 50 per day. Usually hospitals get paid only a portion of the amount they bill, as most have negotiated discounts with insurance companies. The charges don’t include the two weeks of recuperating he did in a rehab facility.
Going through it all, Flor said he was surprised at his own reaction. Which was guilt.
“I feel guilty about surviving,” he says. “There’s a sense of ‘why me?’ Why did I deserve all this? Looking at the incredible cost of it all definitely adds to that survivor’s guilt.”

There also are special financial rules that apply only to COVID-19. Congress set aside more than $100 billion to help hospitals and insurance companies defray the costs of the pandemic, in part to encourage people to seek testing and treatment (including those with no insurance). As a result, Flor probably won’t have to pay even his Medicare Advantage policy’s out-of-pocket charges, which could have amounted to $6,000.
The insurance industry has estimated treatment costs just for COVID-19 could top $500 billion, however, so Congress is being asked to step up with more money.
The writer David Lat got a $320,000 bill for his COVID-19 treatment, and also ended up paying nothing. Yet he heard from dozens of cancer and leukemia patients who have been hit with big bills or co-pays during this same time period.

It’s like we’re doing an experiment for what universal health coverage might be like, but confining it to only this one illness.
“Suffering from the novel coronavirus as opposed to cancer shouldn’t make a difference in terms of your financial burden,” Lat wrote, in Slate. “What you pay as a patient shouldn’t depend, in essence, on whether your disease has a good publicist.”
Flor said he’s hyper-aware that somebody is paying his million-dollar bill — taxpayers, other insurance customers and so on. “Fears of socialism” have always stopped us from guaranteeing full health care for everyone, he said. But there’s also the gold-plated costs here, twice as expensive per capita as anywhere else in the world.
“It was a million bucks to save my life, and of course I’d say that’s money well-spent,” he says. “But I also know I might be the only one saying that.”
 

Rambo

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paywalled so here is the article

Pharmaceutical industry group sues to stop Minnesota's new insulin-aid program
Lawsuit says Minnesota's new program takes drugmakers' property without compensation.


By Jessie Van Berkel Star Tribune

July 1, 2020 — 11:58pm



Glen Stubbe – Star Tribune
Nicole Smith-Holt is pictured in the Minnesota House gallery in St. Paul, Minn. on April 14, 2020. Smith-Holt pushed insulin affordability legislation inspired by her son Alec, who died because he tried to ration his insulin. A pharmaceutical industry group is suing to block the law, which takes effect on Wednesday.

A pharmaceutical-industry group is suing the state of Minnesota over its new insulin-affordability program, which took effect Wednesday.

Pharmaceutical Research and Manufacturers of America, or PhRMA, said the program the Legislature passed in April is unconstitutional and that drugmakers already offer alternatives to help people with diabetes. They are seeking a permanent injunction barring the state from enforcing the insulin act.

Lawmakers and advocates for the measure argued that the existing programs drug companies provide are insufficient. After a protracted political battle at the State Capitol, they reached a deal legislators said would ensure people struggling with the skyrocketing price of the critical drug have a low-cost resource to secure it.



The new law requires insulin manufacturers to supply the drug or reimburse pharmacies giving out insulin. Companies that fail to provide the drug face fines.

As the Legislature was working to develop the insulin program, PhRMA and some Republican lawmakers repeatedly raised concerns about its constitutionality.

“A state cannot simply commandeer private property to achieve its public policy goals,” said PhRMA’s complaint, filed Tuesday in district court. “The Takings Clause of the Fifth Amendment of the U.S. Constitution prohibits states from attempting to solve societal problems in this draconian manner.”



Gov. Tim Walz and other backers of the program gathered Wednesday to celebrate its implementation expressed frustration at the lawsuit. The Alec Smith Insulin Affordability Act was named in honor of a man who died because he was not able to afford his medication.

“In some ways this has been the playbook from big PhRMA, to fight accountability and any sense of responsibility for the welfare of Minnesotans,” said Rep. Michael Howard, DFL-Richfield.

Howard stressed the program is now “the law of the land.” Cody Wiberg, executive director of the Minnesota Board of Pharmacy, said the board has directed pharmacies to comply with the law and believes they will follow it.

Advocates will not allow the lawsuit to alter their work to push for affordable insulin for everyone, said Nicole Smith-Holt, Alec’s mother. She said the law is necessary to prevent “senseless tragedies like the death of Alec and others from occurring in Minnesota.”

Senate Majority Leader Paul Gazelka, R-East Gull Lake, echoed Howard’s disappointment over the lawsuit, particularly after legislators spent so much time working on a compromise bill.

“Senate Republicans remain committed to providing emergency insulin for those in crisis no matter what happens with this poorly timed lawsuit,” Gazelka said in a statement.

Attorney General Keith Ellison, who will represent the state in the case, said his office will defend the insulin legislation “with every resource we have.”
 

Rambo

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this is a great piece

 

Pimpernel Smith

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But is this any better, the filled to the brim with Diversity Managers and other positions of the Woke bureaucratic order, the glorious NHS, relying on charities to fund their bespoke cancer treatment for teenagers:

 
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