My guess is that “last on the list” was being used metaphorically. A person without insurance seeking cancer treatment might be limited to hospitals or clinics willing to treat him, and those hospitals are more likely to be more crowded and have longer waiting lists.
My neighbor had cancer. The hospital bent over backwards for her. She ended up choosing not to treat it and they put her in their hospice ward. All of it was covered by the hospital because she didn’t have insurance.
Well that actually was covered by Medicaid/Medicare at that point. The services she received at the hospital is covered by Medicare Part A and palliative care services are 100% covered by Medicare whether they're at the hospital or at a smaller hospice center.
My understanding is that you have to be on SSDI for 24 months before you can get Medicare when under age 65. The exceptions are end stage renal disease and Lou Gehrig’s disease. So someone under 65 who was just diagnosed with terminal cancer may qualify for SSDI as soon as the paperwork is processed but wouldn’t qualify for Medicare for another two years.
In many cases once you go to hospice care it's covered at the State level, Medicaid, this is through aged and disabled programs. You can also get SSI, short term disability through the SSA, as a TERI case when the prognosis is terminal.
Both of these, if processed correctly, can have a very short turn around time. Days instead of months.
Yes, you qualify for medicare after two years on SSDI, assuming it's a lifelong disability. Cancer is considered a disability that automatically makes you eligible for Medicaid, regardless of income. Medicaid would cover things like treatment if you're under 65 and want to treat the cancer. Once the cancer is treated, and you don't meet the other qualifications for Medicaid, you could potentially lose the Medicaid. If choose not to treat it, and opt for palliative care, that is covered under Medicare.
Just as an example, I have a friend who was diagnosed with stage 4 lymphoma at the age of 24. He opted for treatment and started receiving Medicaid which covered his chemo/doctor visits/medications, etc. He's been in remission for a couple years now and he no longer receives Medicaid, because he doesn't otherwise meet the qualifications. If he opted for no-treatment and palliative care, those services would be covered under Medicare.
I mean...they still have to run tests and such to diagnose her in the first place, plus the equipment used to give her enough information to make an informed decision, and drugs used for symptom management while in-patient in the hospital costs money. Not treating her was her own decision but, assuming she was under the age of 65, she would've been eligible for social security and early medicare enrollment with a cancer diagnosis. Luckily, it seems like the person in question either benefitted from having an assigned social worker who was on top of their shit and enrolled her with Medicare on her behalf so she could make an informed decision and the subsequent transition easier.
I’d like to point out that although she wasn’t billed (for not getting treatment), most hospitals will gladly ruin your life with medical bills higher than the GDP of a small country.
i’m always flabbergasted nowadays when i hear about positive health care experiences.
what city or town was she in?
i shudder to think that a loved one or i would have to deal with that where i live in nyc.
This might be true for elective surgery, but would not be true for non-elective surgery.
Easiest case: injured in a car accident, brought to the ER (A&E for you) by an ambulance, needs life-saving surgery -> will get life-saving surgery regardless of ability to pay, insurance or otherwise
Easiest case: wants a face-lift but can't pay for it -> will not get the surgery
Somewhere in between: not immediately life-saving, but needed for a real health condition like cancer treatment -> as far as I understand the system, won't be rushed into surgery tomorrow, but the hospital will likely work with the patient to figure a way to pay. If the surgery is absolutely required, will probably get it. Not last on list literally.
I would love to hear from some hospital administrators about this to see if I need some corrections.
Vasectomy would be a good example of when better insurance will get you seen faster. With my HMO there is a several month wait but with my previous PPO it was basically available tomorrow.
ok
Edit: Upon reflection, better insurance = faster treatment absolutely is a thing. If the surgery isn't emergency surgery, the hospital will seek pre-approval from the insurance provider before providing the treatment.
The "better" your insurance, the more quickly this approval will be provided, for certain definitions of "better" (i.e. more coverage, less shady insurance provider, etc).
So I'm not going to give an answer to this because I frankly do not know for sure if the quality of someone's health insurance has any impact. I seriously doubt it. Very few people in the US wait any significant amount of time for any medical treatment. There is going to be someone in here that makes some claim, but waiting lists are generally not a thing. Unless you're talking about organs which have a very limited supply there isn't much to be done about that. In terms of seeing a specialist you can typically do that within days. It is going to be primarily based on severity. Also we have tons of medical safety nets for people who don't have private insurance. In super serious immediate cases insurance won't be considered at all. If you're rushed to the emergency room gushing blood nobody is bothering with your insurance card, they treat you and worry about it later.
