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Old 10th September 2019, 10:55 PM   #41
8enotto
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Originally Posted by kellyb View Post
But citizens will always at least get the exam and a tiny bit of care at the ER?
I would assume so, but I wouldn't bet on it if not life threatening and outside the program.
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Old 10th September 2019, 11:29 PM   #42
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Originally Posted by kellyb View Post
I wasn't even conscious when I accumulated my medical debt (over epilepsy.)



It's hard to "shop around for the best price" when you're unconscious. LOL
Why not pay the bills from your trust fund, or are you one of these socialists who blame society for you not chosing to be born into a wealthy family?





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Old 11th September 2019, 06:27 AM   #43
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Originally Posted by Bob001 View Post
Shouldn't your insurer have paid your bills and then sued the driver's insurance company themselves? Thousands of people get hurt in traffic accidents every day. It's hard to believe that what happened to you is standard practice.
Sure, but should and did are two different things, as is often the case.
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Old 11th September 2019, 01:22 PM   #44
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Originally Posted by Bob001 View Post
That's actually an interesting question. When someone is unconscious, how can they consent to be treated, let alone agree to pay for the treatment? Not that I would want ERs to turn away the most desperate cases, but legally, how are you liable for a contract you never signed?

Presumed consent is written into law pretty universally. If a person is in life-threatening circumstances (at least) and unable to clearly and unambiguously consent for whatever reason -- unconscious, underage, mentally incompetent, and so on -- and there is no other person who is legally able to speak on that person's behalf (and sometimes even if there is), then the law presumes that consent would be given under the circumstances, and authorizes medical personnel to act accordingly.

In a few cases, even clear unambiguous refusal of consent by a competent adult is not enough to prevent medical treatment; such as the failure of many hospitals and medical care providers to honor Do Not Resuscitate orders or similar advanced directives (some states actually have ridiculous requirements for creating legally-binding advanced directives, such as insisting it's not valid unless it's on yellow paper).
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Old 11th September 2019, 02:28 PM   #45
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Originally Posted by kellyb View Post
To answer this question as it pertains to ER care, most other "industries" are not ones where you're going to possibly be dead in an hour if you don't get the "service".

The really real question is, "Why is medicine treated like any other industry in the US, where doctors (except for in the ER) can turn patients away for inability to pay? Why is the US alone among developed nations in regularly dooming the poor to die from treatable medical issues?"

Why are we okay with this?
https://news.harvard.edu/gazette/sto...alth-coverage/


That's almost half a million people a decade.
This is the thing yeah. Most developed countries have figured out that this industry is itself special and can't be built on the same model as others.

It's the only industry where "Your money or your life," is a legal salespitch. Any other industry tries to pull this crap, it's a crime.
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Old 11th September 2019, 02:35 PM   #46
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Originally Posted by kellyb View Post
I wasn't even conscious when I accumulated my medical debt (over epilepsy.)

It's hard to "shop around for the best price" when you're unconscious. LOL
Or even fully conscious and injured, for that matter. And that's assuming there *is* an alternative.

I had a bike crash in the 90s where somebody opened a car door without looking into traffic. It was a classic car with non tempered glass, so it shattered into shards and one went into my femoral.

Ambulances in Vancouver at the time were private contractors that were the highest bidder on each neighbourhood catchment. I guess I could have phoned around for a few days and comparison shopped? Limped five miles with a squirting artery to the next catchment?

Seriously, anybody who claims healthcare is a 'market' is either ignorant as **** or a desperate liar.
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Old 11th September 2019, 02:43 PM   #47
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Originally Posted by blutoski View Post
Seriously, anybody who claims healthcare is a 'market' is either ignorant as **** or a desperate liar.
It's willful ignorance when it comes to one person in this thread, with whom we've been having this same conversation about health care and "market forces" for a decade now, since the ACA was being passed back in 2009.

"It is difficult to get a man to understand something when his salary depends upon his not understanding it."
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Old 11th September 2019, 03:02 PM   #48
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Originally Posted by blutoski View Post
....
Seriously, anybody who claims healthcare is a 'market' is either ignorant as **** or a desperate liar.

Well, it's definitely a market, in the sense that products and services are bought and sold. It's just not a free market. Captive market might apply.
Quote:
Potential customers who are constrained to purchase a good or service from a particular supplier because of (1) shortages, (2) competitors' high prices, (3) lack of competition, (4) unique feature or benefit of the item, or (5) the seller owning the buying entity.
http://www.businessdictionary.com/de...ve-market.html
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Old 11th September 2019, 03:06 PM   #49
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Originally Posted by kellyb View Post
What if you're walking down the street and get hit by a car, and are unconscious and bleeding profusely?

Will you just bleed to death over the course of the day and die on the side of the street?

