Healthcare in America

Jolene Benoir

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Health Care is a disgrace in America. whether you are a person who has to sleep on the streets or upper middle class. There's a fairly good chance of either going bankrupt.

Maybe someone older than myself can tell me what it used to be like before HMO's? Some of my earliest memories are of Share...one of my first HMO's that affected my family.

What was it like before that? I honestly do not know as I was too young to see it.
 

GoblinCampFollower

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Maybe someone older than myself can tell me what it used to be like before HMO's?
I'm not sure you can get an apples to apples comparison. Before HMO's the technology and what was available was tremendously more limited. I'm not saying the innovation happened because of HMO's, but there is a bit of a correlation. HMO's were created to help control that ballooning cost. ...and HMO's are found throughout the world. The difference between America and places like Germany is in how they are regulated and funded.
 

Jolene Benoir

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I'm not sure you can get an apples to apples comparison. Before HMO's the technology and what was available was tremendously more limited. I'm not saying the innovation happened because of HMO's, but there is a bit of a correlation. HMO's were created to help control that ballooning cost. ...and HMO's are found throughout the world. The difference between America and places like Germany is in how they are regulated and funded.
Didn't most people have private insurance or that provided by their employer prior to the rise of HMO's? You are absolutely correct about the level of technology. I lost an aunt at age 32 due to cancer and a grandmother due to diabetes complications. Probably would have lived today. But? I still don't remember either them or their loved ones going bankrupt due to their care which did involve long hospital care.
 

GoblinCampFollower

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Didn't most people have private insurance or that provided by their employer prior to the rise of HMO's? You are absolutely correct about the level of technology. I lost an aunt at age 32 due to cancer and a grandmother due to diabetes complications. Probably would have lived today. But? I still don't remember either them or their loved ones going bankrupt due to their care which did involve long hospital care.
Yes, but costs stated to balloon eventually. HMO's formed in response to that ballooning cost not before it. There are probably many reasons why costs started to balloon but two big ones are better technology that allowed us to treat conditions we couldn't before (but at great cost) and also the rise of malpractice lawsuits. Once liability became a big thing, it gave providers a huge motivation to start to give a lot of extra "care" just to avoid liability. Modern HMO's do a lot of work to fight fraud, waste and abuse for this reason. And if you get your insurance through your employer, it's actually the employer that gets to decide how much care they will even be willing to pay for. For example, private insurance will gladly pay for things like gender reassignment surgery if the employer wants it covered but won't otherwise. Insurance companies and HMO's often get to be the bad guys for stingy employers or governments.

I can tell you that Medicaid for example is a lot more generous in different states than others, even when managed by the same HMO, because it's not really about the HMO as much as the customer and regulatory environment. Same is true of private insurance through employers.

Back to my original point, the regulatory environment in America sucks for a lot of reasons... Most other countries collectively bargain with drug and equipment companies to keep prices down, in America, we actively protect their right to charge anything they want... so when you combine thee super high costs with an employer or State government that doesn't want to pay for all of it, the result is super high copays and even people with coverage go bankrupt. There is just so much room to have better cost controls and require coverage to be stronger.
 

WolfEyes

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Health Care is a disgrace in America. whether you are a person who has to sleep on the streets or upper middle class. There's a fairly good chance of either going bankrupt.

Maybe someone older than myself can tell me what it used to be like before HMO's? Some of my earliest memories are of Share...one of my first HMO's that affected my family.

What was it like before that? I honestly do not know as I was too young to see it.
I barely remember the few doctors that still did house calls when I was very young. It wasn't so depersonalized. It's all so different now. And not for the better. It just keeps snowballing downhill. When I could afford insurance (or my parents were willing to cover it) the health care I received was far better in quality overall than what I have to deal with today, which is Medicaid. Medicaid is pretty much worthless. I need prescription glasses, not covered. I need new dentures, have to wait 10 years. I need treatment for a blood born virus, treatment denied until more and more and more blood tests are done and they can't even hit my veins (don't even get me started on that). I recently needed treatment for adhesive capsulitis (in my right shoulder this time)... I was told by my GP that she couldn't give me anything for it, all she could do is refer me to PT when I am in excruciating pain already and no where near ready for PT. Good thing I waited until it had finally started healing before I went to see her. I don't want to think about the further damage the PT would have caused. They pulled that on me the first time it happened. I found acupressure and massages worked far better than anything else and faster. Can't afford either of those this time.

I think what I'm trying to say is, these days, people just don't care compared to how people cared back then.
 

Soen Eber

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I think it's time for people who can afford it to tuck money into a numbered Swiss bank account. The wealthy do it, so why not people who have decent jobs, kids & a house they can lose?
 

Soen Eber

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I barely remember the few doctors that still did house calls when I was very young. It wasn't so depersonalized. It's all so different now. And not for the better. It just keeps snowballing downhill. When I could afford insurance (or my parents were willing to cover it) the health care I received was far better in quality overall than what I have to deal with today, which is Medicaid. Medicaid is pretty much worthless. I need prescription glasses, not covered. I need new dentures, have to wait 10 years. I need treatment for a blood born virus, treatment denied until more and more and more blood tests are done and they can't even hit my veins (don't even get me started on that). I recently needed treatment for adhesive capsulitis (in my right shoulder this time)... I was told by my GP that she couldn't give me anything for it, all she could do is refer me to PT when I am in excruciating pain already and no where near ready for PT. Good thing I waited until it had finally started healing before I went to see her. I don't want to think about the further damage the PT would have caused. They pulled that on me the first time it happened. I found acupressure and massages worked far better than anything else and faster. Can't afford either of those this time.

