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


#102

Even pill factory docs are at least prescribing pharmaceutical grade drugs, rather than street gear, which I’d classify as harm reduction.


#103

Yep. The actions of a small percentage are used to ostensibly justify imposition of draconian measures harming not just the larger percentage, but really everyone everywhere.

People often say our government is divided on partisan lines but somehow this sort of thing - enriching a hereditary boardroom class at the expense of society as a whole - always gets loud bipartisan support.


#104

USD 30 is about what I pay to visit my GP in Norway and we have fully socialized medicine here.

However there is a cap so that the chronically sick don’t end up paying endless amounts of money. You get a refund through the tax system. And of course in patient care is totally free.


#105

Every time I think I have seen all the crazy things that US medical care can come up with someone shows me something even more bonkers.

I’m glad I’m viewing it all from a safe distance.


#106

Sounds like an opportunity for Isaac Flint. See https://en.wikipedia.org/wiki/George_Allan_England.


#107

Really? How do they do that?? Is it magical??


#108

I’m sure that old people and families and people who live in cities like SF and Pittsburgh will happily pedal everywhere.


#109

No kidding.

I’m American, and I have great insurance compared to most people I know. I’m genuinely happy with it and it has never prevented me from getting good quality care at a price I can afford. Yet there are still bizarre quirks in pricing and billing that don’t make any more sense even after I figure out why they happen. Medication whose price varies by a factor of fifty from one month to the next, but I’m not allowed to switch pharmacies if a different one offers it cheaper, and in any case the pharmacy can’t even tell me what the price would be until they’ve already filled the prescription. Payment systems that mean most of the year I pay literally nothing, but for a brief window I pay full price, then after that a small copay, except since I don’t know when those thresholds happen I am completely unable to comply with those “copay due at time of visit” signs. Reimbursement systems so slow I sometimes get bills and even late payment notices from doctors’ offices before the insurance pays them.


#110

Yes, but it’s a dark magic fueled by the blood of the innocents sacrificed at the altar of scary death panels. :roll_eyes:


#111

I figured that Norway must have secured the services of a magic dwarf who can spin straw into gold.


#112

Cycling is currently SF’s fastest growing form of transportation, so maybe not as daunting as you think.

SF has a higher bicycle commuting rate than, say, comparatively flat Boston.


#113

Here the chemist will tell me that a generic will be a lot cheaper than the specific drug that the doctor has prescribed. Generally I take the generic because the rule is that if the health system believes that the generic is a full replacement then they won’t subsidise the specific drug so you end up paying a lot more. For instance I pay NOK 55 (about USD 7) for 100 Losartan Krka pills (for hypertension) but the Cozaar that my doctor prescribed would be almost five times as much.

My point, which I seem to have almost lost track of, is that the chemist knows exactly what each driug will cost me and can advise me on substitutes.

Also the chemist is required by law to offer me the generic.

And if I spend more than about USD 250 on drugs in a tax year I get the excess back in my tax settlement.


#114

In addition to your list, I think there’s a huge problem that insurers are negotiating prices of procedures. If we let fire insurance companies negotiate our home prices, we’d end up with some very expensive homes. Insurers want to insure things of higher value. Obviously it means they pay out more when they have to pay, but it means justifying higher premiums. So the negotiation for price is between two parties that both fundamentally want the price to be higher. A couple of years ago the NYT had an article comparing prices of some fairly routine procedures in Ontario vs. New York. In many cases the exact same procedure using the exact same technology was 10 times as expensive (I think the average was 5 times). The American system has massive administrative costs, but Ontario’s healthcare system is also a red-tape nightmare.

Basically every country in the world is thinking about how to contain rising healthcare costs, but it seems like the costs in the US are off the charts.


#115

If that’s “sticker price” I’m totally unsurprised. In many US cities it’s not unusual for what a hospital actually collects to average 25-35 percent of the sticker across all patients. This is due to the one thing which even I will admit a single payer system solves - cost shifting.

However, single payer advocates who think we can get cost out of the system by reducing all reimbursement to what Medicare pays, without causing a huge disruption in health care delivery, are in major denial.


#116

Sigh. The old hills excuse. And actually, both children and the elderly profit most from decent cycling infrastructure. Build it, and they will come!


#117

He could ask the republicans for help since they seem to be able to do the same with bullshit.

Well, at least for their donors.


#118

Not sure I get your point. What I was saying was that anyone who says “inpatient care is free” is simply wrong. Unless all the doctors and other providers are working pro bono.


#119

But if that’s true it could happen to any of us. THAT MEANS MY ATTITUDE WON’T ACTUALLY PROTECT ME OR MY LOVED ONES. /nobby


#120

It’s “free” in the same way that the Fire Department doesn’t charge you to put out a fire in your house, nor do the police charge you to investigate a crime, yet somehow, magically, those people get paid.

But thanks, “taxes are magic” might be a good slogan for a public service announcement.


#121

“Universal health care paid for by taxes” is a correct and totally appropriate description then.

The problem is that the American public seems to desire “universal health care paid for by taxes levied on someone who’s not me.” No universal system works that way.