Or if someone drops you off at an ER, do you die outside the door?
Just as a comparison model, Canadian hospitals have a treat-first-bill-later directive for patients not covered by the public plan.

This is why we have this frustrating medical tourism problem here in Vancouver. The US insurers buy their expensive surgery customers cruise ship tickets and coach them to have a sudden medical emergency when the ship stops in Vancouver's port. The hospital performs the surgery and bills the private rate, which is cost + 10%, and of course that's something like 25% of what an American hospital would charge, so worth the exercise.

It got so bad (triage is based on human need - a more urgent US visitor will get priority over a less urgent Canadian) for VGH where my wife works that they were pleading with the province to spread out the damage to other Vancouver hospitals.
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Old 11th September 2019, 03:08 PM   #50
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Originally Posted by Bob001 View Post
Well, it's definitely a market, in the sense that products and services are bought and sold. It's just not a free market. Captive market might apply.

http://www.businessdictionary.com/de...ve-market.html
Understood. Good clarification.
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Old 11th September 2019, 03:15 PM   #51
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Originally Posted by blutoski View Post
Just as a comparison model, Canadian hospitals have a treat-first-bill-later directive for patients not covered by the public plan.

This is why we have this frustrating medical tourism problem here in Vancouver. The US insurers buy their expensive surgery customers cruise ship tickets and coach them to have a sudden medical emergency when the ship stops in Vancouver's port. The hospital performs the surgery and bills the private rate, which is cost + 10%, and of course that's something like 25% of what an American hospital would charge, so worth the exercise.

It got so bad (triage is based on human need - a more urgent US visitor will get priority over a less urgent Canadian) for VGH where my wife works that they were pleading with the province to spread out the damage to other Vancouver hospitals.


According to US media, that's impossible, because it's the other way around, and Canadians all travel down here for surgeries, because your wait lists are so long.
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Old 11th September 2019, 03:28 PM   #52
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Originally Posted by kellyb View Post


According to US media, that's impossible, because it's the other way around, and Canadians all travel down here for surgeries, because your wait lists are so long.
I've heard of that happening, absolutely. But not to the USA. Mexico. And they come back botched and often have to get a correcting surgery.



There really are Canadians who bite the hand that feed them. It's the same Kool Aid. They start out with a Libertarian mindset and insist that this is the worst system ever because they had to wait 20 minutes to get examined by an MD in Emergency for their sore hangnail.

My parents are a good example! Hardcore conservatives. My mom voted for Harper in the last federal election. (he was not running, she wrote his name in manually)

Here's how their attitude manifest on the ground: I had cancer over winter and the tumour was removed on Feb 1st. The body needs to recover before chemotherapy. Mainly because chemo drugs nuke cells that are rapidly dividing, which is exactly what's happening in the surgical wound. Don't want to interfere with that until the healing process is done.

So my first cycle was slated for April. My dad's reaction: "Damn waiting list. You should go to a private clinic." I explained maybe ten times that the delay was not a waiting list, it was so the surgical incision and associated ripping out of intestines and mesentery had time to heal. Here we are eight months later and all he talks about to his friends at the golf club was that I am on some sort of waiting list for some sort of treatment. Tsk, tsk, they say, another example of bureaucratic delays. And the rumour propagates.
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Old 11th September 2019, 06:04 PM   #53
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Arguments about the benefits of universal healthcare don’t really address my fundamental question. I understand that other countries have universal healthcare. However, they don’t have universal “foodcare,” where groceries are free at the point of purchase. They don’t have universal housing where shelter costs nothing. Food and shelter are even more fundamental needs than healthcare. Imagine the health outcomes and cost savings in a system where healthy food is provided free of charge and every citizen is given safe shelter with clean drinking water. Yet those two industries are left to the same “evil-profit-over-lives” system that the US healthcare system is condemned for.
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Old 11th September 2019, 06:23 PM   #54
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Originally Posted by xjx388 View Post
Food and shelter are even more fundamental needs than healthcare. Imagine the health outcomes and cost savings in a system where healthy food is provided free of charge and every citizen is given safe shelter with clean drinking water. Yet those two industries are left to the same “evil-profit-over-lives” system that the US healthcare system is condemned for.
Market cost-reduction mechanisms, like "customers shopping around for the best deal resulting in competition and the lowering of prices" actually exist in the grocery stores, restaurants, etc.

Health care overall is not and cannot be anything like a normal "market". You can get a market for completely elective procedures, like cosmetics, eye surgeries that replace wearing glasses, etc. But when it comes to most real health care, "the market" does not really exist.

There's too much "static" in the information system between end customers and suppliers. There's no "invisible hand" there. For example, unconscious people being really poor at "smart shopping" is just one of many types of said "static".

