Good one. Now if I may humorlessly interject a factoid I learned as a parent of small children, the stitches cost you a $25 copay at the local urgent care on my not very generous form of BCBS. ;-)
Urgent care clinics (my dad used to call them "doc-in-the-boxes," which I assume some western US person coined) are a genius invention that is sorely lacking in many int'l systems and US regions. Taking those can't-wait-until-normal-office-hours-but-no-one-will-prioritize-you level cases out of hospital emergency departments makes a huge difference in cost and wait times.
Maori? That's New Zealand. The healthcare system there is that you have to outrun the ringwraiths to Rivendell and if you get there they'll heal anything you've got.
Who the fuck cares what a bunch of sheep-shagging hobbits think.
(In seriousness New Zealand is a beautiful and amazing country and I didn’t detect any resentment of the connection when I travelled there in 2007. They certainly seemed happy to profit off it from tourists!)
It can easily cost multiple thousands though. I had a pretty minor surgery last year (I was put under, but I was in and out of the hospital in a few hours) and my insurance paid more than $40,000.
I live in Western Mass now after living the first 36 years in the NY metro area with great employer-provided health insurance, and the next 4 years with zero health insurance while I bopped around the country as a freelancer, and I have to say Massachusetts, where I moved 8 years ago, fucking sucks. Not only did the process of obtaining the much (bullshittily) lauded state health insurance as a freelancer require ridiculous amounts of hours and faxed pages, I was rudely awakened to the fact that almost no provider of worth accepted it, and it was nearly impossible to determine who *did* accept it as the data on the state websites was hidden or was linked to contact numbers that went 100% unanswered. If you cold-called a provider to ask (in my case, dental practices when I had an excruciating tooth abscess) and they didn’t take the state insurance, they were *legally* prevented from treating you at all even if you could pay out of pocket. I ended up treating my abscess by calling a dentist and lying and telling them I had no insurance at all. I ended up just getting married so I could go on my boyfriend’s insurance. I now have my own through an employer, but I seriously injured my finger recently and couldn’t get an appointment for a specialist for 2 months. My husband has had his annual physical postponed 4 times after having made the appointment a year in advance. He currently has no standing appointment because the staffing issues at the provider group are so abysmal. And this is with insurance through employment by a top-tier college in Massachusetts.
Were you not able to get on Obamacare? I mean, is that what constitutes the state health plan there? Our state health insurance (SC) is exorbitantly expensive.
This was 8 years ago and I’ll confess, I didn’t look into Obamacare in MA (MA has its own state health insurance). I looked into Obamacare as a freelancer in WY when I lived there a year or two before and there was exactly only one provider available, and they were really expensive, so I just went without and pad the penalty. My (now) husband said he liked the MA state health insurance when he was on it (in his 20s, with no problems) so I think I just went into it enthusiastically and by the time I was disgruntled, I was ready to get married. I never before encountered a situation where a provider could turn you down for *having insurance but refusing to use it.* If this is what regulations get us, then color me a Libertarian.
That sucks, I'm sorry. I was on Obamacare for a few years and loved it. Granted, I didn't have any major medical issues during that time but it cost me only $5 to see a therapist!
This is my first new episode as a primo and I just wanted to say how much I enjoy the show. I have to drive all over rural Alberta for work and the both of you keep me company while I was traversing the literal middle of nowhere. :)
I met some of my first detransitioners in the lesbian community about 10 years ago. One friend wrote to me not even three days after her double mascetomy saying she’d made a terrible mistake. She didn’t want to be a man; she was dealing with the trauma of a brutal rape on an agricultural work camp and felt this was the only thing she could do to escape. She stopped T about two weeks after. (She said: “well, you’re not worried about what people will think so I feel like I can tell you.”) I thought a lot about what she had endured and what she felt she couldn’t say. Since then I have always tried to maintain that skepticism and concern about what happens when people can’t speak freely. Fortunately the friend is doing much better now: she and her long term girlfriend run a horse farm and seem to be happy. Such gay stereotypes.
Anyway— keep fighting the good fight. Have fun at your party!!!
"Since then I have always tried to maintain that skepticism and concern about what happens when people can’t speak freely." That's a great instinct and something that I took far too long to internalize myself, so it's nice to see it spelled out so clearly. People self-censor because they think it's helpful, but really it's just creating pluralistic ignorance. Glad to hear your friend is doing better and drive safely - that Medicine Hat to Lethbridge route gets icy this time of year I heard.
Part of my Joker origin story as I moved from smug city dwelling liberal to southern-based heterodox independent was seeing one of the NYT's first "pandemic safety" listicles. A top item was something like "stay home 24/7 - have food and essentials delivered to you, don't go out". I read that and thought, "wait, who's delivering THAT stuff then?" And then a bunch of stuff started to make way more sense.
It was somewhat unintentional that my career also took me from being a Washingtonian in early 2020 to traveling through the South, and clearly where you live has an extraordinary amount of influence on what your experience of the COVID era was.
Oh totally. I also voted with my feet in a way - I purposely moved from a place that was monomaniacally obsessed with preventing death even at the expense of all that makes life worth living to a place that was wide open. But I think where you spent that time does truly affect your recollection of it regardless.
I wasn't in the most open job market due to the way medical training is structured, but now that I did have more of a choice I ended up in the foothills of Appalachia, and I definitely did not consider any of the major cities that have gone insane.
Completely understand. I needed to be within a certain radius of corporate HQ locations which limited me to certain cities...but I could stack rank the cities by craziness and choose the southernmost/sanest and avoid the madness carnivals that were the coastal cities.
I was like hmmm Appalachia and then saw "major cities that have gone insane" so definitely not Asheville. Fun fact: they just installed a $50,000 dollar public toilet to help with the homeless shitting on the street. Guess how well that's going...
1. Every single functional healthcare system, whether it's the one you have or the one you wish you had, rations care. We can talk about trade-offs among the different versions, but I wish we'd all quit pretending that there's some healthcare system available that gives everyone as much healthcare as they want. (I'm setting aside momentarily the ghoulish suggestion that anyone who manages healthcare delivery in another system deserves to be assassinated.)
2. Every healthcare system costs you something unless you're indigent. The large payment Jesse mentions is a fraction of what he'd pay over his lifetime if he were paying into a nationalized healthcare system. I'm not personally opposed to nationalized healthcare systems. But they're not free simply because you pay taxes annually instead of fees at the doctor's office.
I wish we'd all acknowledge these two points when we debate healthcare. Although because rationing healthcare is a political non-starter, I kind of think these debates don't matter, because the only way to have them is to do it dishonestly and pretend our politicians will deliver us a utopia.
That's completely true, of course it is. But if you stand back from all of it, US healthcare is very very costly, and that money is not really going on "healthcare" as such. It could be done far more cheaply, so that whether or not it's insurance based or taxation based might not be the most important thing. With that said, the fact the US model is so explicitly for profit has been a major factor in driving up costs not only in the US but worldwide, affecting all the other national systems too.
Megan McArdle is the GOAT on all this stuff. She's been tweeting about it, and I hope she'll do a WaPo column: https://x.com/asymmetricinfo.
Honorable mention goes to Gabriel Rossman:
"You can have a healthcare system that is:
* cheap
* has generous coverage for patients
* has good employee compensation
"pick one, or at most two. you're not only evil but stupid if you think you can murder your way to getting all three.
"single payer systems optimize for cheap. the US optimizes for generous coverage and good employee compensation. you can reasonably argue about which is better but you can't reasonably think private healthcare is why you got denied some treatment that's a billion dollars per QALY." (https://x.com/RogueWPA/status/1865130173533757504)
Yeah in a country where lots of people are on medications that cost multiples of the general per capita income I occasionally get annoyed when people act like there is some plausible utopia out there.
The US system has a lot of problems, but a lot of the first level critiques of it are critiques that apply just as much to other systems, or simply avoid the tradeoffs involved in changing X or Y.
Right, but I'm arguing that the US system is not really optimised for any of those things, the prices are high because drug, equipment and other costs are higher than they need to be. So even though that trade off exists, it's not necessarily causing the problem.
Also please do bear in mind that in the UK we have private healthcare as well as the NHS. I am just about to use it to skip the line for an MRI, if I can persuade my employer to pay which they probably will. So in fact you don't even really need to "pick one".
One reason drug costs are higher in the US is that US prices subsidize research, which European countries then benefit from when they buy US-developed drugs at European capped prices. Again, McArdle writes about this.
I'd argue while this is true, it's important only if you're being quite credulous with respect to what these companies are saying to justify their costs. In other words it doesn't have to be true, and I certainly don't think it's unreasonable for actors outside the US to be objecting to unnecessary costs. I think the issues are well out of scope for a casual discussion.
I don't know her, but Libertarians in general strike me as credulous when it comes to what companies tell them they are doing.
Also there seems to be a somewhat nationalistic flavour to this perspective. In fact not all drug companies are US companies, but they do all behave in a similar way. I would dispute that any of them are particularly innovative at this stage, much of the actual discovery work happens in universities.
I think we're operating with different levels of familiarity with American drug development. If you want to read about company/academic partnerships in research from someone who is very critical of drug companies, check out Vinay Prasad. But the level of company involvement and the high dollar amounts of private investment are undisputed.
The “dying younger” thing has nothing to do with health care though, it’s because of car accidents and opioid overdoses and people being too fat. The correct point to make is that US health care produces similar outcomes to other countries, not that it produces worse ones: it’s still not worth the extra expense, but it’s not that tons of people are dying because their procedures are being denied. And the poorest Americans actually have relatively good health care through Medicaid.
The sad reality is that expensive parts of health care are mostly end-of-life care, and we’d save a ton of money not trying to perform extraordinary procedures to save people who are probably dying anyways. The challenge of course is that it’s hard to distinguish between “gonna die anyway” and “might be saved by the 15th round of chemo,” but a lot of these stories where someone’s treatment got denied would have turned out the same way in a socialist system, where they would look at the cost benefit of the procedure and say “no.” Jeff Maurer makes this point really well in his recent post.
The real problem with US health care is medical bankruptcy: people got some procedure that they thought was covered, and then get slapped with a $40k bill because the surgeon wasn’t in network or whatever. That’s the thing you won’t run into with other systems.
I'm pretty appalled by the "ha ha CEO dead" posts but if I got a $40K surprise bill I'd get pretty mad, too.
A relative got bum-rushed into an ambulance by the EMT after she had a seizure in public, something that doesn't require going to the hospital based on the standing orders from her neurologist. But every part of the system was "well, better safe than sorry" because they're not the ones getting stuck with the thousands of dollars for the ambulance ride.
I think the US could likely do better with some other country's system, but Democrats insist there are ABSOLUTELY NO TRADEOFFS when selling the plan. And when implementing the plan it turns out those tradeoffs are needed for it to be functional, and trying to do it without those tradeoffs would lead us to a system even more broken.
I think the issue is a company like United spends a lot of money trying to market its company. So that’s an added cost passed on to the consumer. Additionally the company is deliberately trying to be profitable which in some cases can give good incentives to not indulge wasteful services but bad incentives in creating too many rules that evolves into a nonsensical bureaucracy.
I live in Canada and have never really run into a major wait for care when I needed it; must be my white privilege. :D I do know people who have run into those issues though, so yeah, there are always going to be tradeoffse, no matter the system.
Taylor Lorenz is sufficient enough a subliterate pseud that she is unaware that using the royal “we” would imply she personally wants the death of CEO’s. Does she think when Victoria famously said “we are not amused” she meant the British nation? Get better friends, Jessie.