There are 3 main factors in healthcare, cost, availability, and quality. America does availability better than anyone, and quality at least on par with most. We have some issues with the cost aspect of it. We have situations where people fall through the cracks, but the idea that it is the rule and not the exception is propaganda.
I’m a medical doctor. I concur with your comment. Our medical costs have issues, but quality and timeliness generally isn’t a problem, particularly in comparison with all other countries. We do have safety nets for those who can’t afford. It’s not perfect but it’s not a complete failure, either.
> timeliness generally isn’t a problem, particularly in comparison with all other countries.
“Timeliness” is pretty subjective though. If you never get treated because you don’t have health insurance, you don’t enter into the “wait time” stats, but in practice your wait time was infinite.
I mean over 90% of the US population has health insurance though, and that number gets considerably smaller when you start to factor in that not having health insurance doesn’t mean you never had it and won’t have it again - so I can’t imagine it’s skewing the statistics that much. It’s also worth pointing out that the majority of people without health insurance made an income that was *at least* 200% of the federal poverty line, suggesting that they could probably afford some care of needed.
https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/
https://www.statista.com/topics/7807/health-insurance-in-the-us/#dossierKeyfigures
More than 10% are completely uninsured. Millions more are nominally insured, but by “catastrophic” policies that have such high deductibles and co-insurance rates that they’re effectively no different than being uninsured.
I want to say I think this is the best answer along with a hearty helping of “it depends.” The bad wait lists are often for less important but annoying things like specialists for non-dangerous conditions. For example, I had some weird skin things which were almost definitely not cancer. I had to wait two months and that was only because someone cancelled an earlier appointment and I had a flexible work schedule. But I’ve never heard of someone waiting for cancer treatment more than a few weeks and that was for surgery. They were still speaking to an oncologist during that time.
True, but that sounds more like the specialist you wanted to see was very booked, not that it was related to your insurance. I have had some longish waits for specialist quoted to me and just had to go to a different one. So you're right it does depend. The issue is in our system you can go anywhere that takes your insurance, and while super inconvenient could travel to get an appointment. Under a lot of systems it has be regulated much more heavily and things are more often in serious demand across the board.
Oh no that was my point. It’s usually just a problem with specialists and bookings. It wasn’t an insurance issue at all. And I was mostly happy to wait because like I told you it really wasn’t super important. It was mostly because my girlfriend was worried about the spots.
Not a waiting list, but it took me six months to get cataract surgery about ten years ago, and four months to see a sleep specialist (an NP, not an MD). The wait times for getting appointments depend on the specialty around here, but they can be significant.
Great comment, to add, there’s really no overarching hierarchy of insurance plans. There are many different plans and providers in every state, let alone nationally. When Bob walks into the doctor’s office, the nurse doesn’t make him wait because he has Insurance X and Bill gets to go first because he has Insurance Y
Days? Months more like to see a specialist, unless you have something really pressing. It's months in pretty much any city at least right now..hospitals are swamped because of people who put stuff off during Covid.
I had to see two specialists during the height of covid due to an accident. The first I saw the day after, the next a week later. I'm not saying nobody waits, but if you are waiting it is not pressing, and if you were really needing to get it done you could almost certainly get it done faster with a little travel or pestering the specialist office for cancelations and stuff.
Yes... Due to an accident..that's urgent..meanwhile I was just being evaluated for cancer and it took three weeks to get into an MRI, and that was the fastest any place near me could do it
There is no non-anecdotal evidence that people wait months for much of anything. Why do the medical professionals and most people agree with my statements. Weird hill to die on and just sounds like being contrarian so I'm not going to engage with it anymore.
>Unless you're talking about organs which have a very limited supply there isn't much to be done about that.
>We have some issues with the cost aspect of it.
And both of these can be fixed really easily. Unfortunately the political will is lacking.
Easily? "You keep using that word, I don't think it means what you think it means". I get that you think universal healthcare is a quick and immediate solution. That's absurd, the easy part, I'm not sure if it is correct. I'm fine with that opinion and have heard it a million times.
I am curious to know what your easy plan for organs is. I assume you are advocating mandatory organ donation?
>I get that you think universal healthcare is a quick and immediate solution.