How would one of your patients shop around for the best bloodwork/lab company to do a diagnostic test? How would the patient coordinate that service with your MD wife's care? Or if one of your patients needs an MRI, how does the patient go about choosing the best deal on MRIs?
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Old 11th September 2019, 07:42 PM   #55
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I am always partially on the fence about these kind of things, depending on the circumstances. From people I know, charity care at hospitals have covered a large portion or completely what they owed since they were in the range of income that allowed for it.

While I understand there are people that fall into the portion of the population where charity or medicaid/state insurance are not obtainable due to their income being too high, but still lack the income to pay for health insurance. I do have an issue with a certain portion that *could* afford it but take the gamble and then cry about that gamble not paying off. Sacrifices in life are necessary, and healthcare is one of those that should not be gambled and then complained about. The worst cases are always put forward but I wonder how much they represent the majority. Any studies that break down the situation further that I could look into to help form an opinion?

As for universal healthcare, I remember the last time I looked seeing the level of bankruptcies related the illness still remaining a large portion even in such a system. That is not to denounce the merits or benefits of the system, but to point out that the system itself does not necessarily protect against such issues.
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Old 11th September 2019, 07:57 PM   #56
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Originally Posted by xjx388 View Post
Arguments about the benefits of universal healthcare don’t really address my fundamental question. I understand that other countries have universal healthcare. However, they don’t have universal “foodcare,” where groceries are free at the point of purchase. They don’t have universal housing where shelter costs nothing. Food and shelter are even more fundamental needs than healthcare. Imagine the health outcomes and cost savings in a system where healthy food is provided free of charge and every citizen is given safe shelter with clean drinking water. Yet those two industries are left to the same “evil-profit-over-lives” system that the US healthcare system is condemned for.
First of all, an awful lot of countries do have "universal food care", and "universal housing", provided through various forms welfare payments, public housing, and other social safety nets.

The reason that health care is different is that it is unpredictable. You don't know when you will need it, but when you do it might cost more than you could possibly afford, and if you don't get it you might literally die. That changes the way it's administered.

Also, if you charge for it, people might decide to forego routine care, which might result in severe or fatal consequences later. That's different than food or shelter. Failing to get those results in immediately unpleasant consequences. People won't voluntarily forego them for a significant period of time in order to save a few bucks. I'm not saying that you ought not charge for it, but there are predictable results. The challenge with health care policy is to make sure that people don't die or suffer due to lack of ability to pay, while providing incentives somewhere to control the cost so that you aren't demanding the attention of an ICU ward every time you get the sniffles.

ETA: And, what kellyb said. We are not, and cannot be, truly informed consumers making a choice. We cannot accurately judge quality or even need for a product. If some doctor wants to run a test, how do we decide if it's "worth it"? We would have to have the knowledge of a doctor, at least, to make the decision.

In practice today, what we do is push the decision to an insurance company. If they are willing to pay the doctor for the service, it's probably a reasonable service, and if they are willing to provide the malpractice insurance, he's probably at least an ok doctor.

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Old 11th September 2019, 08:16 PM   #57
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Originally Posted by rdwight View Post
The worst cases are always put forward but I wonder how much they represent the majority. Any studies that break down the situation further that I could look into to help form an opinion?

As for universal healthcare, I remember the last time I looked seeing the level of bankruptcies related the illness still remaining a large portion even in such a system. That is not to denounce the merits or benefits of the system, but to point out that the system itself does not necessarily protect against such issues.
https://www.cnbc.com/id/100840148

Quote:
Bankruptcies resulting from unpaid medical bills will affect nearly 2 million people this year—making health care the No. 1 cause of such filings, and outpacing bankruptcies due to credit-card bills or unpaid mortgages, according to new data
Quote:
When their savings are gone and their credit cards are maxed out, stretched consumers take the drastic step of cutting back on prescription medications.

More than 25 million people are skipping doses, taking less medication or delaying refilling prescriptions to save money, NerdWallet found.

"That statistic is actually quite troubling," LaMontagne said. Delaying needed medication is a short-term fix that only triggers more health problems in the long term, she said.
The number of people going bankrupt in the rest of the developed world from unpaid medical bills is going to be extraordinarily low.

Being disabled can throw almost anyone anywhere into financial hardship, and result in bankruptcy, but that's a completely different issue from going bankrupt over medical bills.

Maybe someone from the UK, Oz, NZ, or Canada can explain how common it is there for people to go bankrupt from medical bills.