She is totally insufferable, and is stupid. Her parents paid for that expensive education so she would never have to have an original thought in her life.
I came here to express this. Jesse it’s that Taylor or me, representative of Primo Taylors and all BARpod Taylors. Time to level up and cut through the chaff love. 🤗
I think it might be a moral obligation to publicly say that she's a dumbass. But she also needs a lot of mental health care, but all of it of a different kind than she thinks she does.
Jesse is mistaken for calling out “primarily profit-driven health systems”, because this is all national systems. How many Canadian doctors would stay if they stopped making profit?
I am close to a wonderful nonprofit clinic for infants, but it would cease to exist without profit motive for the nurses, doctors, and administrators.
We’ve gotten it into our heads that because the American system is only say 50% government-funded, that it is the total opposite of Canada’s, which is say 95% government-funded. It sounds like splitting hairs, but things don’t become utopian just by “making profit disappear”.
Exactly! Besides, I disagree with the premise of the whole thing. Medicine is a skilled trade. There *should* be a profit motive in order to incentivize better behavior, better care, and better practitioners. It's a fundamental denial of human nature to think that people will just, in this one aspect of life, work hard and give of their time and skill freely when that isn't and shouldn't be the expectation in any other field.
One of my closest friends is a research oncologist at a leading university hospital; i.e., someone who tries to find remedies for cancers. CEOs of insurance companies make more in a week than my friend does in a whole year. Income is not and has never been based on the value of someone's contributions to society. The man who makes the most money is the one who can find the most efficient ways to exploit others, dodge taxes, and skirt regulations. If wealth were actually distributed to people based on how much they benefit humanity, my friend would be making more money than that asshat who got shot did.
That sounds like a decent idea, the problem is almost everyone can make that argument. You think your friend is important, how about the farmers who grow your food, or the truckers who bring it to you, or the people who take away your garbage? Etc. etc.
A huge portion of jobs are absolutely vital to the good functioning of society. (edit: In fact I would argue cancer research is actually a pretty frivolous low importance activity). Allowing all "essential" jobs to hold society hostage for some huge pile of loot because their work is "super important" is going to leave you with not enough resources to go around. What is more it is basically the core conceit of central planning. And central planning, when tried, just categorically produces worse results than market based solutions. These problems are too hard for you or me, or John Maynard Keynes to figure out what everyone's compensation should be.
Now I do think there are perhaps some mildly pernicious things in the US executive compensation realm. Them sitting on each other's boards and being a relatively small subset of people who perhaps don't actually subject each other to market forces. And maybe some nibbling around the edges is warranted.
But ultimately people get paid what they do based on how replaceable they are generally, and that is a GREAT system. Sure some CEOs are shitheels who play golf and went to some fancy fraternity and are no better than you or me. But many of them are amazing together people who have busted ass their whole life and spend every waking hour thinking about their jobs, not making B&R posts.
Anyway, I understand your instinct, but it is an instinct that leads to a bad place.
“But ultimately people get paid what they do based on how replaceable they are generally, and that is a GREAT system.“
That’s it. For some reason people aren’t taught that these days but that’s 99% of the time how it works. That’s why the warehouse worker, as lovely as he is and as hard as he works, makes far less than the sales guy for the same company. Warehouse guy is replaceable in 10 minutes and sales guy is a month of interviews. It’s really very simple when you consider it through the replaceability lense.
So would a lot of people. Someone’s income is a private matter between private actors. It’s fundamentally gross to assess the “correctness” of someone’s compensation regardless of tax bracket - no different from walking by a busker, looking at the money in their guitar case, and grabbing a handful of bills while saying, “he’s not *that* talented”. I don’t want third parties to feel entitled to criticize my pay, so I don’t do it to others.
If someone's income is a private matter between private actors, then why are you running around saying that "There *should* be a profit motive in order to incentivize better behavior, better care, and better practitioners?" By your own admission, it's not your place to say what should or shouldn't be done with other peoples' paychecks.
And in the case of these CEOs, profits are motivating them to engage in worse, not better, behavior. While health care workers do deserve to be compensated handsomely for their work, not all (or even most) of them are motivated purely by personal profit. My friend is in the line of work because of his love of science and his concern for the wellbeing of others, traits he's possessed since he was a young child. It was never about the money for him, though I acknowledge that he is not representative of everyone in his discipline. I think the best way to improve the performance of medical practitioners is to give them ethical hours, support their research, and give them the resources the need to treat patients as effectively as possible. Those things would also cost money, but they aren't about specifically increasing the salaries of certain individuals.
There’s a tremendous difference between parsing how *much* someone should make and saying in the abstract that people should be incentivized monetarily in order to ensure talented people work in high value fields. The fact that you can’t see that makes me think you’re either trolling, or I’m simply punching well below my intellectual weight class and I don’t stand to gain anything here so I’m blocking you.
Are you very sure more people would get better care if your friend were CEO of a health insurance company instead of the ones that currently are? Not for like the next three weeks or so, but overall.
It's so crazy to find one of your types out here amongst the normal, reasonable adults. Did you feel super duper itchy with the insertion of "asshat" there?
No to mention, a lot of ostensibly non-profit hospital systems act a lot like for-profits. They don't do much in the way of charity care, charge uninsured people a lot more than the rate private insurers pay, sue destitute patients, balance bill patients (some have even been caught balance billing Medicaid patients which is illegal), act like monopolies and bill in ways that are considered fraudulent.
For profit nursing homes tend to be worse than nonprofits, but there are other factors at work, like whether their patients are rich or poor and what percent of their patients are on Medicaid.
If you're looking for a new house and you have a choice of public housing or a house that was built by a private, for-profit company, it is not obvious to me that one should always be choosing the former.
I don't think profit motive is the problem, I think coercion is the problem. Particularly in healthcare, patients are often desperate, often don't know what they're getting or what they could get, and often do not have the luxury of shopping around. So healthcare is not a free market, and it's easy for big companies to take advantage of the little guy.
Regulation of prices is probably necessary. Other countries manage to do this whether they’re all-public or public/private mixes like the US. Just requiring that everyone is charged (and pays) the same for the same procedure at the same hospital would be good. Although the immediate problem would be that we’d need to spend more on Medic(are,aid), or cut back on provision, but that would at least make the current cross-subsidy from private payers explicit.
Disclosure to patients won’t work because people are desperate and because you need high cost sharing to make them care, and high cost sharing leads more to cutbacks in necessary care than to cross-shopping.
The perverse thing about this whole discourse is that insurance companies, highly flawed though they are, are the only ones in the private system with an incentive to keep costs down. If they actually authorized every claim the result would be a flood of medically useless procedures, tests, and medications, and either insurance getting more expensive or coverage getting cut back.
The consolidation of hospitals and absorption of small practices especially seems to have hurt any semblance of competition. I don’t blame the doctors working in those systems but the mergers should not have been allowed. Doing that without also incorporating the insurance side (the Kaiser approach) has created regional monopolies even if there are economies of scale and competence that the big hospitals bring.
Canada has a major shortage of medical doctors at the moment, and one contributing factor is the fact that some doctors are leaving their medical practice or moving to the US because they’re not paid as well here. The workloads are enormous for Canadian doctors and the cost of living has shot up. Many physicians in Canada feel like they’re not getting enough in exchange for what they’re putting in.
Doctors in America are often upper-class (especially if they take the numerous available political routes of hospital admin, academia, medical boards, etc.), and wealthier than doctors used to be.
Sure, but I think it’s reasonable to have certain industries like prisons and health care have extra scrutiny or even caps on profit bc of the obvious reasons. A health insurance company should not be among the most profitable in the country.
USAA which I use for my car insurance will pay a dividend back to members in years in which they have an excess of cash.
I think the biggest argument for treating healthcare a little differently is that it simply is an area where market forces function poorly because the consumers can rarely act rationally. This is less true for preventative care and other things, but especially for emergency and end-of-life care market forces are perhaps inappropriate because some of their strengths don't come to bear.
There are lots of economic reasons why those Puritan intentions are poor policy ideas, but it ultimately doesn’t address my point, because even if you want scrutiny, effective scrutiny would keep an eye on all organizations, not just those who don’t hide their profit incentive.
Not 100% sure I follow you. My comment was Puritan? In what way?
I simply was saying that certain industries should be governed by different rules and regulations with incentive structures being an important focus. Do you not think water and electric utilities are needed and should not be driven by pure profit?
You’re stating we need moral guardrails in sensitive areas such as health and energy, which goes against the economic ethos prevalent in America and among roughly 50% of this comment section’s members. People who believe in it don’t like to be told they can’t pursue infinite increase in personal wealth because screwing others over is not a good thing. Hard to advocate in a culture that’s mostly if not overwhelmingly at odds with this stance.
More specifically, I am drawing an equivalence between profit and income minus subsistence plus a margin for good measure, which seems totally fair to me. Many doctors make income that is simply windfall profit.
I work in finance; your statement is gobbledygook. Profit (revenue minus expenses) and labor income (money paid in exchange for a service) are fundamentally different concepts functioning with different dynamics. The "profit motive" = a firm's impetus to have positive net margins. It doesn't map onto how laborers operate in terms of accounting, behavioral economics, or finance. It's kinda like saying "he's been alive for 20 light years", it's just gobbledygook nonsense.
So crazy. When I was a younger I also experienced sexual abuse which had the exact effect on my perception of female puberty. I was horrified to develop breasts, horrified by the gaze of the others. Never felt like a boy, but was horrified by what it meant to physically be a girl. If I were just a tad younger, that would possibly have landed me in a gender clinic where the issue becomes of gender — not trauma. Essentially shoveling this gender issue over issues of childhood trauma. And this poor woman ended up losing her breasts and possibly her ability to have children on top of that. Horrific.
The story of the therapist's records being 'water damaged' is insane. I always assumed those people were fanatics and it colored their view of reality but it appears they know very well what they are doing is wrong. Somehow it's even more disturbing how can you do those things to a child if you're that scared of it coming out?
And it sounds like she was using paper records. Doing the math, that means she was using paper records back in 2016. Who was still using paper records in 2016?
This is exactly what I was thinking, I’m a therapist and pretty much EVERYONE used electronic health records. Someone could file an ethics complaint against her for not keeping track of her notes for the required amount of time.
Anecdotal but I run a specialists clinic in Canada and a six month wait time is about right….. because we stop accepting referrals once appointments will be more than six months away. More than a few patients get aggressive about the wait time, others will just no show and waste time we could have given to someone else. It’s not worth booking a new referral unless we can offer a decent appointment. This of course exacerbates the problem for the system as a whole but what we need is more specialists to reduce wait times. That doesn’t happen when a. We don’t train enough (med school spots, residency placements) and make the process for foreign doctors coming to work as specialists almost impossible and b. The single payer (government) sets compensation at a rate that leads to brain drain. I think the single payer system works better in Europe lol
I am Canadian and can also confirm about a 6 month wait for specialist referral. I waited about 5 months for a rheumatologist, for example.
However, what I think gets lost in the nuance is that those are non-emergency referrals and associated triage. If you’re in dire need, you get seen quickly. My father had a preventative primary care scan confirming cancer and was seen by an oncologist and nephrologist, and received cancer surgery, within about 14 days.
Maybe ultimately relevant to POD discourse, the “walking well” seem to have the worst time accessing care in Canada while the greatest sickness is addressed quite well.
