The copay assumes the 99% treat healthcare like spiteful buffet gorgers


Oh right, that’s another one of the things in healthcare that doesn’t hold: the customer has to be perfectly well informed. I look at this stuff for fun and I’m nowhere near qualified to say conclusively what treatment is best for myself, what medicines to leave out if I can’t afford all of them, etc. I’m someone who looks this up for fun from a family who works in healthcare; how can you expect some random person off the street to?


OMG and my pediatrician (for my children. My children’s pediatrician)-- their annual visits are not covered by insurance if you’re even a day less than a year since the last one. So gradually, my kids’ annual checkups have been floating well past their birthdays, such that kid 2 is having their 3 months past her actual birthdate.


I do recall an article that many hospitals have chronic ER users that rack up huge bills. It seems to me these people are sick in some way. So in the US I know we have mental hospitals but do we have long term places for people not quit all there?


Yep making the patient “responsible” for the costs of their healthcare is so fucking stupid, for so many reasons.


Shouldn’t it have been the cheapest? It’s Penicillin!!

No, decades ago we closed most of the inpatient facilities, creating the modern mentally ill homeless crisis. But somebody got a tax cut, so it’s all good!


What about for those who an afford it?


Probably, but they’re a minority, psychiatric inpatient care is very expensive. Found this:

The average cost to deliver care was highest for Medicare and lowest for the uninsured: schizophrenia treatment, $8,509 for 11.1 days and $5,707 for 7.4 days, respectively; bipolar disorder treatment, $7,593 for 9.4 days and $4,356 for 5.5 days; depression treatment, $6,990 for 8.4 days and $3,616 for 4.4 days; drug use disorder treatment, $4,591 for 5.2 days and $3,422 for 3.7 days; and alcohol use disorder treatment, $5,908 for 6.2 days and $4,147 for 3.8 days.


It was very hard to find a hospital that would hold my brother for more than a couple weeks during an extended period where he was convinced that his family had all been replaced by imposters. At one point he was dumped at a homeless shelter when he claimed his family was dead.

An above average cop finally got him back home and an above average counselor finally had him held for a few months until he finally recognized our mother again. Most don’t go as far out if their way to help.

“Long term care” for many disturbed people ends up being finding an excuse to throw them in jail.

The current situation with people who need real long term care is a nightmare.

Edit: Of course most of the old long term facilities were a different kind of nightmare. The move towards outpatient care was necessary but massively mishandled.


I think you are mistaking my criticism of 40+ years of British government for an accusation against you.


Its only expensive for the psychiatric ill. For the rest of us their psychiatric care is very cheap - compared for example to getting stabbed in the eye which happened a few years back in Finsbury Park, London.

The approach to mental health in the US is an utter disgrace and the cause of many unnecessary deaths - often by cop. A friend of mine suffered from schizophrenia from the age of 14 to 44. He died of lymphoma. I remember him telling me before he died that despite spending nearly 25 years jacking off to weird Japanese s&m porn, that he was proud of his immense contribution to society. You see he had never once listened to the voices telling him what to do to other people, regardless of how insistent those voices had been.

He was a lovely guy. I miss him terribly.


Think of this as an unreserved apology.

I live in the US, and its easy to come to think of the system in the US as a ridiculous affront to human dignity and also something which has at its root a shitload of racism. I remember suggesting to a friend from South Carolina (white) that the US system was designed to avoid having to give free health care of a reasonable standard to black people and he looked at me and said thats exactly what is going on here. For what little such an opinion is always worth.


Halfway through tetanus injection: “Patient presents with a deep puncture wound, possibly caused by a hypodermic needle.” Problem solved!


SS had cutouts for farm workers and domestic servants. It just so happened that most black workers fit that description before the northern migrations. Purely coincidental I’m sure.


You sound like a creationist.


Here’s the thing about hypochondria - it is a real condition. It’s an anxiety disorder, and should be recognized and treated as such, rather than as a pointless pain in the ass of the medical profession.
And the thing about sliding scales is absolutely right. It should be like Finnish traffic tickets, which are designed to deliver the same “pain” to the driver, not the same amount of money. There was some rich dude who had to pay about $100,000 for a speeding ticket.



When the right wing pushed for co-pays in Oz, they framed it as “lonely grannies are wasting medical resources by going to the doctor just for a chat”.

Most of that argument is raw bullshit, but even to the extent that it has a hint of truth in it…

Treating this phenomena as a pure waste of resources misses the point that, if your elderly people are going to the doctor for “fun”, then that is a clear sign that something is amiss. And you should treat those GP consultations as a valuable opportunity to refer your patients to appropriate psychological and social support services.

We need to stop treating mental illness and distress as “fake”. Get people support before it escalates to physical injury. There are mountains of research demonstrating that this is the better option for both health and financial outcomes.


Over the past few years, I’ve seen an increasing number of reports that studies show people don’t really need frequent tests for preventative care. First they were encouraging fewer mammograms, then pelvic exams, and annual physicals. Now they are going after colonoscopies.

IMO, they want you to have a far more expensive problem, followed by a quick death. “First, do no harm” has gone out the window.



I had two now-deceased relatives with that same attitude. Now, I believe the worst thing you can hear from a doctor is, “If only we had caught it sooner.” There are many conditions that cause no symptoms until it is too late. It might help to think less in terms of fishing, and more in terms of having a baseline for use in the future.


I studied way too much economics for my own good. It is not a science. Thats what 5 years of university economics will teach you in my experience. Its a rhetorical discipline - a series of arguments generally constructed to persuade people to support the status quo or very occasionally to support change.

Being dismissive of economics is not the same as being dismissive of biology, or physics or chemistry. Its more like being dismissive of political science. Personally I have more respect for anthropology than economics although maybe thats primarily due to David Graeber. I definitely have more respect for classics.