ETA:

https://www.amjmed.com/article/S0002...04045/fulltext

Quote:
Results
Using a conservative definition, 62.1% of all bankruptcies in 2007 were medical; 92% of these medical debtors had medical debts over $5000, or 10% of pretax family income. The rest met criteria for medical bankruptcy because they had lost significant income due to illness or mortgaged a home to pay medical bills. Most medical debtors were well educated, owned homes, and had middle-class occupations. Three quarters had health insurance. Using identical definitions in 2001 and 2007, the share of bankruptcies attributable to medical problems rose by 49.6%. In logistic regression analysis controlling for demographic factors, the odds that a bankruptcy had a medical cause was 2.38-fold higher in 2007 than in 2001.

Conclusions
Illness and medical bills contribute to a large and increasing share of US bankruptcies.
etaa:
The above study goes on to say:

Quote:
As recently as 1981, only 8% of families filing for bankruptcy did so in the aftermath of a serious medical problem.1 By contrast, our 2001 study in 5 states found that illness or medical bills contributed to about half of bankruptcies.
I'd assume the rest of the developed world is closer to where the US was around 1981 when it comes to medical bankruptcy.
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Old 11th September 2019, 09:48 PM   #58
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Originally Posted by kellyb View Post
https://www.cnbc.com/id/100840148

The number of people going bankrupt in the rest of the developed world from unpaid medical bills is going to be extraordinarily low.

Being disabled can throw almost anyone anywhere into financial hardship, and result in bankruptcy, but that's a completely different issue from going bankrupt over medical bills.

Maybe someone from the UK, Oz, NZ, or Canada can explain how common it is there for people to go bankrupt from medical bills.

ETA:

https://www.amjmed.com/article/S0002...04045/fulltext



etaa:
The above study goes on to say:



I'd assume the rest of the developed world is closer to where the US was around 1981 when it comes to medical bankruptcy.
Are any of your studies after the ACA was implemented? The data is a bit dated since the system has changed a bit, not that it is completely useless of course. There is a snopes article that questions a meme purporting some of this - Snopes

In Canada, it appears 1/3 of bankruptcy is attributed to medical reasons, putting it near in line with the US according to some research. To put simply, it is not as cut and dry as some seem to think.

When i see the number of insured people that require bankruptcy due to medical bills, I can't help but question what weight is given to such bills as opposed to general financial decisions. Being on the brink of bankruptcy due to bad spending and savings habits but being put over the edge by a 5k medical bill should not on its face being something the system should be blamed with. No time tonight to delve in further but I'll try to inform my opinion a bit more tomorrow.
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Old 12th September 2019, 12:48 AM   #59
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Originally Posted by xjx388 View Post
Arguments about the benefits of universal healthcare don’t really address my fundamental question. I understand that other countries have universal healthcare. However, they don’t have universal “foodcare,” where groceries are free at the point of purchase. They don’t have universal housing where shelter costs nothing. Food and shelter are even more fundamental needs than healthcare. Imagine the health outcomes and cost savings in a system where healthy food is provided free of charge and every citizen is given safe shelter with clean drinking water. Yet those two industries are left to the same “evil-profit-over-lives” system that the US healthcare system is condemned for.
And?
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Old 12th September 2019, 12:55 AM   #60
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Originally Posted by kellyb View Post
https://www.cnbc.com/id/100840148





The number of people going bankrupt in the rest of the developed world from unpaid medical bills is going to be extraordinarily low.

Being disabled can throw almost anyone anywhere into financial hardship, and result in bankruptcy, but that's a completely different issue from going bankrupt over medical bills.

Maybe someone from the UK, Oz, NZ, or Canada can explain how common it is there for people to go bankrupt from medical bills.

ETA:

https://www.amjmed.com/article/S0002...04045/fulltext



etaa:
The above study goes on to say:



I'd assume the rest of the developed world is closer to where the US was around 1981 when it comes to medical bankruptcy.
In the UK you can't go bankrupt for medical bills*, since such bills don't exist and therefore don't need to be paid. Now of course some people who fall ill may face bankruptcy because they can no longer work etc. but that has nothing to do with not being able to pay their medical bills.


*Of course someone could use private health care and then not be able to pay the bills,.
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Old 12th September 2019, 02:18 AM   #61
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Originally Posted by rdwight View Post
Are any of your studies after the ACA was implemented? The data is a bit dated since the system has changed a bit, not that it is completely useless of course.
2019:
https://www.cnbc.com/2019/02/11/this...ankruptcy.html
Quote:
A new study from academic researchers found that 66.5 percent of all bankruptcies were tied to medical issues —either because of high costs for care or time out of work. An estimated 530,000 families turn to bankruptcy each year because of medical issues and bills, the research found.
Quote:
The number of debtors who cited medical issues as a contributing reason for their bankruptcy actually increased slightly after the law's implementation — 67.5 percent in the three years following the law's adoption versus 65.5 percent prior.

