my first rotation as a med student. Obamacare had kicked in. but I kept seeing ppl coming in far too late, refusing followup care, etc. why?
they had insurance! Obamacare meant that they’d be spared from truly financially disastrous illnesses like cancer. so what was the deal.
talk to guy. fam history of esophageal cancer. guy has severe acid reflux. recommend endoscopy. he refuses. why?
see his deductible: $5000!
for you non-Americans: the first $5000 of his medical care in the calendar year, he pays for out of pocket.
answer is obvious: can’t afford
cost just of scoping to diagnose problem: ~$1500. biopsy, $100. add a $100 specialist followup, and you still haven’t even touched treatment
the doctor works 7am-7pm M-F. Saturdays @ hospital. b/c she sees poor pts, she pays her staff thru her salary. earning ~$10k/year herself
this is b/c she does “long” (half-hour) appts. doesn’t over-book. many indigent patients, even if they have insurance.
i can tell you this story again and again. this isn’t even a particularly poor area, but docs who saw poor pts were taking >100k/yr pay cuts
had multiple child psych docs quit b/c our new guidelines changed to basically: just give the kids drugs. b/c TX social services are fucked
so this is the problem: Obama’s signature accomplishment, Obamacare, had almost zero influence on any of the poorest patients we have
the effect was to transform healthcare from totally unaffordable to totally unaffordable. most ppl still had impossible barriers to care
“what about Medicaid?”
I live in Texas. we refused Medicaid expansion. & even if you’re (magically) eligible, getting it can be a nightmare
In medical treatment, there’s a ~guideline of the simpler the better. One pill a day, OK. Two pills, not good. Three pills, too difficult
Every single extra step a patient has to take reduces the odds that a patient will/can be treated properly. It’s a big deal.
All this wonk bullshit in Obamacare? I’ve seen grown adults cry b/c they can’t figure out wtf is going on w/their care. it’s a nightmare
if me, the doc, the nurse, a social worker, the patient, & the insurance co can’t figure out what’s going on, maybe your bill sucks
if you need a team of economists, Vox, and two hundred men wearing lanyards to explain how you’re helping the poor, maybe you aren’t
b/c for the poor, in the case of Obamacare the test came when they went to the doc for the first time & it was still hellish & unaffordable
oh, and I can’t tell you whatever happened to the reflux + family history of esophageal cancer guy. b/c he never came back
To spell it out: health insurance with a deductible of more than a few hundred dollars is essentially null and void for most Americans. It provides zero benefit outside of extraordinary circumstances.
Forcing people to pay for functionally non-existent healthcare does not help them. It hurts them.
The pre-ACA situation was diabolical. The post-ACA situation is still diabolical.
If you’re going to socialise healthcare, as you should, you need to do it properly
