Hilarious.

But I thought we were an anarcho-syndicalist commune?

Of course, that’s because Australia is a communist dictatorship populated by criminal rabbits.

First, we’ve got Medicare: paid for by a 1% levy on taxable income (with conditions, so it’s not like it sounds), this covers GP consults, most surgery stuff, hospital stays, and some specialist stuff. It’s for everyone. There is a small ‘gap’ payment on most things, but it’s affordable: say, $15 for a GP visit, and so on.

Then we can, if we choose, add private health insurance, which can cover private rooms in hospital, specialist and alternative treatment like massage (with a licensed practitioner), dental, gym membership (a contribution thereto), nutritionist, acupuncture, physio, etc.

Before I lost my job, I had pretty much the top of the range coverage. It cost me about $65 a month. And that’s Australian dollars, mind, not greenbacks. Folks with this sort of coverage would complain bitterly and at length if asked to pay a contribution to surgery of some hundreds, not hundreds of thousands.

This stuff was set up by a previous government, not Howard the Weasel. And since Howard has his tongue high up Bush’s rectum, he’s trying to whittle it away, but for the moment we’ve got it and it works. And the emphasis is very much on prevention rather than cure.

Oh, and did I mention that the private health insurers are non-profits?

The new one says you can see a specialist without pre-approval as long as it’s “medically necessary”. Sounds like an improvement, right? No gatekeepers?

It’s had the effect of keeping us from seeing specialists at all. Because we don’t know until after what they’ll pay for, and it turns out to be not much on a regular basis. If you complain, they point out that they explicitly told you there was no guarantee they’d cover it, and they simply don’t agree with your doctor that it was medically necessary, so you’re screwed.

Again, I *have* insurance and I avoid doctors, and have spent close to three thousand in out of pocket this year alone. Not including premiums. We have a five hundred dollar deductible per person per year… but that only applies when they have actually agreed to cover something in the first place.

I have a feeling Congressional health care is not only really comprehensive, but also requires a minimum of paperwork and pre-approval. Why on earth should *they* worry about the rubble-built maze the rest of us have to try to navigate to get treated?

My old insurance, I would like to note, was Aetna. If you’ve got it, hold on to it. They seem to have a copayment and paperwork hurdle they use to decide if you’re really sick, but once you’re over that, they stop fucking with you and pay up, and will actually be helpful. They may get more obnoxious again when you start costing them a lot of money, but I loved them. (Of course, I was abused by bureaucracy at a young age and have a certain Stockholm Syndrome relationship with this sort of thing.)

One of the current GOP candidates for Prez has said pretty much this, with refinements about how people need to be more responsible for their care rather than, you know, just running off to the doctor because you think you’re sick, or going to the first ER you can get to without regard for price.

What planet do these politicians live on? Do they ever read the statistics generated by those reports they appropriate funding for?

The average uninsured family spends less than a thousand dollars per year on medical care–of all types.

Those who are fortunate enough to have insurance are told which doctors we can see, and which pharmacies we must purchase from, for our treatment and prescription meds to be covered under the plan.

Under most insurance plans, you don’t get to see a specialist or have a test performed until you have consulted a “gatekeeper” physician.

Most people under age 65 who have insurance are covered by plans provided through their employers. If you lose this coverage, and you have been covered under the plan for fewer than 18 months, you have to exhaust COBRA/Continuation coverage (usually 18 mos.) in order to receive reasonably priced conversion/individual health insurance that covers any pre-existing conditions. And oh, if your employer changes plans, and the new plan is not as comprehensive, you’re pretty much screwed, as your coverage under COBRA/Continuation is tied to the employer’s plan. In my experience, the cost for this coverage with dental can go as high as $1,200 per month. (Keep in mind that I’m relatively healthy.)

Assuming they are not eligible for federal or state aid, uninsured people pay more for medical care. The heart bypass operation that Medicare pays a hospital $85,000 for will cost most health plans $100,000-$125,000. Uninsured patients are billed the “normal or customary fee” –which may be close to $200,000. Similar economies of scale apply to doctor visits.

Pain is one of the most common patient complaints. Most plans encourage patients to seek the generic “magic bullets” of Rx drugs or surgery, rather than non-pharmaceutical or non traditional intervention, e.g.: appliances, massage or accupuncture. The latter are often equally effective and less expensive. (Not to mention a hell of a lot less addictive than Vicodin!)

And thanks to Hatch-f*cking-Waxman, many patents on prescription drugs can be extended long past the statutory 20 year period when generics would be available to ease costs for many of us.

And then there’s the nightmare of the recently amended Medicare plans that is too involved to broach at 1:00 a.m. …..

So to the men and women in Congress who are Clueless Inside the Beltway: Thanks for allowing Big Pharma to hose me and others in similar straits for thousands every year, while telling us to save money by shopping around for ERs

One of the current GOP candidates for Prez has said pretty much this, with refinements about how people need to be more responsible for their care rather than, you know, just running off to the doctor because you think you’re sick, or going to the first ER you can get to without regard for price.

I’m an extreme case, but I will note that I tend to assume everything will go away on its own eventually, or I’ll get used to it. So when I finally go in to see the doctor and she says, “How long have you been ignoring this this time”, I get to say, Oh, just a few months… And I get a lecture with lurid photos of what this could have turned into because I ignored it. But it’s given with a sense of resignation, and I get the impression that an awful lot of people do the same thing.

In fact, the reason so many people end up in our ERs is that they *don’t* go dashing off to a doctor whenever they think they might be sick, mostly because they can’t afford to or are uninsured altogether or can’t get time off work or have no transportation or childcare.