That's still crazy to me as an American (with basic health insurance). What counts as an emergency? I was having trouble walking and needed to see a podiatrist. Is that an emergency? Technically I could walk but it was painful. I had to go to a new psychiatrist for refills on medication. Is that an emergency? Maybe these weren't life threatening but it would be pretty bad if I had to wait months to see someone.
I don't know about Canada, but this concern is spot on for Italy. IF you can get your primary care doc to declare that whatever you're dealing with is "urgent," and IF you live up north, you can usually get in fairly quickly.
But Italy's entire health care system in its wealthiest region only works because anyone who can afford to, pays to go private (which is still way less expensive than most American doc visits -- a private rheumatologist visit outside Milan cost me €100 paying in cash so they could shirk the taxes, in the US a comparable appointment was upwards of $300). Chronic, scheduled disease care is usually decent, emergency care is a total crapshoot. My husband had to wait a cumulative 18 hours in 3 different ERs (zero private options for urgent matters) before he was finally admitted for a gallbladder that was so far gone they had to fry him with nonstop IV antibiotics for days before it was safe enough to do a cholecystectomy.
I live in Pennsylvania, and my gallbladder ruptured last fall. I drove to a hospital 10 minutes away, got pain meds, IV antibiotics and the thing removed in less than 24 hours. And my copay was $0.
I have Highmark Blue Cross Blue Shield and I love my insurance.
Medication refills can be seen through various expedited systems including telehealth or even walk-in clinics. Those don’t take very long. You could get the medicine in probably 48 hours.
Pain when walking but can still walk? That would not be triaged and you might wait several months. (Unless you had like, an ulcer or something infected that posed a more urgent risk.) MSK pain and associated delay is sometimes used as a measure of efficiency in Canadian provincial healthcare— how quickly can you get a hip or knee replaced?
As an American I’ve had to book appointments months ahead for most specialist visits.
Sometimes they call you back because someone cancels. But if you’re not in dire need you’ll be at the end of the line and the line will be long if the provider takes most insurance (I’m guessing the line is pretty short for docs who don’t take insurance at all).
Not typically. I know of at least one clinic where people pay out of pocket to be members but they advertise access to specialist care that is actually just the regular access (ie they refer to us and their referrals are treated the same as any other, no special access). There are some third party navigators that claim to offer better access but again in my experience they just call around to the regular specialists and ask about wait times, then refer to the one with the shortest list. People who want real special treatment go to the US or Mexico.
Ya, I have a bleeding disorder and I tend to not experience the waiting problem for injuries or imaging if there is something urgent.
It's annoying to wait 6 months for a non-emergency MRI, but... I can get an CT scan in 15 minutes if I hit my head falling off a bike, or if my Hemophilia clinic doctors make the case that it's actually important to get something done ASAP.
Even for non-emergency stuff, I got an MRI for some transient, non-critical neck/spinal issues that were happening during the pandemic within 30 days. Different than being able to walk to an MRI clinic and get one the same day... I wish we had a slightly different model, but in Ontario the yearly health premium I pay is ~$1500CAD per year so ......... I'm not bankrupt
Edit: my girlfriend reminded me while reading my comment that she got an ultrasound of something worrying within a very short time, as well. There are so many ultrasound clinics in Ontario that if you have something that needs imaging like that, you can often get something done within a week.
“MRI within 30 days” is still pretty bad. I tore my ACL (hurt like hell but I could still walk) and was MRI’d, diagnosed, treated surgically, and back to work and in PT within 30 days. And at the time it only cost me $200 in copays (pre-Obamacare before high deductible plans were heavily incentivized).
If someone tears their ACL I'm sure they get an MRI immediately. I don't have all the data. Actually, it would be really cool to do a cross border comparison of people's experience!
A friend's father had a torn quadricep and had surgery within 2-3 days to repair it. I'm just one guy so when I said "within 30 days" it's in my non-critically immediate case where I didn't have stroke symptoms.
I’ve actually heard different specifically for non-emergency knee repair, but it’s purely anecdotal and who knows how representative it was. Given my surgeon actually said rehab-only was an option (as long as I was willing to give up golf and skiing) I doubt I would have gotten high priority.
I would love to see what American surgeons could do for my royally destroyed ankles, maybe I'd get double ankle replacements with incredible technology and pay nothing if I had the right job and insurance coverage. We do replacements here and they're good from what I've heard. I haven't looked into the difference between Canadian and American care at the level I would need though.
I needed to get a specialist intake appointment for my spouse recently (using American employer-based insurance), and the receptionist apologized to me because the closest appointment she had was ten days out.
Obviously, it's complicated and very region/plan dependent. I have other complaints about my insurance coverage. But the idea that American insurance companies always screw you over drives me nuts.
Agreed! I've been considering an intra-US move and am currently disinclined in part because I'm worried about navigating healthcare in the other location.
I’m in the US and need to see an endocrinologist; when I first tried to make an appointment, the wait time was longer than six months. Certain specialists can be difficult to get in to see, even if you live in a major metro area. I think that there is an endocrinologist shortage, in part because they don’t do billable procedures. The health care systems near me are hiring a lot of endocrinology NPs, but if there is anything unusual about your case, they aren’t able to help that much.
Generally I am pretty happy with my health care and my health insurance, but in my experience in the US it is still possible to encounter long wait times.
Becoming an actual endocrinologist requires at bare minimum, a bachelor's degree, a medical degree, three years of modestly-paid overworked residency training in medicine that is not endocrinology, and two more years of fellowship training in endocrinology. Thirteen years out of an adult life before you even start, never mind any other degrees or work one might do. It's no wonder that if every person who has a condition that falls within the scope of endocrinology wants to see one, there is a shortage, and thus a long wait.
That's going to be true regardless of what model of payment is in place.
How much of our brain drain problem is a side effect of how crazy the American system is, and how much money is sloshing around down there? Your point remains correct either way.
I'm not sure about the rest of Europe, but everything you said could apply to the UK... well, except the part about you running a specialist clinic here. Other than that, every point you listed is frequently made about the NHS.
I live in the DMV, have good insurance, and cannot see my GP without scheduling an appointment six months out. Used to be able to see a GPN in a couple of weeks but now I'm waiting over a month to see one of them, as well. The last time I tried to see a specialist, pre-COVID, was either a six or seven month wait.
My Dad lived abroad and he bought insurance that would have international coverage. When he was in the hospital the bills racked up well past the deductible. After he died the insurance wouldn't pay us anything. We were left with $40,000 that we had to pay out of pocket. We had to pay because they wouldn't release his body till we paid. So we paid the hospital and then assumed the insurance would reimburse us which they didn't. So my dad basically paid them for years and never got a cent of coverage.
I don't remember the name of the company (it wasn't United Health Care) but I can't stop thinking about this whenever people discuss health insurance. Yes murder is bad, yada yada, but I'm too bitter and I am enjoying the gloating from this. I'm sure a lot of people who have similar stories feel the same way. It's not just the "eat the rich" commies who are celebrating.
Jesus fucking, farting, tap dancing Christ, Jesse. Just get a $20 prepaid SIM and let people in when they text you. Then you can toss it afterwards or keep it for the month and let the voicemail collect various lude threats involving tenticled lady dicks.
Isn't the point that someone who is not trying to party is screening the calls? I think not giving out his number is secondary to not spending 4 out of 5 hours or whatever trying to hear a ticket dispute over top of a loud bar crowd (or, alternatively, spending 4 out of 5 hours texting people back and forth).
UnitedHealth CEO Brian Thompson was a crime boss. No one thinks of him that way because he wore nice clothes and said words like “Q3,” but that is essentially what he was.
How do you feel when a drug kingpin gets murdered? That’s roughly how you should feel about this. By all means, pursue the murderer. Murder is bad and society collapses if vigilante justice reigns, but don’t expect many to join the manhunt.
“Allegations of fraud
Thompson in May was sued for alleged fraud and illegal insider trading. The Hollywood Firefighters’ Pension Fund filed a lawsuit against UnitedHealth Group, CEO Andrew Witty, Executive Chairman Stephen Hemsley and Thompson, alleging the executives schemed to inflate the company’s stock by failing to disclose a US Justice Department antitrust investigation into the company.”
Yes, inflating the paper value of an equity is exactly like running a criminal enterprise selling addictive drugs and engaging in turf wars and enforcement that involve literally murdering people. Thank God for the moral clarity in this comment section.
OK, so we've established that cheering for the guy's murder is ghoulish and immoral. Great. Congrats for being on the right side of that one.
But spending your life becoming enormously, unreasonably rich trying to find ways to deny fair coverage *does* actually involve people dying so that he can make some more money. That's a totally reasonable observation to be making. I think it does show greater moral clarity than "he never ordered anyone's death so he's not like a drug kingpin". What about Purdue Pharma? Would you say they "killed anyone"? I think they did.
He's not Hitler, but I don't think he's as far from that drug kingpin, morally speaking, as you claim. He made his choices, and the consequence is that a good number of people cheered his death. He took the money, so there it is.
I agree that just because he didn’t murder anyone by beating them with a baseball bat doesn’t mean he/his business didn’t actively contribute to deaths. As a cancer patient myself who recently had my CT scans denied for an unknown reason, I have felt the desire to punch the face of the person at Aetna who denied them. They denied them twice, then overturned the decision a month after appealing with the reason “the member has metastatic melanoma, which has spread to abcdefg locations. The member is approved for CT scans to determine status” like no fucking shit Sherlock, I’ve been getting them for 4 years every 3 months. I was diagnosed in 2020 and been under Aetna the whole time during treatment. This three month delay that I ended up having could have been a death sentence for someone else.
The CEO isn’t reviewing my paperwork, but he supports the way they work that encourages denial or any reason they can come up with. BRB gonna go punch something.
Sorry to hear about your health problems. This one guy isn't responsible for all the bad incentives that lead to this system. But he is literally and personally responsible (as CEO) for devising policies to deny as much coverage as possible. If it wasn't him it would be another guy, but then if it's not one drug kingpin it's another. It's just not a nice thing to be doing.
Yep. And it goes even deeper. United has been a self-dealing crime syndicate from the start. Check out this report from More Perfect Union published a year ago: https://youtu.be/frr4wuvAB6U?si=QWrWaaaOPYP-uWPs
Do you feel the same way about the CEOs of automobile manufacturing companies? Their products are directly responsible for many more deaths than those that can be circuitously attributed to the denial of insurance coverage. And the auto worker unions are like the assembly line of genocide, should they get what's coming to them too? Liquor company CEOs? Casino owners?
No, I think selling cars is in principle different. We know the risks, we buy them anyway so that we can get around. If there are specific cases, like in "fight club":
then maybe that's similar, but in general no I think there's a clear difference.
Obviously selling health insurance isn't inherently immoral. That's great. What's immoral is screwing people out of coverage to amass vast sums of money, so that they end up dead despite buying your insurance in good faith.
It's not that simple of course, but also maybe it sort of is.
I'd be willing to bet that quite a lot of people died (albeit indirectly) because of decisions Thompson made, yes.
Owning cars, gambling, and drinking are not basic human needs. Health care is. When someone purchases a vehicle, they accept the associated risk. No one decides to develop a pre-existing condition.
Are you a child? You are either a child or the embodiment of the just-world fallacy.
Our president elect *instigated a deadly insurrection.* Corrupt rich people are above the law. They pillage with impunity.
That’s why so many people are happy to see a corrupt rich person finally reap what they sowed.
But like I said, murder is wrong. Not necessary in this case, because fuck that guy, but because we really can’t trust our idiot population with vigilante justice.