The culprit for the lack of improvement was inadequate health-care insurance, according to a co-author of the research, Dr. David U. Himmelstein, a distinguished professor at Hunter College and founder of advocacy group Physicians for a National Health Program.
Regarding Canada...

Quote:
In Canada, it appears 1/3 of bankruptcy is attributed to medical reasons, putting it near in line with the US according to some research. To put simply, it is not as cut and dry as some seem to think.
30% vs 50% is a significant difference, and I can't find any research showing 30%.

See:

https://www.researchgate.net/profile...solvencies.pdf

Quote:
Based on research assistants’ review of debtors’ free-text descriptions of the cause of their insolvency, we estimate that health-related problems were the primary cause of 11.2 percent of insolvencies among our survey respondents

Quote:
Our findings are consonant with a previous study that reviewed OSB filings and concluded that 8 percent of individual debtors declared medical reasons as the primary cause of their bankruptcy/insolvency (3)
So...like I said earlier about the research saying "As recently as 1981, only 8% of families filing for bankruptcy did so in the aftermath of a serious medical problem"...and I commented "I'd assume the rest of the developed world is closer to where the US was around 1981 when it comes to medical bankruptcy". <<<---that looks to be about correct, according to the Canadian research I'm seeing.
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Old 12th September 2019, 02:36 AM   #62
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Originally Posted by rdwight View Post
When i see the number of insured people that require bankruptcy due to medical bills, I can't help but question what weight is given to such bills as opposed to general financial decisions. Being on the brink of bankruptcy due to bad spending and savings habits but being put over the edge by a 5k medical bill should not on its face being something the system should be blamed with. No time tonight to delve in further but I'll try to inform my opinion a bit more tomorrow.
$5k in medical bills was the minimum they mentioned, not the max. Most of these people will have bills in serious excess of $5k.


Also, most of the people in the study I linked to earlier were paying for insurance that didn't actually end up preventing them from having to file for bankruptcy over medical bills after falling ill, so I guess you could call that "bad spending and savings habits".

This is what insurance did for them:

Quote:
Unaffordable medical bills and income shortfalls due to illness were common; 57.1% of the entire sample (92% of the medically bankrupt) had high medical bills, proportions that did not vary by insurance status
If you're wondering what the breakdown is on going bankrupt from the bills vs losing work:

Quote:
When asked about problems that contributed very much or somewhat to their bankruptcy, 41.8% of interviewees specifically identified a health problem, 54.9% cited medical or drug costs, and 37.8% blamed income loss due to illness. Overall, 68.8% cited at least one of these medical causes.
Most of them were bankrupt from the bills.

Here's the chart that gives a really specific breakdown:
https://www.amjmed.com/action/showFu...02934309004045
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Old 12th September 2019, 02:58 AM   #63
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Originally Posted by Darat View Post
In the UK you can't go bankrupt for medical bills*, since such bills don't exist and therefore don't need to be paid. Now of course some people who fall ill may face bankruptcy because they can no longer work etc. but that has nothing to do with not being able to pay their medical bills.


*Of course someone could use private health care and then not be able to pay the bills,.
Page 10, table 2 here says it's a whopping 5% of UK bankruptcies due to illness/accident.
https://www.yumpu.com/en/document/re...ry-liquidation

You guys must have a pretty good income safety net for sick people compared to the US.

"Business failure" and "living beyond your means" are the primary causes of insolvency there.

eta:

https://www.who.int/healthsystems/to...Bankruptcy.pdf

Quote:
Outside of the US, research on links between over-indebtedness and health has been quite limited to date,
consisting largely of rankings of factors in consumer debt. For instance, within the United Kingdom,
sickness or disability accounted for 5% of households in financial difficulties in 2002
18. A ranking of
causes of over-indebtedness and private bankruptcy in Germany found that “psychological problems” and
“own sickness”, if added together, would rank in fourth place of reasons for over-indebtedness and
private bankruptcy19.
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Old 12th September 2019, 03:04 AM   #64
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Originally Posted by xjx388
Arguments about the benefits of universal healthcare don’t really address my fundamental question. I understand that other countries have universal healthcare. However, they don’t have universal “foodcare,” where groceries are free at the point of purchase. They don’t have universal housing where shelter costs nothing. Food and shelter are even more fundamental needs than healthcare. Imagine the health outcomes and cost savings in a system where healthy food is provided free of charge and every citizen is given safe shelter with clean drinking water. Yet those two industries are left to the same “evil-profit-over-lives” system that the US healthcare system is condemned for.

Actually most developed societies do have the equivalent of universal foodcare and housing care, it's just done in a different way, through the tax and benefits system.

As has already been noted, necessary food and housing costs are essentially the same for everyone, and are constant and predictable. In addition, many if not most people will choose to forego the most basic diet and housing requirements and opt for more luxurious choices at their own expense. There's therefore no benefit to giving everyone plain staple food or a basic small house.