I do know that it’s often presented as a common sense measure that you should call around to pharmacies to find the best price on meds. I will take generics whenever they are available, but they aren’t always, and that’s a matter of industry lobbying as well. But you really should get your prescriptions all filled at the same pharmacy, especially if they’re from different doctors, and it is pretty much routine for each pharmacy to charge a lower-then-average price for some things and a higher-than-average price for others, so comparison shopping doesn’t help as much as you might hope.

I know my insurance tries to encourage me to get my doctor to sample me by various measures, but I tend to agree with my doctor that samples should be saved for people without insurance, who can’t afford the meds any other way, and I will not ask for them unless the insurance company is outright denying me something I need right away, and even then I still feel guilty and something of a sucker because I have a feeling that’s what they were hoping for all along.

In general the free market health care boosters suggest things like asking a number of doctors for their rates on elective and non-emergency surgeries and procedures, but most of the time you’re still on the hook for the consultation, and your insurance company won’t pay more than one of those for any given procedure.

As far as I can tell, the whole thing is designed to make you feel like ignoring your problem is easier unless you’re actually going to die. It seems to work pretty well, too.

Of course, between the millions of people who have to dig into their tax returns to pay for basic care and the thousands of poor, afflicted MBA-men cruelly deprived of a fifth Lamborighini, well, we all know which the political media – and the lobbyist-saturated major parties – care more about.

For one thing? Never ever ever ever blame doctors for it. Doctors in the aggregate – represented by assholes like the AMA – possibly, but the people running those freakshows are typically rich jerks anyway.

Every dollar that gets spent on healthcare? Two cents of it go to physicians. Eighty go to hospital administration – of which about three pay for actual administrative costs.

In other words? A physician makes between 150,000 and 500,000 a year. (This is, for what it’s worth, what I’d like to see the maximum salary in America be; it represents over a decade of concerted training and experience to do something completely vital in which the better you are the better off people are and in many cases the doctors are just barely able to pay off their student loans with it anyway.) They spend 8 years getting an MD for it, spend between 3 and 10 (!!) years in residencies before they get to use it, take a barrage of incredibly difficult exams to even get hired by the hospital, and maybe by the end of their lives get paid a million, tops.

Medical administrators, whose MBA apparently makes them better-qualified, are paid between $5 and $20 million a year. Yes – APIECE.

How in the hell does the hospital pay for that absurd capitalist graft, you ask? Well – simple! Because the insurance agencies essentially dictate the prices for procedures as an invincible cartel, and because hospital administration and medical insurance are basically friendly to one another, some procedures cost slightly more than the market value would seem to dictate. Take, for example, changing a bandage.

The hospital might break this down into five procedures: examining the dressing, removing the old bandage, examining the wound, cleaning the wound, dressing the wound. Typical costs for that start – as in, they might be an order of magnitude more in some places – at respectively about $100, $250, $250, $400, and $500. This costs the hospital between $5 and $10 for supplies, and the physician isn’t even paid a cent for it – it’s a routine part of her or his follow-up. If you break down her time in terms of opportunity costs, you’re dealing with a maximum of $50, maybe $100 for a particularly egregrious industry (which could, again, cost an order of magnitude more.) So the hospital has just pocketed $1400 or so for what amounts to a high-end band-aid.

The hospital has a lot of money to throw around that way, which it might spend on equipment or it might spend on generous pay for its administrative staff (guess which they usually prioritize – go on!). The insurance company only has to pay a bit of those prices – but they get to pass the entire cost onto the patient, pretending they’ve shelled out more than they have and charging accordingly.

American medicine is intensely bureaucratic. Government bureaucracies are the best of both worlds: they get the humanizing touch of the bureaucracy in executing government policy and the public oversight that comes along with a democratic government. Private bureaucracies have no official oversight and usually turn into corruption mills that prey off of human misery. There’s more human misery to pray on in the hospital injury than in any other.

In short, the system is more fucked than you can imagine, and almost certainly for reasons you’ve never even heard of. (The Powers that Be have a certain interest in people having the wrong answer.) And don’t even get me started on pharmaceutical companies.

Apparently Clarian Health is an insurance provider, so I’m guessing they have access to the records as the insurer. Pretty gross.

Someone will sue the hospital under the Americans With Disabilities Act, and win.

Penalizing people for poor health is discrimination.against people with disabilities. It doesn’t matter whether the disability is addiction, obesity, some inherited condition, a condition due to injury, or what.

And it has even more invidious implications. Will black employees face deductions for being more likely to have or carry sickle cell anemia? Will Jewish employees get nailed for having or carrying Tay-Sachs? What about diseases unique to each sex? It’s not just disability discrimination; it’s also effectively race, religion, and sex discrimination, too.

Any way they approach it, it’s discrimination under the ADA and actionable. We need to get fair, equal, NON-PROFIT SINGLE-PAYER health insurance, and the best way to do that is open Medicare to all (or to all employers, at the very least!) and stop the blood-sucking, benefit-chiseling behavior we see from for-profit entities like this hospital’s insurance scheme.

Did someone say ‘fucking bastard’?

Snicker. *scarfs down chicken, growls at sister* Snicker.

Ahem. *licks paws*

Teh Handmaiden is uninsurable, because she has MS. In order to get on one of the interferon treatments, you need a diagnosis of MS, but once you get the diagnosis, no one will insure you except Medicare. Or Medicaid, I think, but we make ‘too much money’ for that. Also, the Handmaiden can’t buy life insurance, even though life expectancy for people with Relapsing/Remitting MS is pretty much the same as for people without it.

As long as she lives longer than I do, and stays well enough to be my minion, I don’t care, though. The Handmaiden says I have the temperament to ‘work’ for an insurance company. I don’t know what she means by this ‘work,’ but I don’t really care enough to find out.

Mmm. Chicken.