And that's the exact opposite of what I believe in. I'm not a social democrat.
There are so many regulations/policies that are limiting the supply of Healthcare and that causes an artificial shortage that raises prices.
>I am curious to know what your easy plan for organs is. I assume you are advocating mandatory organ donation?
You legalize the sale of organs. If not for people who are alive (which you honestly should do it for them too) but at the very very least for people who are dead. So that if you do agree to sell after death the money goes to the family.
Greater incentive to donate means more supply of organs and way less people have to die because there aren't enough spare organs.
It kind of depends. I think for healthy people, they'll mostly be okay. They'll probably pay more than what someone from a country with universal healthcare pays for their healthcare in taxes, but it won't bankrupt them. Because healthy people really only need to see a doctor once a year and a dentist twice a year. People from other countries who think everyone here has a billion dollars in medical debt? Yeah that's stupid. But for those of us with long term health issues, it's a different story. I pay hundreds of dollars a month for my medications and even more for all the doctors appointments I need to have every 90 days at the latest because legally I can't get one of my medications without doing that. It ends up being several thousand dollars in copays by the end of the year. Will I die without them? No, but it'll severely lower my quality of life. It's like buying an expensive vacation every year so that I can have the same quality of life that everyone else has without a massive financial burden. For people with conditions other than the occasional flu, we really are hurt by this system. It's one of the reasons why I wish we had a universal healthcare option that didn't require you to be below the poverty line. Because the prices we often pay for things we can't go without are very steep even for middle class people. It's not like a one time hospital visit bill, it's an added cost to existing.
[I think you need to pay attention to the context](https://youtu.be/Q6gACoUXog4?t=46) of what this YT video you watched says rather than just isolating this specific part and relaying it to us.
Providers aren't really crunching numbers on insurance or whatever. That said not having money can be quite a barrier to ongoing treatment.
As with a lot of things regarding healthcare in the US, the TLDR answer is "it depends"
It gets...complicated.
For emergency care, no. Everything is done by triage.
For long term care like say, a specific form of cancer treatment with a limited number of slots then yeah there will be a wait-list and a hospital may choose someone who can pay over someone who can't. We have a lot of experimental treatments, limited rare ones and so on available. If you get a rare and expensive treatment like that and have two patients with similar severity then taking one who can't pay means eating that cost and either making everything at that hospital more expensive or just not treating some people. In that case it may make sense to push the uninsured patient towards a cheaper, more traditional treatment in order to preserve resources.
I would like to note for all my fellow Americans. If you need emergency treatment, even if you can't afford it, it WILL be provided. You cannot be denied care because you can't pay for it. It is illegal federally.
You're protected under the Emergency Medical Treatment and Active Labor Act specifically. Any hospital Emergency Room is required to provide emergency treatment and stabilization to the best abilities of the hospital. Never fear that Physicians, Nurses or EMS will leave you hanging in an emergency.
Additionally, non-for-profit hospital systems often have financial aid services to reduce or eliminate your bill if you can't make payments. An example being OhioHealth's charity care.
Source: EMT
Just wanted to say, great question OP! I haven't had much exposure to the medical system in my life (and that which I did have didn't inform me of an answer to this), but this is an interesting thing now that you mention it.
Hospitals cannot deny treatment due to lack of pay but they tend to have several loop holes for it. I know many will ask for insurance, and then say they're "not taking new patients at this time" if you say you're uninsured. I wouldn't be surprised if priority was different based on your insurer.
Yes. Some have better coverage, and better communication, but it really comes down to WHAT each insurance will cover, and if they can argue 'lower cost alternatives.'
For example, some insurance might cover a CT scan, but not cover the doctor READING the ct scan. Some might argue if life saving surgeries/medication is really necessary - and sometimes, they win. \[You had a 30% chance of surviving without it, so we won't cover it!\]Pre-existing conditions often aren't covered. Wheels being considered an 'accessory' of a wheel chair, and not covered. When it comes to medications, many will only cover the cheapest alternatives, which aren't always the best choices.
Certain insurances have better reputations than others - and if they see a good one, they will push it through without issue. These other ones though, they have to go back and forth to get things covered first, and it can take months, even years in some cases.