Instead the tax system is organised so that everyone has a protected income which is large enough to be able to afford the basics. It's then left to them to decide what exactly they want to spend the money on - basics or something fancier. If someone doesn't have an income high enough to be able to afford the basics then the benefits system kicks in to make up the difference. This may be in the form of a financial grant, or something like food or accommodation vouchers.

But just because more affluent people don't get the grants or the vouchers doesn't mean it's not a universal system. The tax-free allowance ensures that they aren't paying tax on the slice of their income needed to cover these basics, so this is protected.
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Old 12th September 2019, 03:18 AM   #65
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Originally Posted by xjx388 View Post
Arguments about the benefits of universal healthcare don’t really address my fundamental question. I understand that other countries have universal healthcare. However, they don’t have universal “foodcare,” where groceries are free at the point of purchase. They don’t have universal housing where shelter costs nothing. Food and shelter are even more fundamental needs than healthcare. Imagine the health outcomes and cost savings in a system where healthy food is provided free of charge and every citizen is given safe shelter with clean drinking water. Yet those two industries are left to the same “evil-profit-over-lives” system that the US healthcare system is condemned for.
The NHS is not "free" and does not "cost nothing." It is funded out of our taxes - around 19% of them (i.e. 19% of tax paid, not 19% of income).
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Old 12th September 2019, 03:26 AM   #66
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Originally Posted by rdwight View Post
As for universal healthcare, I remember the last time I looked seeing the level of bankruptcies related the illness still remaining a large portion even in such a system. That is not to denounce the merits or benefits of the system, but to point out that the system itself does not necessarily protect against such issues.
Medical bankruptcies do not functionally exist in the UK.
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Old 12th September 2019, 03:48 AM   #67
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Originally Posted by kellyb View Post
Page 10, table 2 here says it's a whopping 5% of UK bankruptcies due to illness/accident.
https://www.yumpu.com/en/document/re...ry-liquidation

You guys must have a pretty good income safety net for sick people compared to the US.
By "illness/accident" the vast majority will be in the sense that that leads to them losing their job and/or experiencing a massive drop in income as a result of not being able to work as much or at all. It's not because of medical bills.
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Old 12th September 2019, 09:05 AM   #68
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Originally Posted by Information Analyst View Post
The NHS is not "free" and does not "cost nothing." It is funded out of our taxes - around 19% of them (i.e. 19% of tax paid, not 19% of income).


You highlited “free” but left out “at the point of purchase.” I think we are all well aware that it isn’t free.
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Old 12th September 2019, 09:12 AM   #69
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Originally Posted by xjx388 View Post
Arguments about the benefits of universal healthcare don’t really address my fundamental question. I understand that other countries have universal healthcare. However, they don’t have universal “foodcare,” where groceries are free at the point of purchase.
Originally Posted by Meadmaker View Post
The reason that health care is different is that it is unpredictable. You don't know when you will need it, but when you do it might cost more than you could possibly afford, and if you don't get it you might literally die. That changes the way it's administered.
I was trying to remember the last time I was suddenly and out of nowhere so hungry that if I didn't get a sandwich immediately I was going to die, but then I realized it was a painfully stupid analogy.
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Old 12th September 2019, 09:36 AM   #70
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Quote:
Also, most of the people in the study I linked to earlier were paying for insurance that didn't actually end up preventing them from having to file for bankruptcy over medical bills after falling ill, so I guess you could call that "bad spending and savings habits".
Unfortunately that happen a lot. Many of my employers offered insurance for a portion of every paycheck, but that insurance was next to useless because it didn't cover even the most basic care. "Dental coverage" that costs $200.00 per month, but won't even pay the cost of a routine cleaning or 10% of the cost of a filling is nothing but a complete rip-off.
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Old 12th September 2019, 09:43 AM   #71
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The impact of unpaid medical bills.

Originally Posted by kellyb View Post
Market cost-reduction mechanisms, like "customers shopping around for the best deal resulting in competition and the lowering of prices" actually exist in the grocery stores, restaurants, etc.

Health care overall is not and cannot be anything like a normal "market". You can get a market for completely elective procedures, like cosmetics, eye surgeries that replace wearing glasses, etc. But when it comes to most real health care, "the market" does not really exist.
Putting aside true emergency care for now, you have to think about why the market is that way in medicine. For so long now, we haven’t really had to worry about consumer facing prices. In fact, prices (as in what we actually charge) aren’t really important at all; what’s important is mandated/negotiated reimbursement from the government and commercial payers. On the other side, patients don’t have to think about it either for the most part. They have no idea how much their healthcare actually costs -they only know about whatever their insurance tells them they are responsible.