I’ve already seen the Eat the Rich crowd call for the heads of all rich people. Even Taylor Switch.
Most people are too dumb to tell between oligarchs who water their lawn with the blood of deceased chemo patients and rich people who make delightful pop songs and give millions of dollars to charity.
So, yea. Murder is wrong. Also wrong: a system where corrupt rich people use an abstraction called a corporation to kill thousands of people.
That's not what the suit alleges, and we have no idea if what it *does* allege (that he sold United Stock when he allegedly knew that the US DOJ was trying to block the Change Healthcare merger, at which time the Firefighters Union owned an undisclosed amount of United Shares) is even true.
Also, the Firefighters were trying to make a profit off the inhumane insurance industry in the US by investing in United stock. I'm not saying anyone should shoot them, but you know...
Ha! I do like that line a lot, but "Everything is securities fraud" doesn't mean "every securities fraud lawsuit is successful" or "everything proves that the defendant stole millions of dollars from firefighters."
I feel like there are a lot of people who don't want their name to be associated with "lolz, maybe this guy deserved it" comments?
My is-my-employer-reading-this? stance is "what did you think was going to happen?" My polite dinner party view is that shooting people is bad, and I certainly don't have the temperment to shoot someone, but... what do truly vile people who make decisions that kill their fellow citizens think is going to happen?
I find it pretty funny how article/podcast sentiment (NYT and Fifth Column eg) is vs my private chats where we are howling laughing about some of the jokes that are coming out of this event. Or the confusion/incredulity of articles being like "whoa nelly, how can people be celebrating this?!" Really?
I think he and other who engage in people-killing-as-a-corporate-policy are literally not crime bosses... because modern corporatism turns people who would have been crime bosses in the 70s into normal citizens who occasionally pay 2% in tax when they're feeling charitable.
But that public/private distinction is important, because people know they should be ashamed for the dark jokes they're telling their friends. That's the purpose of having narrowcast and broadcast communications channels. I've laughed and some of the memes (particularly a Dark Souls one I saw) but would not be a vector for sharing that stuff with the whole world.
What's disturbing about the whole thing is that many people, not just insane political nut jobs who already talk about murdering rich people, are not feeling a sense of shame for laughing about a stranger being murdered in the public square. That's weird and bad.
Nah. Not in this case. And I'm not laughing about it. I don't think it's funny at all, I think it's extremely serious. But it is perfectly understandable for people to not feel sorry about it. The healthcare system in this country is a fucking travesty. People suffer medically, and then on top of it, they lose their house to bankruptcy. The system is rotten from top to bottom, and certain people are getting rich from it. This guy was one of them.
This mealy-mouthed "omg, NO ONE should ever get shot on the street" - dude, come ON. OF COURSE some people deserve that. It rarely happens here because we're a country with rule of law. But those rules have allowed this guy and people like him to harm people by the thousands. For ONCE there was some consequence for that. Our government has shown us repeatedly that they won't do shit about crime and criminals, from the people breaking into your car and doing drugs on public transit, to legalized mafiosos in the healthcare industry.
This is a sign of failed government - the people are suffering, criminals run rampant, and no one gives a shit. And if one guy gets some justice, everyone clutches their pearls.
PS this is why I don't flip out when personal chats among doctors, lawyers etc. talking shit about their customers come out, everyone has a narrow personal group of friends to whom they say things they would never say in public.
Sure, to a degree. Some people are more reserved than others. I'm fine saying "what did you think was going to happen?" With regards to executives who lead companies with profit maximizing policies which kill people. I find the jokes pretty hilarious.
I think this group of people in the comments should be aware of the public/private distinction because of things like people who are forced to do DEI trainings pretending to drink the Kool aid and not actually believing any of the crap. Saying "aww that's so sad" about someone no one actually cares about is on the same spectrum as admitting your social justice guilt in a training session at work.
So true about the private vs public responses. Many of the people Jesse et al believe agree with them are memeing it up with the rest of us on private FB pages and group chats.
Exactly. Their criminal behavior is allowed by the US govt. Doesn't mean they aren't pieces of shit who might occasionally get served real justice. This guy knew what he was doing.
Insider trading?! Ye gods. I don't understand why he didn't just study the shrewd stock picks of financial genius Paul Pelosi. He wouldn't have had to stoop so low and cheat.
I remember reading a New Yorker article a couple years ago about a guy who had a son with precocious puberty and their decision about what to do. I don’t remember the outcome, just my introduction to the concept through this article.
Curious about the differences in hormone blockers for precocious puberty versus in people who are approaching puberty at a normal age, as well as the prevalence of precocious puberty, I did some basic googling.
First I learned that .0006% of kids have this disorder. Secondly I learned that complications, especially decreased bone density, related to the use of puberty blockers for precocious puberty are typically associated with using them for too long & past the normal age of puberty.
Then I did some googling about when kids go through puberty, and at what age kids start puberty blockers for either precocious puberty or gender dysphoria.
My conclusion is that kids with precocious puberty are at most going to be on blockers for a couple of years, if they go on blockers at all. By contrast, a kid who is trying to prevent puberty while they make up their mind could end up on these drugs for twice as long, including during the time when their child would normally be going through puberty.
The side effects are real, severe, and have been dramatically downplayed. Parents need to know this because they’re going to be plenty of states in which this is legal indefinitely because it is such a culture war debate.
I’m just gonna say this that in Canada, my aunt who died of ALS, my uncle who got cancer and their son who had down syndrome required a lot of expensive treatment for very serious illnesses as a family. If they were the US, they would be completely bankrupt and instead they can like move on with their lives, even after my aunt’s death. I think we forget that what we get in the us is a system that ruins a lot of people with medical debt and I think it’s that system that is creating so much rage and anger
>If they were the US, they would be completely bankrupt and instead they can like move on with their lives, even after my aunt’s death
This really isn't how the US system works *most* of the time. Like at all. Most of the time people (or their employers) pay high premiums all year, and mostly get their shit covered.
The issue here is when a sick person becomes too sick to work, and loses their job and their health insurance. My friend lost her insurance and her income when she had to take a leave of absence to give/recover from childbirth. (No maternity leave at the employer. Just unpaid family leave!). She couldn't keep her insurance through the leave because she was still in the probationary six month period when you're first hired. If it wasn't for her husband's student health insurance, I'm not sure what she would have done for money or healthcare.
Do you have any clue how expensive COBRA is? It's a fucking joke. Someone loses their job and income, and the answer is, well you can keep your healthcare coverage by paying like $1800 a month, even though you don't have an income anymore. How on earth is that feasible for most people?
Sorry about your family. But it's probabilistic, right? There are plenty of people in the US who get their expensive medical bills covered by insurance. It's been the case for my family. That's what Katie brought up, with her brother's hospitalization.
I have several not-well-to-do relatives with chronic conditions and they get them taken care of without being bankrupt. It's a patchwork of systems that could be radically improved, but they've kept it going for decades.
Don’t many/most US health insurance plans have maximum out of pocket limits? Doesn’t this prevent most people from going bankrupt? I don’t know that much about the details of the industry tbh.
A very common plan might be something like: you have $1000 in premiums a month, your employer covers $700 you cover $300, and then you have a yearly out of packet max of $6,000.
Something like that. But people love to scare monger. There are of course people driven to bankruptcy, but it is not an every day thing that is happening left and right as some want you to believe and even then what happens in a medical bankruptcy is YOU DON'T PAY THE DEBT.
Something like seventy percent of humanities students are female, and the majority of the faculty are now female also. I think it's fair to assume that if, when the majority of students and professors were male, the scholarship produced showed biases, then the same would surely hold for women. The over-focus on intersectionality, and the concomitant suite of beliefs, may just be an example: most social justice activists are women. I have not said anything about the quality of scholarship, merely on the topics of study chosen. The PHD candidate got the reaction she did because her thesis seemed symptomatic of a "discourse" with which everyone is now thoroughly bored, and was in turn amplified by right-wing edge-lords. Why her out of all the dumb shit that we have been told is problematic over the past decade? Who knows, but people have developed a hair-trigger reaction to words like "Intersectionality" and "misogynoir", because they want this stuff to go away. The fact she used "misogynoir" shows how thoroughly Americanised academia in the Anglo-sphere has become-when I did English at university 20 years ago we didn't even study American authors, other than TS Eliot, at my university.
I’ve been sounding the alarm about the decline of men in the humanities for a decade now, to little avail until, like, a month ago – it’s a serious problem because it does impact what research gets done, and to a great extent what gets taught. (The other problem–and honestly the bigger one–is the decline in the number of students who do not come from elite backgrounds, especially in grad school. I grew up small-town working-class, I never would have had even my modest academic career if I was just starting today.)
"Ow, this is gonna need stitches"
USA: that'll be $58,000
UK: I can help you in 38 months
Canada: kill yourself
Good one. Now if I may humorlessly interject a factoid I learned as a parent of small children, the stitches cost you a $25 copay at the local urgent care on my not very generous form of BCBS. ;-)
Urgent care clinics (my dad used to call them "doc-in-the-boxes," which I assume some western US person coined) are a genius invention that is sorely lacking in many int'l systems and US regions. Taking those can't-wait-until-normal-office-hours-but-no-one-will-prioritize-you level cases out of hospital emergency departments makes a huge difference in cost and wait times.
Depending on insurance or lack thereof, I’ve found enclosed to about 300 if it’s on the weekend. Give or take a 100 or so. For urgent care.
If you have to hit up the ER, more like 1500-2500. (500 with some insurance)
Australia: just rub a eucalyptus leaf on it, mate
But make sure to use the Maori word for eucalyptus
Maori? That's New Zealand. The healthcare system there is that you have to outrun the ringwraiths to Rivendell and if you get there they'll heal anything you've got.
Best comment ever
Interestingly enough, actual New Zealanders resent being associated with Lord of the Rings, in my experience.
Who the fuck cares what a bunch of sheep-shagging hobbits think.
(In seriousness New Zealand is a beautiful and amazing country and I didn’t detect any resentment of the connection when I travelled there in 2007. They certainly seemed happy to profit off it from tourists!)
It’s a good set up… but it doesn’t take that long to get stitches in Canada. Maybe it’s worse in Ontario, I don’t know.
It's a joke about Canadian doctors suggesting assisted suicide for things when the patient never even mentioned wanting to die.
Ah yes got it.
But they're Canadian, so wanting to die is implied.
This may surprise you as well, but it actually does not cost $58k to get stitches in the U.S.
Jokes are jokes
Fair enough.
It can easily cost multiple thousands though. I had a pretty minor surgery last year (I was put under, but I was in and out of the hospital in a few hours) and my insurance paid more than $40,000.
We pay our anesthesiologists very very well. Any time you go under that whole apparatus comes into play
I live in Western Mass now after living the first 36 years in the NY metro area with great employer-provided health insurance, and the next 4 years with zero health insurance while I bopped around the country as a freelancer, and I have to say Massachusetts, where I moved 8 years ago, fucking sucks. Not only did the process of obtaining the much (bullshittily) lauded state health insurance as a freelancer require ridiculous amounts of hours and faxed pages, I was rudely awakened to the fact that almost no provider of worth accepted it, and it was nearly impossible to determine who *did* accept it as the data on the state websites was hidden or was linked to contact numbers that went 100% unanswered. If you cold-called a provider to ask (in my case, dental practices when I had an excruciating tooth abscess) and they didn’t take the state insurance, they were *legally* prevented from treating you at all even if you could pay out of pocket. I ended up treating my abscess by calling a dentist and lying and telling them I had no insurance at all. I ended up just getting married so I could go on my boyfriend’s insurance. I now have my own through an employer, but I seriously injured my finger recently and couldn’t get an appointment for a specialist for 2 months. My husband has had his annual physical postponed 4 times after having made the appointment a year in advance. He currently has no standing appointment because the staffing issues at the provider group are so abysmal. And this is with insurance through employment by a top-tier college in Massachusetts.