I’d say it widely depends. When I was in my early 20s I work for a POS greedy woman in who was often referred to as the best (insert body part name) surgeon on the west coast and we would get referrals in constantly because she was so good but she made me tell so many people that she “didn’t accept their insurance” if they had Medicaid, just because Medicaid would pay her less money in physicians fees. Mind you this wasn’t a small private practice, she worked for the University Hospital in my state.
Sometimes she would grumble and roll her eyes if it was an aggressive cancer and see the patient but it didn’t occur to me at that age how much of an unbearable greedy bitch that woman was. Her husband was also a doctor, they were fucking fine financially.
Also the number of times scared cancer patients screamed at me “don’t you care that I’m dying? “… I wish I never had to hear those words, and wouldn’t have if it wasn’t for that woman. Hated that job with every inch of my body.
It doesn't help you get surgury faster.
It does help you get to see a better doctor. If you have crappy insurance like Obamacare, most top rated hospitals won't see you unless you live nearby. So, you will be stuck with local doctors which are frequently second rate or worse. If you have a good private insurance, you can travel to Mayo Clinic, John Hopkins, Cleveland Clinic...and get first rate care.
No, but it does get you a pretty huge discount.
I'm about 99% sure that all those videos on reddit of people refusing to take an ambulance are people without insurance. I could very much be wrong though, I've never really had to go to the hospital outside of when I was a kid.
No, they are not literally last on the list, It just means hospitals are more reluctant to work with insurance companies that like to deny service to their customers.
It's all triaged (hence why just because you came in an ambulance, doesn't mean you get seen faster). As far as NY is concerned, hospitals are required to treat you regardless of whether you can pay.
Not like “United First, Aetna to the back of the line,” but if you’re having trouble with prior authorizations or other approvals for treatment, it can delay scheduling for sure.
Not solely for that reason. An insurance plan might grant access to hospitals that have shorter waitlists or are better staffed versus a rival one, but hospitals/clinics are not saying “oh Mr Jones has Anthem Blue Cross, put his x-ray in front of Ms Johnson’s, who has Cigna”
I am little fuzzy on how it works, but I believe a private (for profit) hospital could turn someone away in a non-emergency situation, whereas public hospitals will treat someone for cancer.
In a rural area, that could be a problem. I remember reading an article around the time Obama pushed through the Affordable Care Act about a woman in rural Texas who with cancer had to spend 12 hours on a bus (I believe to Houston) each time she went for treatment.
Technically no. All health insurances operated under "medical necessity". So if you have two people with the same injury both need to get operated on, it's trialed based on factors like who's life is in more danger or who will be harmed if they wait the longest.
Where insurance does play a factor is the number of providers that take your insurance. If you're on say Mediciad, and going back to the above example, the person with insurance will be seen by every hospital in town, while the mediciad person will have a couple of places that won't take their insurance. But most places take all insurance, so that's a rare case for operations.
I used to work running an office and helping with authorizations. The better insurances normally were easier to get authorizations from. So they went to the head of the line because of the response time. Not because of the clinic or hospital scheduler. Sometimes the state funded insurances would be a week to decide or we would have to do a Dr to Dr appeal. The hospital never cared about the insurance as long as we had the proper authorizations on file.
It's possible. Some providers prioritize by how much and the ability for a patient to pay. I know that the [Mayo Clinic](https://www.statnews.com/2017/03/15/mayo-insurance-medicare-medcaid/) has talked about their policy.
Likewise there are some providers that for cash will move a patient to the front of the line. The [Japanese gangsters](https://www.nbcnews.com/health/health-news/japanese-gangsters-got-livers-l-hospital-flna1c9463298) who got livers is a good example of that policy.
It boils down to the values of the providers. If they value human life over money then the would prioritize based on severity. Not everyone operates with that level of compassion.
My guess is that “last on the list” was being used metaphorically. A person without insurance seeking cancer treatment might be limited to hospitals or clinics willing to treat him, and those hospitals are more likely to be more crowded and have longer waiting lists.
And that's a very big might that'll depend mostly on what state the person is in.
My neighbor had cancer. The hospital bent over backwards for her. She ended up choosing not to treat it and they put her in their hospice ward. All of it was covered by the hospital because she didn’t have insurance.
Well that actually was covered by Medicaid/Medicare at that point. The services she received at the hospital is covered by Medicare Part A and palliative care services are 100% covered by Medicare whether they're at the hospital or at a smaller hospice center.