The ones who suffer from this are the uninsured. Our charges, being based off of insurance/government reimbursement rather than our actual costs, are ridiculously high. Well, at least most doctors’ charges are. We do things a little differently-our cash prices are completely divorced from what we charge insurance/govt. Our cash prices are affordable and very clear. Our cash patients know exactly how much they will pay at every step of the way -every test, every visit, every procedure. It takes effort to do that in our current system but it isn’t difficult.

If patients were directly responsible for paying, the system would have to adapt and make pricing clear and affordable.

Quote:
There's too much "static" in the information system between end customers and suppliers. There's no "invisible hand" there. For example, unconscious people being really poor at "smart shopping" is just one of many types of said "static".
There doesn’t have to be such static; it’s a direct consequence of the insurance-based system we have now.

Quote:
How would one of your patients shop around for the best bloodwork/lab company to do a diagnostic test? How would the patient coordinate that service with your MD wife's care? Or if one of your patients needs an MRI, how does the patient go about choosing the best deal on MRIs?
I’ll tell you a dirty little secret: Labs give us “client pricing,” which is extremely low. For our cash paying patients, we charge a little bit more than the client price which is still ridiculously cheap. So our patients don’t have to shop around; they are getting the best possible prices directly through us. We draw them, the lab picks it up and sends us the results electronically.

But every lab also has patient prices. They could easily call around and get prices. Insured patients rarely have a choice. Their insurer has negotiated rates with one or two national labs and they must use those labs. Even so, the prices they pay through their insurance are, frankly, ridiculous. In almost every case, they are better off paying us directly.


We have also negotiated with imaging centers. They have a cash price that would really blow your mind at how low it is compared to what they charge insurance/the government. The patient pays us, we send them across the street and the imaging center bills us each month.

As for my wife, she is actually doing something a little different: Direct Primary Care. She charges one monthly price that covers all her patients visits. For a little bit more, it covers almost every service she offers. The price is stupid low -$50/month for the basic plan. That’s it -she doesn’t take insurance so no copays or deductibles. I think in a truly free healthcare market, this is the kind of stuff you’d start to see.
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Old 12th September 2019, 10:00 AM   #72
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Originally Posted by xjx388 View Post
If patients were directly responsible for paying, the system would have to adapt and make pricing clear and affordable.

There doesn’t have to be such static; it’s a direct consequence of the insurance-based system we have now.
No argument from me. It's why a lot of Americans go down to Mexico to pay out of pocket for care.


Quote:
So our patients don’t have to shop around; they are getting the best possible prices directly through us. We draw them, the lab picks it up and sends us the results electronically.
How would a patient know they're getting the best price? How would they verify that?

Quote:
But every lab also has patient prices. They could easily call around and get prices.
Couldn't other doctors have other "client prices" what are lower than the patient price directly from the lab? There could be a cheaper doc and a cheaper "client price" from a lab out there.

Quote:
As for my wife, she is actually doing something a little different: Direct Primary Care. She charges one monthly price that covers all her patients visits. For a little bit more, it covers almost every service she offers. The price is stupid low -$50/month for the basic plan. That’s it -she doesn’t take insurance so no copays or deductibles. I think in a truly free healthcare market, this is the kind of stuff you’d start to see.
How much does she charge for a cancer diagnosis and treatment on average? For breast cancer, or kidney cancer? From initial visit to surgery/chemo/whatever, how much does that run on average?
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Old 12th September 2019, 10:05 AM   #73
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Quote:
it’s a direct consequence of the insurance-based system we have now.
I've long believed we should eliminate insurance altogether. It's a nice idea -pay in a small amount on a regular basis, and be covered later when we have bills to pay. But in practice it's just a Ponzi scheme with extra steps.
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Old 12th September 2019, 10:18 AM   #74
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Originally Posted by DragonLady View Post
I've long believed we should eliminate insurance altogether. It's a nice idea -pay in a small amount on a regular basis, and be covered later when we have bills to pay. But in practice it's just a Ponzi scheme with extra steps.
Actually, it's not insurance that's the problem. I mean, that basic idea is exactly what universal health care works on: everyone pays in, so they're covered later.

The problem is not so much the basic idea, but the implementation.