Were you not able to get on Obamacare? I mean, is that what constitutes the state health plan there? Our state health insurance (SC) is exorbitantly expensive.
This was 8 years ago and I’ll confess, I didn’t look into Obamacare in MA (MA has its own state health insurance). I looked into Obamacare as a freelancer in WY when I lived there a year or two before and there was exactly only one provider available, and they were really expensive, so I just went without and pad the penalty. My (now) husband said he liked the MA state health insurance when he was on it (in his 20s, with no problems) so I think I just went into it enthusiastically and by the time I was disgruntled, I was ready to get married. I never before encountered a situation where a provider could turn you down for *having insurance but refusing to use it.* If this is what regulations get us, then color me a Libertarian.
That sucks, I'm sorry. I was on Obamacare for a few years and loved it. Granted, I didn't have any major medical issues during that time but it cost me only $5 to see a therapist!
Stitches are free if you give a fake name and don't bring an ID.
This is my first new episode as a primo and I just wanted to say how much I enjoy the show. I have to drive all over rural Alberta for work and the both of you keep me company while I was traversing the literal middle of nowhere. :)
I met some of my first detransitioners in the lesbian community about 10 years ago. One friend wrote to me not even three days after her double mascetomy saying she’d made a terrible mistake. She didn’t want to be a man; she was dealing with the trauma of a brutal rape on an agricultural work camp and felt this was the only thing she could do to escape. She stopped T about two weeks after. (She said: “well, you’re not worried about what people will think so I feel like I can tell you.”) I thought a lot about what she had endured and what she felt she couldn’t say. Since then I have always tried to maintain that skepticism and concern about what happens when people can’t speak freely. Fortunately the friend is doing much better now: she and her long term girlfriend run a horse farm and seem to be happy. Such gay stereotypes.
Anyway— keep fighting the good fight. Have fun at your party!!!
"Since then I have always tried to maintain that skepticism and concern about what happens when people can’t speak freely." That's a great instinct and something that I took far too long to internalize myself, so it's nice to see it spelled out so clearly. People self-censor because they think it's helpful, but really it's just creating pluralistic ignorance. Glad to hear your friend is doing better and drive safely - that Medicine Hat to Lethbridge route gets icy this time of year I heard.
Has anyone told you we are cousins now?
Welcome LJ! We’re happy to have you 🙂
welcome fellow Albertan!
Welcome fellow Primo!
Katie's quip about folx like TL only encountering the working class through Uber Eats was spot on comedy gold.
Part of my Joker origin story as I moved from smug city dwelling liberal to southern-based heterodox independent was seeing one of the NYT's first "pandemic safety" listicles. A top item was something like "stay home 24/7 - have food and essentials delivered to you, don't go out". I read that and thought, "wait, who's delivering THAT stuff then?" And then a bunch of stuff started to make way more sense.
It was somewhat unintentional that my career also took me from being a Washingtonian in early 2020 to traveling through the South, and clearly where you live has an extraordinary amount of influence on what your experience of the COVID era was.
Oh totally. I also voted with my feet in a way - I purposely moved from a place that was monomaniacally obsessed with preventing death even at the expense of all that makes life worth living to a place that was wide open. But I think where you spent that time does truly affect your recollection of it regardless.
I wasn't in the most open job market due to the way medical training is structured, but now that I did have more of a choice I ended up in the foothills of Appalachia, and I definitely did not consider any of the major cities that have gone insane.
Completely understand. I needed to be within a certain radius of corporate HQ locations which limited me to certain cities...but I could stack rank the cities by craziness and choose the southernmost/sanest and avoid the madness carnivals that were the coastal cities.
I was like hmmm Appalachia and then saw "major cities that have gone insane" so definitely not Asheville. Fun fact: they just installed a $50,000 dollar public toilet to help with the homeless shitting on the street. Guess how well that's going...
I like Asheville, but that is the sort of problem I would expect Asheville to have.
500k, not 50. Haha it's so much worse.
The advice was for the elect, erhm I mean NT readers, not those dirty plebs!
Not like she's going to make her own avocado toast.
It's probably true, and yet, on this Lorenz's opinion is identical to every working class person I know
1. Every single functional healthcare system, whether it's the one you have or the one you wish you had, rations care. We can talk about trade-offs among the different versions, but I wish we'd all quit pretending that there's some healthcare system available that gives everyone as much healthcare as they want. (I'm setting aside momentarily the ghoulish suggestion that anyone who manages healthcare delivery in another system deserves to be assassinated.)
2. Every healthcare system costs you something unless you're indigent. The large payment Jesse mentions is a fraction of what he'd pay over his lifetime if he were paying into a nationalized healthcare system. I'm not personally opposed to nationalized healthcare systems. But they're not free simply because you pay taxes annually instead of fees at the doctor's office.
I wish we'd all acknowledge these two points when we debate healthcare. Although because rationing healthcare is a political non-starter, I kind of think these debates don't matter, because the only way to have them is to do it dishonestly and pretend our politicians will deliver us a utopia.
That's completely true, of course it is. But if you stand back from all of it, US healthcare is very very costly, and that money is not really going on "healthcare" as such. It could be done far more cheaply, so that whether or not it's insurance based or taxation based might not be the most important thing. With that said, the fact the US model is so explicitly for profit has been a major factor in driving up costs not only in the US but worldwide, affecting all the other national systems too.
Megan McArdle is the GOAT on all this stuff. She's been tweeting about it, and I hope she'll do a WaPo column: https://x.com/asymmetricinfo.
Honorable mention goes to Gabriel Rossman:
"You can have a healthcare system that is:
* cheap
* has generous coverage for patients
* has good employee compensation
"pick one, or at most two. you're not only evil but stupid if you think you can murder your way to getting all three.
"single payer systems optimize for cheap. the US optimizes for generous coverage and good employee compensation. you can reasonably argue about which is better but you can't reasonably think private healthcare is why you got denied some treatment that's a billion dollars per QALY." (https://x.com/RogueWPA/status/1865130173533757504)
Yeah in a country where lots of people are on medications that cost multiples of the general per capita income I occasionally get annoyed when people act like there is some plausible utopia out there.
The US system has a lot of problems, but a lot of the first level critiques of it are critiques that apply just as much to other systems, or simply avoid the tradeoffs involved in changing X or Y.
Right, but I'm arguing that the US system is not really optimised for any of those things, the prices are high because drug, equipment and other costs are higher than they need to be. So even though that trade off exists, it's not necessarily causing the problem.
Also please do bear in mind that in the UK we have private healthcare as well as the NHS. I am just about to use it to skip the line for an MRI, if I can persuade my employer to pay which they probably will. So in fact you don't even really need to "pick one".
One reason drug costs are higher in the US is that US prices subsidize research, which European countries then benefit from when they buy US-developed drugs at European capped prices. Again, McArdle writes about this.
I'd argue while this is true, it's important only if you're being quite credulous with respect to what these companies are saying to justify their costs. In other words it doesn't have to be true, and I certainly don't think it's unreasonable for actors outside the US to be objecting to unnecessary costs. I think the issues are well out of scope for a casual discussion.
I don't know her, but Libertarians in general strike me as credulous when it comes to what companies tell them they are doing.
Also there seems to be a somewhat nationalistic flavour to this perspective. In fact not all drug companies are US companies, but they do all behave in a similar way. I would dispute that any of them are particularly innovative at this stage, much of the actual discovery work happens in universities.
I think we're operating with different levels of familiarity with American drug development. If you want to read about company/academic partnerships in research from someone who is very critical of drug companies, check out Vinay Prasad. But the level of company involvement and the high dollar amounts of private investment are undisputed.
Yes. But also: Americans pay more per capita on healthcare and die younger + all the personal bankruptcy stuff. Dollar per dollar it works less well.
The “dying younger” thing has nothing to do with health care though, it’s because of car accidents and opioid overdoses and people being too fat. The correct point to make is that US health care produces similar outcomes to other countries, not that it produces worse ones: it’s still not worth the extra expense, but it’s not that tons of people are dying because their procedures are being denied. And the poorest Americans actually have relatively good health care through Medicaid.
The sad reality is that expensive parts of health care are mostly end-of-life care, and we’d save a ton of money not trying to perform extraordinary procedures to save people who are probably dying anyways. The challenge of course is that it’s hard to distinguish between “gonna die anyway” and “might be saved by the 15th round of chemo,” but a lot of these stories where someone’s treatment got denied would have turned out the same way in a socialist system, where they would look at the cost benefit of the procedure and say “no.” Jeff Maurer makes this point really well in his recent post.
The real problem with US health care is medical bankruptcy: people got some procedure that they thought was covered, and then get slapped with a $40k bill because the surgeon wasn’t in network or whatever. That’s the thing you won’t run into with other systems.
I'm pretty appalled by the "ha ha CEO dead" posts but if I got a $40K surprise bill I'd get pretty mad, too.
A relative got bum-rushed into an ambulance by the EMT after she had a seizure in public, something that doesn't require going to the hospital based on the standing orders from her neurologist. But every part of the system was "well, better safe than sorry" because they're not the ones getting stuck with the thousands of dollars for the ambulance ride.
Yep. Life expectancies flip around 55 or so, depending which country you’re comparing to.
I think the US could likely do better with some other country's system, but Democrats insist there are ABSOLUTELY NO TRADEOFFS when selling the plan. And when implementing the plan it turns out those tradeoffs are needed for it to be functional, and trying to do it without those tradeoffs would lead us to a system even more broken.
Yes, I'm genuinely agnostic on the best solution but inclined to see the situation this way until someone persuades me otherwise.
I think the issue is a company like United spends a lot of money trying to market its company. So that’s an added cost passed on to the consumer. Additionally the company is deliberately trying to be profitable which in some cases can give good incentives to not indulge wasteful services but bad incentives in creating too many rules that evolves into a nonsensical bureaucracy.
Good post. You sound like Peter Suderman.
I live in Canada and have never really run into a major wait for care when I needed it; must be my white privilege. :D I do know people who have run into those issues though, so yeah, there are always going to be tradeoffse, no matter the system.
Taylor Lorenz is sufficient enough a subliterate pseud that she is unaware that using the royal “we” would imply she personally wants the death of CEO’s. Does she think when Victoria famously said “we are not amused” she meant the British nation? Get better friends, Jessie.
I really wanted this pointed out! The "Royal we" is a confession, not a defense!
I think this is the first time Jesse refrained from defending Taylor. It’s a start
She is totally insufferable, and is stupid. Her parents paid for that expensive education so she would never have to have an original thought in her life.
I came here to express this. Jesse it’s that Taylor or me, representative of Primo Taylors and all BARpod Taylors. Time to level up and cut through the chaff love. 🤗
I think it might be a moral obligation to publicly say that she's a dumbass. But she also needs a lot of mental health care, but all of it of a different kind than she thinks she does.
Jesse is mistaken for calling out “primarily profit-driven health systems”, because this is all national systems. How many Canadian doctors would stay if they stopped making profit?