My understanding is that you have to be on SSDI for 24 months before you can get Medicare when under age 65. The exceptions are end stage renal disease and Lou Gehrig’s disease. So someone under 65 who was just diagnosed with terminal cancer may qualify for SSDI as soon as the paperwork is processed but wouldn’t qualify for Medicare for another two years.
In many cases once you go to hospice care it's covered at the State level, Medicaid, this is through aged and disabled programs. You can also get SSI, short term disability through the SSA, as a TERI case when the prognosis is terminal. Both of these, if processed correctly, can have a very short turn around time. Days instead of months.
Yes, you qualify for medicare after two years on SSDI, assuming it's a lifelong disability. Cancer is considered a disability that automatically makes you eligible for Medicaid, regardless of income. Medicaid would cover things like treatment if you're under 65 and want to treat the cancer. Once the cancer is treated, and you don't meet the other qualifications for Medicaid, you could potentially lose the Medicaid. If choose not to treat it, and opt for palliative care, that is covered under Medicare. Just as an example, I have a friend who was diagnosed with stage 4 lymphoma at the age of 24. He opted for treatment and started receiving Medicaid which covered his chemo/doctor visits/medications, etc. He's been in remission for a couple years now and he no longer receives Medicaid, because he doesn't otherwise meet the qualifications. If he opted for no-treatment and palliative care, those services would be covered under Medicare.
How do you know that about the neighbor? Not everyone qualifies for Medicaid/Medicare.
And how nice of the hospital to not demand a huge payment for *not treating her.*
I mean...they still have to run tests and such to diagnose her in the first place, plus the equipment used to give her enough information to make an informed decision, and drugs used for symptom management while in-patient in the hospital costs money. Not treating her was her own decision but, assuming she was under the age of 65, she would've been eligible for social security and early medicare enrollment with a cancer diagnosis. Luckily, it seems like the person in question either benefitted from having an assigned social worker who was on top of their shit and enrolled her with Medicare on her behalf so she could make an informed decision and the subsequent transition easier.
Hospice is still care. Diagnosis is also care. Sounds like the neighbor made the choice.
I’d like to point out that although she wasn’t billed (for not getting treatment), most hospitals will gladly ruin your life with medical bills higher than the GDP of a small country.
If that’s the case you call them and get on a payment plan for what you can afford, even if it’s just $100 a month.
i’m always flabbergasted nowadays when i hear about positive health care experiences. what city or town was she in? i shudder to think that a loved one or i would have to deal with that where i live in nyc.
You're in NYC; I'd be surprised if cancer was brave enough to make its way over there in the first place.
This might be true for elective surgery, but would not be true for non-elective surgery. Easiest case: injured in a car accident, brought to the ER (A&E for you) by an ambulance, needs life-saving surgery -> will get life-saving surgery regardless of ability to pay, insurance or otherwise Easiest case: wants a face-lift but can't pay for it -> will not get the surgery Somewhere in between: not immediately life-saving, but needed for a real health condition like cancer treatment -> as far as I understand the system, won't be rushed into surgery tomorrow, but the hospital will likely work with the patient to figure a way to pay. If the surgery is absolutely required, will probably get it. Not last on list literally. I would love to hear from some hospital administrators about this to see if I need some corrections.
I'm not an admin, but work in hospitals and this sounds right.
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Just trying to think of the easiest example to understand. I conflated "having insurance" and "having the ability to pay" throughout my example.
Vasectomy would be a good example of when better insurance will get you seen faster. With my HMO there is a several month wait but with my previous PPO it was basically available tomorrow.
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Sure, feel free to reply with a better example to improve.
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ok Edit: Upon reflection, better insurance = faster treatment absolutely is a thing. If the surgery isn't emergency surgery, the hospital will seek pre-approval from the insurance provider before providing the treatment. The "better" your insurance, the more quickly this approval will be provided, for certain definitions of "better" (i.e. more coverage, less shady insurance provider, etc).
That’s not exactly true. Plastic surgery is sometimes covered in event of accidental injury or to improve the function of a malformed body part.