By making it voluntary, you end up "sorting" the pay-in pool in ways that defeat the advantage. People who are young and/or generally healthy look towards no insurance or cheaper plans with lower coverage amounts. High-coverage expensive plans tend to be filled by those who need that coverage. That sorting makes it worse, as the high-cost plans have to raise prices as the number of ill people increase, and healthy people leave the expensive plan for cheaper ones. The cheap plans end up getting their pool of healthy people, which works fine for a while, but then those people start aging or getting ill...which means the plan cost has to go up...which means the still healthy people start looking for a new plan...etc.

there are still problems, but just mandating that EVERYONE is in the pool is a big first step towards making it work. Various universal systems improve that more by making a single pool instead of competing ones, or similar things.
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Old 12th September 2019, 10:44 AM   #75
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Originally Posted by DragonLady View Post
I've long believed we should eliminate insurance altogether. It's a nice idea -pay in a small amount on a regular basis, and be covered later when we have bills to pay. But in practice it's just a Ponzi scheme with extra steps.
There's nothing wrong with insurance. Some people will have smaller health care costs all their lives, and others will have a catastrophic accident or need cancer care or brain surgery or a heart transplant, but there's no way to know in advance who will need what. Nobody should be ruined financially because of medical necessity.

But some countries -- France, Germany, Switzerland, Japan -- provide universal coverage through private insurance companies that are closely regulated, like public utilities, and provider fees are regulated, too. The problem with American health insurance is that it is profit-oriented, with financial incentives for charging as much as possible and paying out as little as possible. And the insurers aren't the only problem; hospital and provider fees are largely unregulated. Saying "everybody should just pay for themselves" is no solution at all.
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Old 12th September 2019, 10:50 AM   #76
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Originally Posted by kellyb View Post
I can't get the full report to look over but if his standards remain the same as his past work I still find his parameters too vast. It included everyone that had over $1,000 in medical bills or were out of work for two weeks at any point in the past two years.


Quote:
Regarding Canada...

30% vs 50% is a significant difference, and I can't find any research showing 30%.

See:

https://www.researchgate.net/profile...solvencies.pdf
Yup, been a while since I researched this any and numbers got conflated in my head. Was in regards to the overall rate of bankruptcies and a comparison between the US and Canada. Think Canada's rate was .3 which for some reason I equated with the ongoing discussion. It was close to the US overall rate, which the author purported to show 'if its not one thing, it'll be another' more or less.

The other study I remembered referenced 15% of people over 55 citing medical bills as the cause. That seems a bad age set to base anything on and dental and prescription costs, which are not covered, were primary drivers.
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Old 12th September 2019, 10:59 AM   #77
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Originally Posted by xjx388 View Post
Arguments about the benefits of universal healthcare don’t really address my fundamental question. I understand that other countries have universal healthcare. However, they don’t have universal “food care,” ...... They don’t have universal housing where shelter costs nothing. .....
Yes they do ... even the US has both ... food and shelter (and healthcare) in the US are free ... ask anyone on Welfare.
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Old 12th September 2019, 11:05 AM   #78
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Originally Posted by rdwight View Post
I can't get the full report to look over but if his standards remain the same as his past work I still find his parameters too vast. It included everyone that had over $1,000 in medical bills or were out of work for two weeks at any point in the past two years.
It says (this is the full text):

Quote:
Table 1 displays debtors’ responses regarding the (often
multiple) contributors to their bankruptcy.
The majority (58.5%) “very much” or “somewhat” agreed that medical expenses contributed, and 44.3% cited illness-related work loss; 66.5% cited at least one of these two medical contributors—equivalent to about 530 000 medical bankruptcies annually.
(the "very much" figure in the table is 37%, and "somewhat" is 21%)

I'm not seeing anything about "everyone that had over $1,000 in medical bills or were out of work for two weeks at any point in the past two years" anywhere in there.

Quote:
The other study I remembered referenced 15% of people over 55 citing medical bills as the cause. That seems a bad age set to base anything on and dental and prescription costs, which are not covered, were primary drivers.
I saw that, too, and also thought it wasn't very useful data for doing a US vs Canada comparison.
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Old 12th September 2019, 11:11 AM   #79
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Originally Posted by Ron Swanson View Post
Yes they do ... even the US has both ... food and shelter (and healthcare) in the US are free ... ask anyone on Welfare.
We don't really have much in the way of "welfare" any more, and haven't since the 1990's.

Are you talking about this?
https://en.wikipedia.org/wiki/Tempor...Needy_Families

Quote:
The TANF program, emphasizing the welfare-to-work principle, is a grant given to each state to run their own welfare program and designed to be temporary in nature and has several limits and requirements. The TANF grant has a maximum benefit of two consecutive years and a five-year lifetime limit and requires that all recipients of welfare aid must find work within two years of receiving aid, including single parents who are required to work at least 30 hours per week opposed to 35 or 55 required by two parent families.
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Old 12th September 2019, 11:46 AM   #80
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Originally Posted by johnny karate View Post
I was trying to remember the last time I was suddenly and out of nowhere so hungry that if I didn't get a sandwich immediately I was going to die, but then I realized it was a painfully stupid analogy.
That, for some, would be an added motivation to post. What's wrong with you?
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