I am close to a wonderful nonprofit clinic for infants, but it would cease to exist without profit motive for the nurses, doctors, and administrators.
We’ve gotten it into our heads that because the American system is only say 50% government-funded, that it is the total opposite of Canada’s, which is say 95% government-funded. It sounds like splitting hairs, but things don’t become utopian just by “making profit disappear”.
Exactly! Besides, I disagree with the premise of the whole thing. Medicine is a skilled trade. There *should* be a profit motive in order to incentivize better behavior, better care, and better practitioners. It's a fundamental denial of human nature to think that people will just, in this one aspect of life, work hard and give of their time and skill freely when that isn't and shouldn't be the expectation in any other field.
One of my closest friends is a research oncologist at a leading university hospital; i.e., someone who tries to find remedies for cancers. CEOs of insurance companies make more in a week than my friend does in a whole year. Income is not and has never been based on the value of someone's contributions to society. The man who makes the most money is the one who can find the most efficient ways to exploit others, dodge taxes, and skirt regulations. If wealth were actually distributed to people based on how much they benefit humanity, my friend would be making more money than that asshat who got shot did.
That sounds like a decent idea, the problem is almost everyone can make that argument. You think your friend is important, how about the farmers who grow your food, or the truckers who bring it to you, or the people who take away your garbage? Etc. etc.
A huge portion of jobs are absolutely vital to the good functioning of society. (edit: In fact I would argue cancer research is actually a pretty frivolous low importance activity). Allowing all "essential" jobs to hold society hostage for some huge pile of loot because their work is "super important" is going to leave you with not enough resources to go around. What is more it is basically the core conceit of central planning. And central planning, when tried, just categorically produces worse results than market based solutions. These problems are too hard for you or me, or John Maynard Keynes to figure out what everyone's compensation should be.
Now I do think there are perhaps some mildly pernicious things in the US executive compensation realm. Them sitting on each other's boards and being a relatively small subset of people who perhaps don't actually subject each other to market forces. And maybe some nibbling around the edges is warranted.
But ultimately people get paid what they do based on how replaceable they are generally, and that is a GREAT system. Sure some CEOs are shitheels who play golf and went to some fancy fraternity and are no better than you or me. But many of them are amazing together people who have busted ass their whole life and spend every waking hour thinking about their jobs, not making B&R posts.
Anyway, I understand your instinct, but it is an instinct that leads to a bad place.
“But ultimately people get paid what they do based on how replaceable they are generally, and that is a GREAT system.“
That’s it. For some reason people aren’t taught that these days but that’s 99% of the time how it works. That’s why the warehouse worker, as lovely as he is and as hard as he works, makes far less than the sales guy for the same company. Warehouse guy is replaceable in 10 minutes and sales guy is a month of interviews. It’s really very simple when you consider it through the replaceability lense.
So would a lot of people. Someone’s income is a private matter between private actors. It’s fundamentally gross to assess the “correctness” of someone’s compensation regardless of tax bracket - no different from walking by a busker, looking at the money in their guitar case, and grabbing a handful of bills while saying, “he’s not *that* talented”. I don’t want third parties to feel entitled to criticize my pay, so I don’t do it to others.
If someone's income is a private matter between private actors, then why are you running around saying that "There *should* be a profit motive in order to incentivize better behavior, better care, and better practitioners?" By your own admission, it's not your place to say what should or shouldn't be done with other peoples' paychecks.
And in the case of these CEOs, profits are motivating them to engage in worse, not better, behavior. While health care workers do deserve to be compensated handsomely for their work, not all (or even most) of them are motivated purely by personal profit. My friend is in the line of work because of his love of science and his concern for the wellbeing of others, traits he's possessed since he was a young child. It was never about the money for him, though I acknowledge that he is not representative of everyone in his discipline. I think the best way to improve the performance of medical practitioners is to give them ethical hours, support their research, and give them the resources the need to treat patients as effectively as possible. Those things would also cost money, but they aren't about specifically increasing the salaries of certain individuals.
There’s a tremendous difference between parsing how *much* someone should make and saying in the abstract that people should be incentivized monetarily in order to ensure talented people work in high value fields. The fact that you can’t see that makes me think you’re either trolling, or I’m simply punching well below my intellectual weight class and I don’t stand to gain anything here so I’m blocking you.
He demolished your own line of "reasoning" but yeah, you're the one punching below your weight. Lmao!
Someone sure loves to be contradicted.
Wow, you sure showed her
Are you very sure more people would get better care if your friend were CEO of a health insurance company instead of the ones that currently are? Not for like the next three weeks or so, but overall.
Thank you, a glimmer of reason in an ocean of libertarian-adjacent rhetoric.
It's so crazy to find one of your types out here amongst the normal, reasonable adults. Did you feel super duper itchy with the insertion of "asshat" there?
That’s why I hate articles about the “most successful women”. Getting paid a crap ton doesn’t mean you do something worthwhile it that you work hard.
Wait, you mean from each according to their abilities, to each according to their needs doesn’t work? I’m shocked.
It's just a theory of mine, it's never *really* been tried. Big if true though.
No to mention, a lot of ostensibly non-profit hospital systems act a lot like for-profits. They don't do much in the way of charity care, charge uninsured people a lot more than the rate private insurers pay, sue destitute patients, balance bill patients (some have even been caught balance billing Medicaid patients which is illegal), act like monopolies and bill in ways that are considered fraudulent.
For profit nursing homes tend to be worse than nonprofits, but there are other factors at work, like whether their patients are rich or poor and what percent of their patients are on Medicaid.
If you're looking for a new house and you have a choice of public housing or a house that was built by a private, for-profit company, it is not obvious to me that one should always be choosing the former.
I don't think profit motive is the problem, I think coercion is the problem. Particularly in healthcare, patients are often desperate, often don't know what they're getting or what they could get, and often do not have the luxury of shopping around. So healthcare is not a free market, and it's easy for big companies to take advantage of the little guy.
Regulation of prices is probably necessary. Other countries manage to do this whether they’re all-public or public/private mixes like the US. Just requiring that everyone is charged (and pays) the same for the same procedure at the same hospital would be good. Although the immediate problem would be that we’d need to spend more on Medic(are,aid), or cut back on provision, but that would at least make the current cross-subsidy from private payers explicit.
Disclosure to patients won’t work because people are desperate and because you need high cost sharing to make them care, and high cost sharing leads more to cutbacks in necessary care than to cross-shopping.
The perverse thing about this whole discourse is that insurance companies, highly flawed though they are, are the only ones in the private system with an incentive to keep costs down. If they actually authorized every claim the result would be a flood of medically useless procedures, tests, and medications, and either insurance getting more expensive or coverage getting cut back.
The consolidation of hospitals and absorption of small practices especially seems to have hurt any semblance of competition. I don’t blame the doctors working in those systems but the mergers should not have been allowed. Doing that without also incorporating the insurance side (the Kaiser approach) has created regional monopolies even if there are economies of scale and competence that the big hospitals bring.
It’s easy for big companies to take advantage of the little guy, and the State is the largest of corporations.
But this is irrelevant to my point, because my point was about a specific comment made in the podcast about profit, not coercion.
Canada has a major shortage of medical doctors at the moment, and one contributing factor is the fact that some doctors are leaving their medical practice or moving to the US because they’re not paid as well here. The workloads are enormous for Canadian doctors and the cost of living has shot up. Many physicians in Canada feel like they’re not getting enough in exchange for what they’re putting in.
Doctors in America are often upper-class (especially if they take the numerous available political routes of hospital admin, academia, medical boards, etc.), and wealthier than doctors used to be.
Sure, but I think it’s reasonable to have certain industries like prisons and health care have extra scrutiny or even caps on profit bc of the obvious reasons. A health insurance company should not be among the most profitable in the country.
USAA which I use for my car insurance will pay a dividend back to members in years in which they have an excess of cash.
I think the biggest argument for treating healthcare a little differently is that it simply is an area where market forces function poorly because the consumers can rarely act rationally. This is less true for preventative care and other things, but especially for emergency and end-of-life care market forces are perhaps inappropriate because some of their strengths don't come to bear.
There are lots of economic reasons why those Puritan intentions are poor policy ideas, but it ultimately doesn’t address my point, because even if you want scrutiny, effective scrutiny would keep an eye on all organizations, not just those who don’t hide their profit incentive.
Not 100% sure I follow you. My comment was Puritan? In what way?
I simply was saying that certain industries should be governed by different rules and regulations with incentive structures being an important focus. Do you not think water and electric utilities are needed and should not be driven by pure profit?
You’re stating we need moral guardrails in sensitive areas such as health and energy, which goes against the economic ethos prevalent in America and among roughly 50% of this comment section’s members. People who believe in it don’t like to be told they can’t pursue infinite increase in personal wealth because screwing others over is not a good thing. Hard to advocate in a culture that’s mostly if not overwhelmingly at odds with this stance.
Telling Americans they can’t be selfish is ultimately enforcing a moral code, a religion if you will.
I wouldn’t go as far as calling it a religion, but it certainly is a moral code.
Labor income and profit aren't the same thing; you're conflating two very very different economic concepts.
More specifically, I am drawing an equivalence between profit and income minus subsistence plus a margin for good measure, which seems totally fair to me. Many doctors make income that is simply windfall profit.
I work in finance; your statement is gobbledygook. Profit (revenue minus expenses) and labor income (money paid in exchange for a service) are fundamentally different concepts functioning with different dynamics. The "profit motive" = a firm's impetus to have positive net margins. It doesn't map onto how laborers operate in terms of accounting, behavioral economics, or finance. It's kinda like saying "he's been alive for 20 light years", it's just gobbledygook nonsense.
So crazy. When I was a younger I also experienced sexual abuse which had the exact effect on my perception of female puberty. I was horrified to develop breasts, horrified by the gaze of the others. Never felt like a boy, but was horrified by what it meant to physically be a girl. If I were just a tad younger, that would possibly have landed me in a gender clinic where the issue becomes of gender — not trauma. Essentially shoveling this gender issue over issues of childhood trauma. And this poor woman ended up losing her breasts and possibly her ability to have children on top of that. Horrific.
The story of the therapist's records being 'water damaged' is insane. I always assumed those people were fanatics and it colored their view of reality but it appears they know very well what they are doing is wrong. Somehow it's even more disturbing how can you do those things to a child if you're that scared of it coming out?
And it sounds like she was using paper records. Doing the math, that means she was using paper records back in 2016. Who was still using paper records in 2016?
I don’t know any health systems that even allow that.
« Who was still using paper records in 2016? »
Someone with an escape plan I would say.
This is exactly what I was thinking, I’m a therapist and pretty much EVERYONE used electronic health records. Someone could file an ethics complaint against her for not keeping track of her notes for the required amount of time.
Anecdotal but I run a specialists clinic in Canada and a six month wait time is about right….. because we stop accepting referrals once appointments will be more than six months away. More than a few patients get aggressive about the wait time, others will just no show and waste time we could have given to someone else. It’s not worth booking a new referral unless we can offer a decent appointment. This of course exacerbates the problem for the system as a whole but what we need is more specialists to reduce wait times. That doesn’t happen when a. We don’t train enough (med school spots, residency placements) and make the process for foreign doctors coming to work as specialists almost impossible and b. The single payer (government) sets compensation at a rate that leads to brain drain. I think the single payer system works better in Europe lol
I am Canadian and can also confirm about a 6 month wait for specialist referral. I waited about 5 months for a rheumatologist, for example.
