A topical steroid I assume? Sure it’s an immune suppressant, since eczema is an immune condition. Topical steroids are standard of care.

Definitely, but it is a result of the mismatch in costs relative to expectations of quality and quantity of healthcare with current supply of doctors and medicines (out of patent).

I am in favor of the US federal government to spend money on R&D for medicines resulting in fewer patented medications resulting in lower cost medications. And also reforming the process to becoming a doctor because obviously people want more doctors. Not necessarily making doctors less qualified, but the whole spend your 20s torturing yourself is unnecessary, along with wasting 4 years on a bachelors.

> Thanks, Obama.

Yes, thanks for getting the only legislation passed in the past 30+ years that expanded access to healthcare.

FYI, ACA is what made it possible for people to even purchase healthcare coverage without an employer. And also, taxpayer funded healthcare (“public option”) was preferred by the Obama administration, but had to be whittled down to meet the compromises needed since there was basically zero support from across the aisle.

The tax benefits of health coverage via employers is a separate matter, and while it should have been addressed, I am not surprised nor would I blame Obama for that, since it was already hard enough to get what we currently have passed.

Yes, it is difficult to pin down an exact definition of insurance in cases where the cost is all but guaranteed.

I can see their point now, but at the time I was thinking relative to other taxpayer funded healthcare systems.

There are many different kinds of insulins at different prices, and apparently, in the US there is not though political will to pay for any choice of them as even the federal government restricts which one it pays for.

https://www.healthline.com/diabetesmine/new-medicare-program...

Is it 20 to 40 euros for any and all insulin or specific insulins?

Or you start cooking meth.

All asian countries ? china ? japan ? india ?

Any book about their systems ?

It is a spectrum of course, but a 500 Euro out of pocket maximum is probably better described as taxpayer funded healthcare.

The US is pay $400 to $1,200 per person per month from age 0 to 64, and then pay up to $8,700 individual / $17,400 family per calendar year.

At age 65, the government starts paying for your hospital care assuming you or your spouse paid Medicare taxes for at least 10 years, and you then have to buy a nebulous blend of subsidized care / insurance for other things like medication, doctor visits, etc.

This is a really interesting idea. Seems like it would kind of level the playing field and might help guide us toward what I think is the ideal situation - no one needs health insurance other than for a catastrophic event because prices are known and reasonable and you just pay them, like literally every other service we need and consume.

> The twisted thing is that you can't just get the operation done and let the prior authorization work itself out later. It truly has to be prior or you get stuck paying out of pocket, even if the operation is obviously medically necessary.

I have had doctors collect payment, and then refund me once they get paid by the MCO.

One more thing that would help here is decoupling employers from your MCO. That way, when you change employer and location at the same time, it does not mean you change your MCO. If the person who wrote the article had the same Blue Cross Blue Shield MCO (or other MCO part of a nationwide network) with old and new employer, then he would have had no reason to seek out a new doctor and new medication.

Then you sell the Emmy, and you'll have enough money for one month worth of insulin.

The relatively new surprise billing and emergency care from out of network providers to be treated as in network providers legislation changes that:

https://www.cms.gov/nosurprises

https://www.hhs.gov/about/news/2021/07/01/hhs-announces-rule...

For non emergency care, it should be easy to login to insurance company’s website and see if doctor or doctor group is in network or out of network.

Who is they? And define quality control.

I think the point was that seniors as a demographic generally vote for politicians that don’t support those policies, against the wishes of the majority of the rest of the population.

This is an overly paternalistic point of view that robs these people of their agency.

They've spent their lives participating and interacting within the current political framework. Blaming all problems at the feet of "morally bankrupt leaders" is hyperbolic populist rhetoric to absolve personal responsibility.

> A system that rations care based on ability to pay... is immoral.

You lost me there. What makes it immoral? Money is an asset allocation tool, so why is it morally wrong to use it for medicine the same way we do for food and housing?

Genuine question. I have a hard time understanding what sets medicine apart from everything else when people think healthcare should be universally free, but not food, water, clothing, housing, etc. especially considering those other things are more directly necessary for survival.

In countries with public healthcare it’s still based on ability to pay. You pay out of pocket and cut the queue, have decent time allotment with the doctor, get best medication available without money-saving algorithms etc.

Right. The rationing should be based on ability to lobby, and the decisions should be made by politicians and agency bureaucrats.

The worst part is we only got this service because it was represented to us as free. It was a genetic test that was nice to have but not strictly necessary. We would not have gotten it if we'd known we would be billed $6k.

Now I feel like I will have to screenshot and archive every digital representation that is made to us about whether X will be covered and be prepared to initiate a lawsuit over it.

In the meantime we will simply not be paying the bill. I've been thinking about doing this for many other medical bills we receive as well. It's all so arbitrary and uncontrollable. I simply don't feel I have an obligation to pay a bill in a made-up amount for made-up reasons I have nothing to do with.

I am a very reliable bill payer and normally see it as a basic matter of personal responsibility, but this broke me.