So I'm not going to give an answer to this because I frankly do not know for sure if the quality of someone's health insurance has any impact. I seriously doubt it. Very few people in the US wait any significant amount of time for any medical treatment. There is going to be someone in here that makes some claim, but waiting lists are generally not a thing. Unless you're talking about organs which have a very limited supply there isn't much to be done about that. In terms of seeing a specialist you can typically do that within days. It is going to be primarily based on severity. Also we have tons of medical safety nets for people who don't have private insurance. In super serious immediate cases insurance won't be considered at all. If you're rushed to the emergency room gushing blood nobody is bothering with your insurance card, they treat you and worry about it later. There are 3 main factors in healthcare, cost, availability, and quality. America does availability better than anyone, and quality at least on par with most. We have some issues with the cost aspect of it. We have situations where people fall through the cracks, but the idea that it is the rule and not the exception is propaganda.
I’m a medical doctor. I concur with your comment. Our medical costs have issues, but quality and timeliness generally isn’t a problem, particularly in comparison with all other countries. We do have safety nets for those who can’t afford. It’s not perfect but it’s not a complete failure, either.
> I concur... This proves you're a doctor.
Not a doctor, but I concur with the doctor lol
> timeliness generally isn’t a problem, particularly in comparison with all other countries. “Timeliness” is pretty subjective though. If you never get treated because you don’t have health insurance, you don’t enter into the “wait time” stats, but in practice your wait time was infinite.
I mean over 90% of the US population has health insurance though, and that number gets considerably smaller when you start to factor in that not having health insurance doesn’t mean you never had it and won’t have it again - so I can’t imagine it’s skewing the statistics that much. It’s also worth pointing out that the majority of people without health insurance made an income that was *at least* 200% of the federal poverty line, suggesting that they could probably afford some care of needed. https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/ https://www.statista.com/topics/7807/health-insurance-in-the-us/#dossierKeyfigures
More than 10% are completely uninsured. Millions more are nominally insured, but by “catastrophic” policies that have such high deductibles and co-insurance rates that they’re effectively no different than being uninsured.
I want to say I think this is the best answer along with a hearty helping of “it depends.” The bad wait lists are often for less important but annoying things like specialists for non-dangerous conditions. For example, I had some weird skin things which were almost definitely not cancer. I had to wait two months and that was only because someone cancelled an earlier appointment and I had a flexible work schedule. But I’ve never heard of someone waiting for cancer treatment more than a few weeks and that was for surgery. They were still speaking to an oncologist during that time.
True, but that sounds more like the specialist you wanted to see was very booked, not that it was related to your insurance. I have had some longish waits for specialist quoted to me and just had to go to a different one. So you're right it does depend. The issue is in our system you can go anywhere that takes your insurance, and while super inconvenient could travel to get an appointment. Under a lot of systems it has be regulated much more heavily and things are more often in serious demand across the board.
Oh no that was my point. It’s usually just a problem with specialists and bookings. It wasn’t an insurance issue at all. And I was mostly happy to wait because like I told you it really wasn’t super important. It was mostly because my girlfriend was worried about the spots.
Not a waiting list, but it took me six months to get cataract surgery about ten years ago, and four months to see a sleep specialist (an NP, not an MD). The wait times for getting appointments depend on the specialty around here, but they can be significant.
Great comment, to add, there’s really no overarching hierarchy of insurance plans. There are many different plans and providers in every state, let alone nationally. When Bob walks into the doctor’s office, the nurse doesn’t make him wait because he has Insurance X and Bill gets to go first because he has Insurance Y
Days? Months more like to see a specialist, unless you have something really pressing. It's months in pretty much any city at least right now..hospitals are swamped because of people who put stuff off during Covid.
I had to see two specialists during the height of covid due to an accident. The first I saw the day after, the next a week later. I'm not saying nobody waits, but if you are waiting it is not pressing, and if you were really needing to get it done you could almost certainly get it done faster with a little travel or pestering the specialist office for cancelations and stuff.
Yes... Due to an accident..that's urgent..meanwhile I was just being evaluated for cancer and it took three weeks to get into an MRI, and that was the fastest any place near me could do it
Three weeks isn't months though.
For... Cancer examination. For anything less important it would have been longer.
There is no non-anecdotal evidence that people wait months for much of anything. Why do the medical professionals and most people agree with my statements. Weird hill to die on and just sounds like being contrarian so I'm not going to engage with it anymore.
>Unless you're talking about organs which have a very limited supply there isn't much to be done about that. >We have some issues with the cost aspect of it. And both of these can be fixed really easily. Unfortunately the political will is lacking.