However, what I think gets lost in the nuance is that those are non-emergency referrals and associated triage. If you’re in dire need, you get seen quickly. My father had a preventative primary care scan confirming cancer and was seen by an oncologist and nephrologist, and received cancer surgery, within about 14 days.
Maybe ultimately relevant to POD discourse, the “walking well” seem to have the worst time accessing care in Canada while the greatest sickness is addressed quite well.
That's still crazy to me as an American (with basic health insurance). What counts as an emergency? I was having trouble walking and needed to see a podiatrist. Is that an emergency? Technically I could walk but it was painful. I had to go to a new psychiatrist for refills on medication. Is that an emergency? Maybe these weren't life threatening but it would be pretty bad if I had to wait months to see someone.
I don't know about Canada, but this concern is spot on for Italy. IF you can get your primary care doc to declare that whatever you're dealing with is "urgent," and IF you live up north, you can usually get in fairly quickly.
But Italy's entire health care system in its wealthiest region only works because anyone who can afford to, pays to go private (which is still way less expensive than most American doc visits -- a private rheumatologist visit outside Milan cost me €100 paying in cash so they could shirk the taxes, in the US a comparable appointment was upwards of $300). Chronic, scheduled disease care is usually decent, emergency care is a total crapshoot. My husband had to wait a cumulative 18 hours in 3 different ERs (zero private options for urgent matters) before he was finally admitted for a gallbladder that was so far gone they had to fry him with nonstop IV antibiotics for days before it was safe enough to do a cholecystectomy.
Geez!
I live in Pennsylvania, and my gallbladder ruptured last fall. I drove to a hospital 10 minutes away, got pain meds, IV antibiotics and the thing removed in less than 24 hours. And my copay was $0.
I have Highmark Blue Cross Blue Shield and I love my insurance.
Medication refills can be seen through various expedited systems including telehealth or even walk-in clinics. Those don’t take very long. You could get the medicine in probably 48 hours.
Pain when walking but can still walk? That would not be triaged and you might wait several months. (Unless you had like, an ulcer or something infected that posed a more urgent risk.) MSK pain and associated delay is sometimes used as a measure of efficiency in Canadian provincial healthcare— how quickly can you get a hip or knee replaced?
As an American I’ve had to book appointments months ahead for most specialist visits.
Sometimes they call you back because someone cancels. But if you’re not in dire need you’ll be at the end of the line and the line will be long if the provider takes most insurance (I’m guessing the line is pretty short for docs who don’t take insurance at all).
Is there an option to access privately paid care in Canada, if you don't want to wait?
No, it’s mostly legally forbidden to offer private healthcare due to Canadian law.
Whoa. To an American that sounds insane - but I can understand the reasoning behind it for sure.
Not typically. I know of at least one clinic where people pay out of pocket to be members but they advertise access to specialist care that is actually just the regular access (ie they refer to us and their referrals are treated the same as any other, no special access). There are some third party navigators that claim to offer better access but again in my experience they just call around to the regular specialists and ask about wait times, then refer to the one with the shortest list. People who want real special treatment go to the US or Mexico.
Ya, I have a bleeding disorder and I tend to not experience the waiting problem for injuries or imaging if there is something urgent.
It's annoying to wait 6 months for a non-emergency MRI, but... I can get an CT scan in 15 minutes if I hit my head falling off a bike, or if my Hemophilia clinic doctors make the case that it's actually important to get something done ASAP.
Even for non-emergency stuff, I got an MRI for some transient, non-critical neck/spinal issues that were happening during the pandemic within 30 days. Different than being able to walk to an MRI clinic and get one the same day... I wish we had a slightly different model, but in Ontario the yearly health premium I pay is ~$1500CAD per year so ......... I'm not bankrupt
Edit: my girlfriend reminded me while reading my comment that she got an ultrasound of something worrying within a very short time, as well. There are so many ultrasound clinics in Ontario that if you have something that needs imaging like that, you can often get something done within a week.
“MRI within 30 days” is still pretty bad. I tore my ACL (hurt like hell but I could still walk) and was MRI’d, diagnosed, treated surgically, and back to work and in PT within 30 days. And at the time it only cost me $200 in copays (pre-Obamacare before high deductible plans were heavily incentivized).
If someone tears their ACL I'm sure they get an MRI immediately. I don't have all the data. Actually, it would be really cool to do a cross border comparison of people's experience!
A friend's father had a torn quadricep and had surgery within 2-3 days to repair it. I'm just one guy so when I said "within 30 days" it's in my non-critically immediate case where I didn't have stroke symptoms.
I’ve actually heard different specifically for non-emergency knee repair, but it’s purely anecdotal and who knows how representative it was. Given my surgeon actually said rehab-only was an option (as long as I was willing to give up golf and skiing) I doubt I would have gotten high priority.
I would love to see what American surgeons could do for my royally destroyed ankles, maybe I'd get double ankle replacements with incredible technology and pay nothing if I had the right job and insurance coverage. We do replacements here and they're good from what I've heard. I haven't looked into the difference between Canadian and American care at the level I would need though.
100%
I needed to get a specialist intake appointment for my spouse recently (using American employer-based insurance), and the receptionist apologized to me because the closest appointment she had was ten days out.
Obviously, it's complicated and very region/plan dependent. I have other complaints about my insurance coverage. But the idea that American insurance companies always screw you over drives me nuts.
Yeah I recently wanted a dermatology referral and they called me the same day to set something up for the next week.
I’ve had to wait months for specialists in the US. So I don’t think this is some universal thing.
Agreed! I've been considering an intra-US move and am currently disinclined in part because I'm worried about navigating healthcare in the other location.
I’m in the US and need to see an endocrinologist; when I first tried to make an appointment, the wait time was longer than six months. Certain specialists can be difficult to get in to see, even if you live in a major metro area. I think that there is an endocrinologist shortage, in part because they don’t do billable procedures. The health care systems near me are hiring a lot of endocrinology NPs, but if there is anything unusual about your case, they aren’t able to help that much.
Generally I am pretty happy with my health care and my health insurance, but in my experience in the US it is still possible to encounter long wait times.
Becoming an actual endocrinologist requires at bare minimum, a bachelor's degree, a medical degree, three years of modestly-paid overworked residency training in medicine that is not endocrinology, and two more years of fellowship training in endocrinology. Thirteen years out of an adult life before you even start, never mind any other degrees or work one might do. It's no wonder that if every person who has a condition that falls within the scope of endocrinology wants to see one, there is a shortage, and thus a long wait.
That's going to be true regardless of what model of payment is in place.
How much of our brain drain problem is a side effect of how crazy the American system is, and how much money is sloshing around down there? Your point remains correct either way.
It’s a factor but we also lose people to other provinces.
I'm not sure about the rest of Europe, but everything you said could apply to the UK... well, except the part about you running a specialist clinic here. Other than that, every point you listed is frequently made about the NHS.
I live in the DMV, have good insurance, and cannot see my GP without scheduling an appointment six months out. Used to be able to see a GPN in a couple of weeks but now I'm waiting over a month to see one of them, as well. The last time I tried to see a specialist, pre-COVID, was either a six or seven month wait.
American healthcare is rotten.
My Dad lived abroad and he bought insurance that would have international coverage. When he was in the hospital the bills racked up well past the deductible. After he died the insurance wouldn't pay us anything. We were left with $40,000 that we had to pay out of pocket. We had to pay because they wouldn't release his body till we paid. So we paid the hospital and then assumed the insurance would reimburse us which they didn't. So my dad basically paid them for years and never got a cent of coverage.
I don't remember the name of the company (it wasn't United Health Care) but I can't stop thinking about this whenever people discuss health insurance. Yes murder is bad, yada yada, but I'm too bitter and I am enjoying the gloating from this. I'm sure a lot of people who have similar stories feel the same way. It's not just the "eat the rich" commies who are celebrating.
Yep, my comment is similarly bitter. I don’t think he should have died, but the system is messed up they KNOW this happens. *shakes fist*
It's personal, not political.
Jesus fucking, farting, tap dancing Christ, Jesse. Just get a $20 prepaid SIM and let people in when they text you. Then you can toss it afterwards or keep it for the month and let the voicemail collect various lude threats involving tenticled lady dicks.
Seriously my eyes started glazing over at Jesse's ridiculous scheme. I like the man but his lack of practical knowledge never ceases to amaze.
Jesse desperately needs a wife. This becomes more and more clear each day.
Isn't the point that someone who is not trying to party is screening the calls? I think not giving out his number is secondary to not spending 4 out of 5 hours or whatever trying to hear a ticket dispute over top of a loud bar crowd (or, alternatively, spending 4 out of 5 hours texting people back and forth).
I totally get the point of it, but his solution is absurd.
UnitedHealth CEO Brian Thompson was a crime boss. No one thinks of him that way because he wore nice clothes and said words like “Q3,” but that is essentially what he was.
How do you feel when a drug kingpin gets murdered? That’s roughly how you should feel about this. By all means, pursue the murderer. Murder is bad and society collapses if vigilante justice reigns, but don’t expect many to join the manhunt.
“Allegations of fraud
Thompson in May was sued for alleged fraud and illegal insider trading. The Hollywood Firefighters’ Pension Fund filed a lawsuit against UnitedHealth Group, CEO Andrew Witty, Executive Chairman Stephen Hemsley and Thompson, alleging the executives schemed to inflate the company’s stock by failing to disclose a US Justice Department antitrust investigation into the company.”
https://amp.cnn.com/cnn/2024/12/04/business/who-was-brian-thompson
Yes, inflating the paper value of an equity is exactly like running a criminal enterprise selling addictive drugs and engaging in turf wars and enforcement that involve literally murdering people. Thank God for the moral clarity in this comment section.
He stole millions from firefighters, you snarky asshole
That's really bad and he should be prosecuted and jailed. Did he kill any of them?
Edit: should have been, but won't get the chance because someone murdered him.
OK, so we've established that cheering for the guy's murder is ghoulish and immoral. Great. Congrats for being on the right side of that one.
But spending your life becoming enormously, unreasonably rich trying to find ways to deny fair coverage *does* actually involve people dying so that he can make some more money. That's a totally reasonable observation to be making. I think it does show greater moral clarity than "he never ordered anyone's death so he's not like a drug kingpin". What about Purdue Pharma? Would you say they "killed anyone"? I think they did.
He's not Hitler, but I don't think he's as far from that drug kingpin, morally speaking, as you claim. He made his choices, and the consequence is that a good number of people cheered his death. He took the money, so there it is.
I agree that just because he didn’t murder anyone by beating them with a baseball bat doesn’t mean he/his business didn’t actively contribute to deaths. As a cancer patient myself who recently had my CT scans denied for an unknown reason, I have felt the desire to punch the face of the person at Aetna who denied them. They denied them twice, then overturned the decision a month after appealing with the reason “the member has metastatic melanoma, which has spread to abcdefg locations. The member is approved for CT scans to determine status” like no fucking shit Sherlock, I’ve been getting them for 4 years every 3 months. I was diagnosed in 2020 and been under Aetna the whole time during treatment. This three month delay that I ended up having could have been a death sentence for someone else.
The CEO isn’t reviewing my paperwork, but he supports the way they work that encourages denial or any reason they can come up with. BRB gonna go punch something.
Sorry to hear about your health problems. This one guy isn't responsible for all the bad incentives that lead to this system. But he is literally and personally responsible (as CEO) for devising policies to deny as much coverage as possible. If it wasn't him it would be another guy, but then if it's not one drug kingpin it's another. It's just not a nice thing to be doing.