If the problem is around different insurers paying for different brands, then yes, I think the solution is for the consumer to have the choice of MCO rather than it being tied to the employer. But I'm sure this would create other problems and snarl the system with even more complexity.

That's ignoring the fundamental cosmic absurdity of this entire system, with its pretense to be some kind of competitive private market with the usual benefits of such. When in reality, insurers are just a bunch of hogs at the trough that you're shuffled between as you change employers. The private market does not seem to create any sort of incentive for efficiency or a better consumer experience.

That’s exaggerated. Generics are well known to be effective, and exceptions are unusual. Here’s some commentary to that effect, talking about research to the contrary: https://www.health.harvard.edu/staying-healthy/do-generic-dr...

It’s reasonable to expect people to exhaust lower cost alternatives, that are reasonably expected to work, before stepping up costs.

It can also just be a matter of convenience. When I was first put on testosterone I was prescribed AndroGel, which is a gel you out on once daily. It costs $400 a month. Insurance gave a bit of hassle but with my test numbers they acquiesced.

They shouldn’t have, though. Injections (what I’m on now) work better. They’re easier to maintain the correct dose, you don’t have to worry about getting it on your partner/kids, you only take it once every week or two…and it’s maybe $20 a month.

That’s not just a few dollars saved. There are probably hundreds of thousands of men out there that take it. I see there’s a generic gel now but it still costs anywhere from $60-$150 a month.

Thousands of dollars per patient times many different patients and drugs quickly adds up to a substantial proportion of all healthcare spending. Countries with universal healthcare have specific programs in place to move people over to generic drugs for exactly this reason, or at least the UK does - along with policies that intentionally give people less effective treatments if the better ones are a lot more expensive. It's one of the ways they stop costs from ballooning as much as they have in the USA.

No, sorry “the doctor knows it won’t work” is complete BS.

We don’t spend 100x on a drug because a doctor “has a feeling”.

The insurance requirements are typically quite limited for 1st line failures. Doctor just needs to prescribe then 2 weeks later attest that it didn’t work.

Seems reasonable to save the healthcare system thousands of dollars when tens of dollars would do?

Which doctors know? Insurers have doctors too, that's why they have these rules. What do the doctors treating the patient know that the insurers don't know or are refusing to acknowledge?

Well at least in Europe pharmacists always tell you about generics, that they are cheaper and work the same. Not sure who is spreading misinformation here.

Maybe you're talking about different medicines that people are using (like different insulins), the generics use the same formula as the original.

Above my pay grade. Would be good to look at the countries that have a lower death rate per 100k and see what they are doing.

Most likely we need to reform the insurance industry, but systemic changes are definitely needed.

The first covid vaccines came out of the UK and Germany. Whoever told you we're just stealing from the US has their head firmly in the sand.

Your last comment is the reason for the massive gap between list price versus net price in the US system.

The US has a rule about “usual & customary price”. That’s a legal definition and providers can’t charge any customer more than that.

If you’re looking to price discriminate, you set your U&C price as high as possible, maybe 2-5x what you’d accept. That way if you find a customer willing to pay 4X, you’re not running afoul of the law.

For everyone else, you negotiate a much more reasonable net price, typically through insurance.

The people who get screwed in the end are ones without insurance. They get billed the imaginary number nobody ever intended anyone to pay.

People don't consume healthcare "all the time" the same way they do food, housing, water. Preventive healthcare is cheaper/less work than treating illnesses that have gotten more serious, leading to less total consumption of healthcare (and those other downstream resources impacted by people avoiding preventive care). Also "Free healthcare available to all" doesn't preclude a private market. The Govt Healthcare is not always timely, may not cover treatments people want, or cover certain elective surgeries. Some people will always choose to participate in a private insurance market that provides value above a baseline govt health plan.

Someone must be lobbying for it. I would like to be in the room when the Senate panel discusses things like this.

Let us let businesses pay for MCOs with pre tax dollars. But not individuals, that would be undesirable….why?

Let us let businesses select retirement fund options for employees, and then let employees save $21k to $50k per year of pre tax money if they invest in their employer’s retirement savings options (401k).

Let us only let individuals save $6k pre tax in their own retirement account, without the meddling of employers. Let us go one step further and phase this benefit out if one employee works for an employer with 401k and the other does not.

As of 2020, let us let employees pay for student loans with pre tax money if they pay through their employer. But not students who pay themselves.

Let us pay for public transit with pre tax money, but only if via employer.

And so on and so forth. You see TONS of laws that explicitly give an upper hand to employees of well funded employers, effectively giving a competitive disadvantage to employees of poorer employers (small businesses, immigrants) and simultaneously incentivizing those who do work for well funded employers to not seek other options, such as starting their own small business.

The people that are most concerned about insurance before quitting are generally the ones that have expensive, known health issues.

Which self insured employers pay for directly.

So the barriers to switching aren't necessarily good for the employer either, because the more reliant someone is on their health insurance, the more they cost the company, and the less likely they are to ever leave.