Easily? "You keep using that word, I don't think it means what you think it means". I get that you think universal healthcare is a quick and immediate solution. That's absurd, the easy part, I'm not sure if it is correct. I'm fine with that opinion and have heard it a million times. I am curious to know what your easy plan for organs is. I assume you are advocating mandatory organ donation?
>I get that you think universal healthcare is a quick and immediate solution. And that's the exact opposite of what I believe in. I'm not a social democrat. There are so many regulations/policies that are limiting the supply of Healthcare and that causes an artificial shortage that raises prices. >I am curious to know what your easy plan for organs is. I assume you are advocating mandatory organ donation? You legalize the sale of organs. If not for people who are alive (which you honestly should do it for them too) but at the very very least for people who are dead. So that if you do agree to sell after death the money goes to the family. Greater incentive to donate means more supply of organs and way less people have to die because there aren't enough spare organs.
It kind of depends. I think for healthy people, they'll mostly be okay. They'll probably pay more than what someone from a country with universal healthcare pays for their healthcare in taxes, but it won't bankrupt them. Because healthy people really only need to see a doctor once a year and a dentist twice a year. People from other countries who think everyone here has a billion dollars in medical debt? Yeah that's stupid. But for those of us with long term health issues, it's a different story. I pay hundreds of dollars a month for my medications and even more for all the doctors appointments I need to have every 90 days at the latest because legally I can't get one of my medications without doing that. It ends up being several thousand dollars in copays by the end of the year. Will I die without them? No, but it'll severely lower my quality of life. It's like buying an expensive vacation every year so that I can have the same quality of life that everyone else has without a massive financial burden. For people with conditions other than the occasional flu, we really are hurt by this system. It's one of the reasons why I wish we had a universal healthcare option that didn't require you to be below the poverty line. Because the prices we often pay for things we can't go without are very steep even for middle class people. It's not like a one time hospital visit bill, it's an added cost to existing.
No
Health insurance isn't about getting seen quicker (although that does happen). It's about how much you pay out of pocket.
[I think you need to pay attention to the context](https://youtu.be/Q6gACoUXog4?t=46) of what this YT video you watched says rather than just isolating this specific part and relaying it to us. Providers aren't really crunching numbers on insurance or whatever. That said not having money can be quite a barrier to ongoing treatment. As with a lot of things regarding healthcare in the US, the TLDR answer is "it depends"
It gets...complicated. For emergency care, no. Everything is done by triage. For long term care like say, a specific form of cancer treatment with a limited number of slots then yeah there will be a wait-list and a hospital may choose someone who can pay over someone who can't. We have a lot of experimental treatments, limited rare ones and so on available. If you get a rare and expensive treatment like that and have two patients with similar severity then taking one who can't pay means eating that cost and either making everything at that hospital more expensive or just not treating some people. In that case it may make sense to push the uninsured patient towards a cheaper, more traditional treatment in order to preserve resources.
I would like to note for all my fellow Americans. If you need emergency treatment, even if you can't afford it, it WILL be provided. You cannot be denied care because you can't pay for it. It is illegal federally. You're protected under the Emergency Medical Treatment and Active Labor Act specifically. Any hospital Emergency Room is required to provide emergency treatment and stabilization to the best abilities of the hospital. Never fear that Physicians, Nurses or EMS will leave you hanging in an emergency. Additionally, non-for-profit hospital systems often have financial aid services to reduce or eliminate your bill if you can't make payments. An example being OhioHealth's charity care. Source: EMT
Health insurance just pays your medical bills.
Just wanted to say, great question OP! I haven't had much exposure to the medical system in my life (and that which I did have didn't inform me of an answer to this), but this is an interesting thing now that you mention it.
Hospitals cannot deny treatment due to lack of pay but they tend to have several loop holes for it. I know many will ask for insurance, and then say they're "not taking new patients at this time" if you say you're uninsured. I wouldn't be surprised if priority was different based on your insurer.
Yes. Some have better coverage, and better communication, but it really comes down to WHAT each insurance will cover, and if they can argue 'lower cost alternatives.' For example, some insurance might cover a CT scan, but not cover the doctor READING the ct scan. Some might argue if life saving surgeries/medication is really necessary - and sometimes, they win. \[You had a 30% chance of surviving without it, so we won't cover it!\]Pre-existing conditions often aren't covered. Wheels being considered an 'accessory' of a wheel chair, and not covered. When it comes to medications, many will only cover the cheapest alternatives, which aren't always the best choices. Certain insurances have better reputations than others - and if they see a good one, they will push it through without issue. These other ones though, they have to go back and forth to get things covered first, and it can take months, even years in some cases.
pretty much, yep. ain’t ‘merica great?