Yep. And it goes even deeper. United has been a self-dealing crime syndicate from the start. Check out this report from More Perfect Union published a year ago: https://youtu.be/frr4wuvAB6U?si=QWrWaaaOPYP-uWPs
Do you feel the same way about the CEOs of automobile manufacturing companies? Their products are directly responsible for many more deaths than those that can be circuitously attributed to the denial of insurance coverage. And the auto worker unions are like the assembly line of genocide, should they get what's coming to them too? Liquor company CEOs? Casino owners?
No, I think selling cars is in principle different. We know the risks, we buy them anyway so that we can get around. If there are specific cases, like in "fight club":
https://www.youtube.com/watch?v=SiB8GVMNJkE
then maybe that's similar, but in general no I think there's a clear difference.
Obviously selling health insurance isn't inherently immoral. That's great. What's immoral is screwing people out of coverage to amass vast sums of money, so that they end up dead despite buying your insurance in good faith.
It's not that simple of course, but also maybe it sort of is.
I'd be willing to bet that quite a lot of people died (albeit indirectly) because of decisions Thompson made, yes.
Owning cars, gambling, and drinking are not basic human needs. Health care is. When someone purchases a vehicle, they accept the associated risk. No one decides to develop a pre-existing condition.
Also "allegations" are not evidence that a person has committed a crime much less a crime boss.
The allegations are not evidence but the allegations are based on evidence.
You’re a willfully ignorant apologist for fundamentally wretched people: https://youtu.be/frr4wuvAB6U?si=QWrWaaaOPYP-uWPs
Uh huh.
Big jump there bub.
Are you a child? You are either a child or the embodiment of the just-world fallacy.
Our president elect *instigated a deadly insurrection.* Corrupt rich people are above the law. They pillage with impunity.
That’s why so many people are happy to see a corrupt rich person finally reap what they sowed.
But like I said, murder is wrong. Not necessary in this case, because fuck that guy, but because we really can’t trust our idiot population with vigilante justice.
I’ve already seen the Eat the Rich crowd call for the heads of all rich people. Even Taylor Switch.
Most people are too dumb to tell between oligarchs who water their lawn with the blood of deceased chemo patients and rich people who make delightful pop songs and give millions of dollars to charity.
So, yea. Murder is wrong. Also wrong: a system where corrupt rich people use an abstraction called a corporation to kill thousands of people.
That's not what the suit alleges, and we have no idea if what it *does* allege (that he sold United Stock when he allegedly knew that the US DOJ was trying to block the Change Healthcare merger, at which time the Firefighters Union owned an undisclosed amount of United Shares) is even true.
Also, the Firefighters were trying to make a profit off the inhumane insurance industry in the US by investing in United stock. I'm not saying anyone should shoot them, but you know...
Someone has never heard the "everything is securities fraud" line before.
Ha! I do like that line a lot, but "Everything is securities fraud" doesn't mean "every securities fraud lawsuit is successful" or "everything proves that the defendant stole millions of dollars from firefighters."
Ah yes, the healthcare industry famously adverse to selling people drugs and pushing others out of their territories.
It's almost as if Noah Stephens is dishonest.
I feel like there are a lot of people who don't want their name to be associated with "lolz, maybe this guy deserved it" comments?
My is-my-employer-reading-this? stance is "what did you think was going to happen?" My polite dinner party view is that shooting people is bad, and I certainly don't have the temperment to shoot someone, but... what do truly vile people who make decisions that kill their fellow citizens think is going to happen?
I find it pretty funny how article/podcast sentiment (NYT and Fifth Column eg) is vs my private chats where we are howling laughing about some of the jokes that are coming out of this event. Or the confusion/incredulity of articles being like "whoa nelly, how can people be celebrating this?!" Really?
I think he and other who engage in people-killing-as-a-corporate-policy are literally not crime bosses... because modern corporatism turns people who would have been crime bosses in the 70s into normal citizens who occasionally pay 2% in tax when they're feeling charitable.
But that public/private distinction is important, because people know they should be ashamed for the dark jokes they're telling their friends. That's the purpose of having narrowcast and broadcast communications channels. I've laughed and some of the memes (particularly a Dark Souls one I saw) but would not be a vector for sharing that stuff with the whole world.
What's disturbing about the whole thing is that many people, not just insane political nut jobs who already talk about murdering rich people, are not feeling a sense of shame for laughing about a stranger being murdered in the public square. That's weird and bad.
Nah. Not in this case. And I'm not laughing about it. I don't think it's funny at all, I think it's extremely serious. But it is perfectly understandable for people to not feel sorry about it. The healthcare system in this country is a fucking travesty. People suffer medically, and then on top of it, they lose their house to bankruptcy. The system is rotten from top to bottom, and certain people are getting rich from it. This guy was one of them.
This mealy-mouthed "omg, NO ONE should ever get shot on the street" - dude, come ON. OF COURSE some people deserve that. It rarely happens here because we're a country with rule of law. But those rules have allowed this guy and people like him to harm people by the thousands. For ONCE there was some consequence for that. Our government has shown us repeatedly that they won't do shit about crime and criminals, from the people breaking into your car and doing drugs on public transit, to legalized mafiosos in the healthcare industry.
This is a sign of failed government - the people are suffering, criminals run rampant, and no one gives a shit. And if one guy gets some justice, everyone clutches their pearls.
Pathetic
PS this is why I don't flip out when personal chats among doctors, lawyers etc. talking shit about their customers come out, everyone has a narrow personal group of friends to whom they say things they would never say in public.
Sure, to a degree. Some people are more reserved than others. I'm fine saying "what did you think was going to happen?" With regards to executives who lead companies with profit maximizing policies which kill people. I find the jokes pretty hilarious.
I think this group of people in the comments should be aware of the public/private distinction because of things like people who are forced to do DEI trainings pretending to drink the Kool aid and not actually believing any of the crap. Saying "aww that's so sad" about someone no one actually cares about is on the same spectrum as admitting your social justice guilt in a training session at work.
So true about the private vs public responses. Many of the people Jesse et al believe agree with them are memeing it up with the rest of us on private FB pages and group chats.
Exactly. Their criminal behavior is allowed by the US govt. Doesn't mean they aren't pieces of shit who might occasionally get served real justice. This guy knew what he was doing.
Insider trading?! Ye gods. I don't understand why he didn't just study the shrewd stock picks of financial genius Paul Pelosi. He wouldn't have had to stoop so low and cheat.
I remember reading a New Yorker article a couple years ago about a guy who had a son with precocious puberty and their decision about what to do. I don’t remember the outcome, just my introduction to the concept through this article.
Curious about the differences in hormone blockers for precocious puberty versus in people who are approaching puberty at a normal age, as well as the prevalence of precocious puberty, I did some basic googling.
First I learned that .0006% of kids have this disorder. Secondly I learned that complications, especially decreased bone density, related to the use of puberty blockers for precocious puberty are typically associated with using them for too long & past the normal age of puberty.
Then I did some googling about when kids go through puberty, and at what age kids start puberty blockers for either precocious puberty or gender dysphoria.
My conclusion is that kids with precocious puberty are at most going to be on blockers for a couple of years, if they go on blockers at all. By contrast, a kid who is trying to prevent puberty while they make up their mind could end up on these drugs for twice as long, including during the time when their child would normally be going through puberty.
The side effects are real, severe, and have been dramatically downplayed. Parents need to know this because they’re going to be plenty of states in which this is legal indefinitely because it is such a culture war debate.
I’m just gonna say this that in Canada, my aunt who died of ALS, my uncle who got cancer and their son who had down syndrome required a lot of expensive treatment for very serious illnesses as a family. If they were the US, they would be completely bankrupt and instead they can like move on with their lives, even after my aunt’s death. I think we forget that what we get in the us is a system that ruins a lot of people with medical debt and I think it’s that system that is creating so much rage and anger
>If they were the US, they would be completely bankrupt and instead they can like move on with their lives, even after my aunt’s death
This really isn't how the US system works *most* of the time. Like at all. Most of the time people (or their employers) pay high premiums all year, and mostly get their shit covered.
The issue here is when a sick person becomes too sick to work, and loses their job and their health insurance. My friend lost her insurance and her income when she had to take a leave of absence to give/recover from childbirth. (No maternity leave at the employer. Just unpaid family leave!). She couldn't keep her insurance through the leave because she was still in the probationary six month period when you're first hired. If it wasn't for her husband's student health insurance, I'm not sure what she would have done for money or healthcare.
Well there is COBRA, and the ACA, and medicaid. In your very example she did in fact have coverage.
https://en.wikipedia.org/wiki/Medicaid
Do you have any clue how expensive COBRA is? It's a fucking joke. Someone loses their job and income, and the answer is, well you can keep your healthcare coverage by paying like $1800 a month, even though you don't have an income anymore. How on earth is that feasible for most people?
It’s not always that expensive, depends on what your previous insurance was.
Look up the rules.
Babe, I went through it personally 10 months ago.
Sorry about your family. But it's probabilistic, right? There are plenty of people in the US who get their expensive medical bills covered by insurance. It's been the case for my family. That's what Katie brought up, with her brother's hospitalization.
I have several not-well-to-do relatives with chronic conditions and they get them taken care of without being bankrupt. It's a patchwork of systems that could be radically improved, but they've kept it going for decades.
Don’t many/most US health insurance plans have maximum out of pocket limits? Doesn’t this prevent most people from going bankrupt? I don’t know that much about the details of the industry tbh.
A very common plan might be something like: you have $1000 in premiums a month, your employer covers $700 you cover $300, and then you have a yearly out of packet max of $6,000.
Something like that. But people love to scare monger. There are of course people driven to bankruptcy, but it is not an every day thing that is happening left and right as some want you to believe and even then what happens in a medical bankruptcy is YOU DON'T PAY THE DEBT.
Something like seventy percent of humanities students are female, and the majority of the faculty are now female also. I think it's fair to assume that if, when the majority of students and professors were male, the scholarship produced showed biases, then the same would surely hold for women. The over-focus on intersectionality, and the concomitant suite of beliefs, may just be an example: most social justice activists are women. I have not said anything about the quality of scholarship, merely on the topics of study chosen. The PHD candidate got the reaction she did because her thesis seemed symptomatic of a "discourse" with which everyone is now thoroughly bored, and was in turn amplified by right-wing edge-lords. Why her out of all the dumb shit that we have been told is problematic over the past decade? Who knows, but people have developed a hair-trigger reaction to words like "Intersectionality" and "misogynoir", because they want this stuff to go away. The fact she used "misogynoir" shows how thoroughly Americanised academia in the Anglo-sphere has become-when I did English at university 20 years ago we didn't even study American authors, other than TS Eliot, at my university.
I guess I have to look up "misogynoir" now. (Looks it up.) OK, it's mashup. New oppression word learned.
I’ve been sounding the alarm about the decline of men in the humanities for a decade now, to little avail until, like, a month ago – it’s a serious problem because it does impact what research gets done, and to a great extent what gets taught. (The other problem–and honestly the bigger one–is the decline in the number of students who do not come from elite backgrounds, especially in grad school. I grew up small-town working-class, I never would have had even my modest academic career if I was just starting today.)
Lol Katie meant to say Shahada but said Shanda, I'm beginning to suspect she may not be a faithful member of the Ummah
Katie’s a Shanda fon d’goyim
Shanda 'Pon Da Goyim sounds like the best Jamaican Jewish reggae song never written
Who knows, maybe Shonda Rimes has a cult following in the Muslim community