You're choices are: die, or pay whatever cost is associated. its not a choice that can be negotiated. markets don't deal with this situation well. changing hospitals don't change the baseline costs for providing health care in a significant manner for there to be competition nor are many hospitals in a competitive market (often there is only one hospital for an entire rural region).

that's before even getting into pharma. which can charge millions of dollars for life saving/changing drugs for single course treatments. hell take a look at what happened with epipens. there is no protection against profiteering via nebulous 'markets' when your choices are 'purchase or die'.

The analogy is apt since it was an example of the idea that some people, thankfully, are aware that some services should not have their availability based on ability to pay at the point of usage. In the U.S. system denials of care by insurance companies are not done so another person can get said care. They are done to increase profit margins and profiting from denying someone care is immoral.

Ahhh, ok. I see where we are disagreeing. You're assuming some equivalencies in what I'm saying that I do not.

> Police, most roads, and certain aspects of the legal system are free at the point of usage.

Sure, and those generally work well because the overhead is low. The per person cost of all of those services combined is extremely low compared to medical expenses. If giving everyone healthcare cost the same as giving every 911 service, this conversation wouldn't be happening.

> It’s bad to have for profit police, court system, and Air Force.

I think government and the monopoly on violence are generally good so long as the government is democratic, so sure.

> Some things ought not be profit driven

Totally agree. Executions and jails for instance. Anything were the service involves inflicting violence or removing rights is probably better left to a democratically elected organization.

> It’s quite disconcerting that someone sees no problem with a person profiting from denying healthcare. I should not be able to enrich myself by denying you health care. Tough decisions need to be made and the motive for the decision should not be profit.

You're confusing the role with the action. I think 'being the organization that prioritizes care' can be profitable and ethical. That's different from saying 'an organization should get paid for saying no to someone'. Those are two different things and you're assuming that you can't have the first without the second. The insurance company doesn't make money off 'saying no', it makes money off codifying rules that distribute healthcare and enforcing them on a set of people buying into those rules. When more people are denied they make more money, but they aren't 'denying to make money'. It's a different incentive structure from you're describing. Also, nobody in that scenario is 'denying care' they are denying paying for the care. You're still free to go receive the care and pay for it yourself. You can also find a charity and convince them to pay, or crowd fund. That's actually a benefit of the market driven system: there is no such thing as a 'hard' no.

> I am not more important than you or anyone else. I don’t deserve health care before you just because I have more money. That’s a perverse idea.

Totally agree. Having the ability to purchase something is not the same as 'deserving' that something. Two entirely different concepts that live in different systems. One is grounded in the philosophical idea of fairness, and the other in the physical process of voluntary exchange.

> Unfortunately too many Americans embody the Bible’s warning regarding the love of money.

Totally agree here too, as an agnostic, although that's kind of a tangent.

> sadly its not. you're in pain? you need to visit a medical facility to figure out whats wrong. without knowing how serious it is it can lead to a life long issue. again you don't really have choices here. pay the healthcare tax or risk long term issues.

I don't see how that is a congruent thought. The 'sadly it's not' doesn't follow from your statement after. If you are in pain without knowing how serious it is, you would likely get opinions from several doctors. You're not going to walk into the first hospital you find and say "I'll pay anything you ask just fix me."

> the capitalists idea of a market simply doesn't apply to healthcare.

You still haven't made a logically coherent argument as to why it doesn't. The vast majority of healthcare transactions are made between two lucid and consenting parties.

> this isn't true. we fund hospitals in rural areas because there literally isnt enough people to keep one operating via patient care.

That backs my point, right? Those hospitals aren't funded by emergency care either, which means the point about costs being a one sided negotiation while the other party is dying is still inaccurate.

> you're also asserting that if the populace can't sustain the healthcare system then it shouldn't be available to people. which is fairly cruel and immoral.

I don't think recognizing the limits of a given resource is cruel or immoral, it's reality. Us not having perfectly clean energy is killing us all, but it isn't cruel and immoral, it's a problem that needs solving. If a town can't afford a hospital, and you want to live in a town with a hospital, move, right? I don't see any reason why taxpayers should pay so a small mountain town in the middle of nowhere can have a staff of doctors and nurses to support a population of 100 people. If someone wants to live in the mountains of Oregon, I don't see how we have a responsibility to pay for a medical care facility to follow them up.

> No you're not. You can choose which hospitals you're getting opinions from.

you clearly don't understand how hospitals work. getting opinions costs money. just visiting and taking their time costs money.

you can get a hospital to quote you the cost of a procedure. but to actually get a doctor to diagnose you takes time, resources, and tests. this costs money. and without doing said work you have no idea what procedures to get a quote for.

and frankly the only reason to get multiple opinions is if the current doctor has failed to resolve your problem.

no one jumps doctor to doctor unless there is something wrong with the current one like a lack of progress on resolving the issue.

> You're the one constantly conjuring some vague sense of morality as opposed to discussing which models may work better than others.

without understanding the moral outcomes of an economic system makes any such discussion meaningless. You should checkout Albert Hirschman https://www.ias.edu/press-releases/albert-o-hirschman-1915%E...