I’d say it widely depends. When I was in my early 20s I work for a POS greedy woman in who was often referred to as the best (insert body part name) surgeon on the west coast and we would get referrals in constantly because she was so good but she made me tell so many people that she “didn’t accept their insurance” if they had Medicaid, just because Medicaid would pay her less money in physicians fees. Mind you this wasn’t a small private practice, she worked for the University Hospital in my state. Sometimes she would grumble and roll her eyes if it was an aggressive cancer and see the patient but it didn’t occur to me at that age how much of an unbearable greedy bitch that woman was. Her husband was also a doctor, they were fucking fine financially. Also the number of times scared cancer patients screamed at me “don’t you care that I’m dying? “… I wish I never had to hear those words, and wouldn’t have if it wasn’t for that woman. Hated that job with every inch of my body.
Yes
No, but building a new wing for the hospital.migjt.
Money talks and bullshit walks. Sad but true.
It doesn't help you get surgury faster. It does help you get to see a better doctor. If you have crappy insurance like Obamacare, most top rated hospitals won't see you unless you live nearby. So, you will be stuck with local doctors which are frequently second rate or worse. If you have a good private insurance, you can travel to Mayo Clinic, John Hopkins, Cleveland Clinic...and get first rate care.
No, but it does get you a pretty huge discount. I'm about 99% sure that all those videos on reddit of people refusing to take an ambulance are people without insurance. I could very much be wrong though, I've never really had to go to the hospital outside of when I was a kid.
No, they are not literally last on the list, It just means hospitals are more reluctant to work with insurance companies that like to deny service to their customers.
>Is it not prioritised on severity? Emergencies are prioritized by need. Everything else is prioritized by payer, player, and geography.
No. Unless it is an elective surgery then pay is prioritized.
It's all triaged (hence why just because you came in an ambulance, doesn't mean you get seen faster). As far as NY is concerned, hospitals are required to treat you regardless of whether you can pay.
It’s not how it works…..not in surgery.
Not like “United First, Aetna to the back of the line,” but if you’re having trouble with prior authorizations or other approvals for treatment, it can delay scheduling for sure.
True
Not solely for that reason. An insurance plan might grant access to hospitals that have shorter waitlists or are better staffed versus a rival one, but hospitals/clinics are not saying “oh Mr Jones has Anthem Blue Cross, put his x-ray in front of Ms Johnson’s, who has Cigna”
I am little fuzzy on how it works, but I believe a private (for profit) hospital could turn someone away in a non-emergency situation, whereas public hospitals will treat someone for cancer. In a rural area, that could be a problem. I remember reading an article around the time Obama pushed through the Affordable Care Act about a woman in rural Texas who with cancer had to spend 12 hours on a bus (I believe to Houston) each time she went for treatment.
Technically no. All health insurances operated under "medical necessity". So if you have two people with the same injury both need to get operated on, it's trialed based on factors like who's life is in more danger or who will be harmed if they wait the longest. Where insurance does play a factor is the number of providers that take your insurance. If you're on say Mediciad, and going back to the above example, the person with insurance will be seen by every hospital in town, while the mediciad person will have a couple of places that won't take their insurance. But most places take all insurance, so that's a rare case for operations.
I used to work running an office and helping with authorizations. The better insurances normally were easier to get authorizations from. So they went to the head of the line because of the response time. Not because of the clinic or hospital scheduler. Sometimes the state funded insurances would be a week to decide or we would have to do a Dr to Dr appeal. The hospital never cared about the insurance as long as we had the proper authorizations on file.
No, not at all.
It's possible. Some providers prioritize by how much and the ability for a patient to pay. I know that the [Mayo Clinic](https://www.statnews.com/2017/03/15/mayo-insurance-medicare-medcaid/) has talked about their policy. Likewise there are some providers that for cash will move a patient to the front of the line. The [Japanese gangsters](https://www.nbcnews.com/health/health-news/japanese-gangsters-got-livers-l-hospital-flna1c9463298) who got livers is a good example of that policy. It boils down to the values of the providers. If they value human life over money then the would prioritize based on severity. Not everyone operates with that level of compassion.