I think what I'm trying to say is, these days, people just don't care compared to how people cared back then.
We have better public poor care in Minnesota, I get glasses, hearing aids, prescriptions & physician visits for next to nothing. Maybe it's time to rent your current house to a friend or relative, establish residency, and get stuff taken care of for a few months?
 
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Govi

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Health Care is a disgrace in America. whether you are a person who has to sleep on the streets or upper middle class. There's a fairly good chance of either going bankrupt.

Maybe someone older than myself can tell me what it used to be like before HMO's? Some of my earliest memories are of Share...one of my first HMO's that affected my family.

What was it like before that? I honestly do not know as I was too young to see it.
When I was small (in the late 50s), I recall adults discussing the illness and hospitalization of other adults. Often enough that I remember them, there were exchanges between them along these lines.

"So-and-so was hurt badly in the accident."

"Oh God! They're in hospital? How will they manage?"

"I think So-and-so will be OK, They have BlueCross/BlueShield."

"But that only covers hospitalization. How will they manage after?"

"I don't know. Maybe their hospitalization insurance covers part of the recovery?"

"I hope so!"

This was among women whose husbands were factory or office workers in what was then an industrial San Francisco. Hospital stays were longer then than they are now.

I remember being taken on a tour of Kaiser Permanente's new hospital/clinic on Geary Blvd. in San Francisco and how appreciative that my parents were that they'd now be able to enroll our family in Kaiser's HMO (though that term didn't exist then). Kaiser had doctors who made house calls, then, too. I got penicillin shots at home during our family's various bouts with childhood disease (measles, chicken pox), much to my distress (I had thought I was safe at home from the Terrible Needle.)
 

WolfEyes

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We have better public poor care in Minnesota, I get glasses, hearing aids, prescriptions & physician visits for next to nothing. Maybe it's time to rent your current house to a friend or relative, establish residency, and get stuff taken care of for a few months?
I appreciate the suggestion but it's not possible. No friends (no surprise there), have no contact with what relatives are left because they only care about themselves and I can go to hell, and no money. If I leave OR, I lose what little I have left, including the singlewide which we don't owe anything on, just lot rent. And no one wants to live in a park where the neighbors don't discipline their dogs and allow them to bark incessantly, disturbing the peace and keeping the neighbors awake. 😬
 

Jolene Benoir

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We have better public poor care in Minnesota, I get glasses, hearing aids, prescriptions & physician visits for next to nothing. Maybe it's time to rent your current house to a friend or relative, establish residency, and get stuff taken care of for a few months?
Hearing aids, really? Glasses yes, every two years.
 

Jolene Benoir

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Thank you to all that responded to me as to what health care consisted of prior to my time and prior to the rise of HMO's. Eye-opening.
 

Jolene Benoir

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When I was small (in the late 50s), I recall adults discussing the illness and hospitalization of other adults. Often enough that I remember them, there were exchanges between them along these lines.

"So-and-so was hurt badly in the accident."

"Oh God! They're in hospital? How will they manage?"

"I think So-and-so will be OK, They have BlueCross/BlueShield."

"But that only covers hospitalization. How will they manage after?"

"I don't know. Maybe their hospitalization insurance covers part of the recovery?"

"I hope so!"

This was among women whose husbands were factory or office workers in what was then an industrial San Francisco. Hospital stays were longer then than they are now.

I remember being taken on a tour of Kaiser Permanente's new hospital/clinic on Geary Blvd. in San Francisco and how appreciative that my parents were that they'd now be able to enroll our family in Kaiser's HMO (though that term didn't exist then). Kaiser had doctors who made house calls, then, too. I got penicillin shots at home during our family's various bouts with childhood disease (measles, chicken pox), much to my distress (I had thought I was safe at home from the Terrible Needle.)
Wow, thank you so very much.
 
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Jolene Benoir

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It may have been primitive by today's standards but the quality of care was far, far better.
I couldn't decide between thanks and agree. I don't have experience of it other than as a toddler, in the emergency room with a punctured ear drum so I cannot really speak to the quality of care, though I got good care, probably a bit better than I would today, bit I take your word for it.
 
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Jolene Benoir

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So..if I am reading y'all correctly HMO's have brought costs down as they might, in the past, have had runaway costs with the increases in technology? No doubt liability played a part, as well. Did the HMO's help DRIVE that forward movement om technology?

Hmm...so? It was always destined to be a situation of us gong bankrupt due to the rising costs?

Am I off base in this?
 

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Countries with national medical systems didn't have the kind of cost increases we have had in the US. HMOs didn't drive costs down so much as centralized care in fewer hospitals then connected existing doctor's groups and management companies, driving out most of the nonprofits from healthcare. Today even not for profit hospitals are managed, staffed, cleaned, and catered by for profit contractors. They have also driven over specialization as fewer medical students find GP work rewarding and profitable. Which has added more to costs.