The Venting Thread

[poiuy]

But it's essentially a market-based structure, isn't it?

Doesn't the market work in this case?

M.

There is no neutral 'market' for health care (or wealth care as it's better described) in the U.S. There is no marketplace of vendors with transparent prices and no way for people to shop around and find what they prefer and can afford.

Among other distortions in the market:
- there are people with and without health insurance. Those with health insurance are charged more (or their insurance companies are charged highly inflated prices) and they are charged co-pays. Those without insurance have to go through a process of negotiating their payments down and showing they are indigent, and their costs are passed on to people with insurance.
- the hospital administration is interested in being as opaque as possible on prices. Prices for the same procedures vary wildly across regions of the country based on what the admins think people will pay, no other choice available, etc.
- people don't have the option of shopping for care providers or emergency care to find favourable rates (as they might if 'market conditions' prevailed). Maybe they can ask around for routine care but everything is based on who is in network for insurance. Emergency care - patients are in no position to figure anything out, they go to the nearest ER, and almost always get hit with surprise billing.
- hospital admins are now aggressively upcoding as much as they can. Did you just walk through the ER lobby on your way to labor and delivery - bam! you are charged for an ER visit. Is your primary care outpatient visit classified as a hospital visit even though the facility is on the other side of town, just because the doctors are affiliated? Yes, because they can. 
- plus unnecessary tests, scans, treatments because of the perverse incentives in the fee-for-service model. Plus marking up prices to keep cash flow coming in - e.g. the legendary $400 bag of saline/glucose IV, or $325 ibuprofen, etc.
- you stay in the hospital overnight. Is your status 'observation' or 'admitted'?  You will be billed very differently either way.
- don't get me started on what ambulances can charge, often because counties are recouping their expenses. Avoid going by ambulance if at all possible.

And so on .... 

[marshwiggle]

But it's essentially a market-based structure, isn't it?

Doesn't the market work in this case?

M.

The problem with insurance (of any sort) is that if the company could tell who was going to cost them money, and how much, it would be in their interest to not have those people as customers. (And those are the people who most need the service.)  In how many industries is the best move to avoid customers who will use the product or service?

[clean]

Just to compare...
When I tested Covid Positive I called my PCP.  I expected that I would have a televisit and be prescribed whatever was on the top of this week's charts of best practices.
Instead, because i have other issues, I was told to go to a stand alone emergency room (not the hospital emeregency room) becuase if the covid had caused a problem with the other issues, that they could detect it faster and start treatment faster, and I would not be surrounded by sicker people.
I did not check (then) if the one nearest me was IN NETWORK.  (They are not!).  and after the insurance has paid what it feels it is contractually obligated to pay, BCBS says I may owe this stand alone ER over $800.  I wasnt there 80 minutes... so $100 a minute!  I didnt have any tests (with machines).  The doctor did confirm that the issues that i have were not aggrevated by COVID and I dont need an MRI, or CT scan (fortunately!) but that is the bill!

While Im not thrilled with it, I will say that My Bride is not objecting to the bill as she would prefer that we pay the bill than me not go to the doctor, or get stuck in the ER for 1/2 a day to find out the same thing.  We have(well had!) the money, and while the money is gone, I m still here!

[poiuy]

Sorry you had that experience, clean. Glad it wasn't worse.

It's another terrible feature of the US system that a patient who is ill enough to require urgent care has to spend time and energy figuring out who is in network before seeking care, and has to do this at every step it seems.

[mamselle]

No!

   https://www.theguardian.com/us-news/live/2022/aug/12/salman-rushdie-attack-stabbed-onstage-new-york-latest-updates

M.

[ergative]

Filling out my yearly performance review. I hate this so much. I'm putting in every box, 'No, I didn't do as much this year as you would have liked, because your health and safety guidelines were based on politically motivated government regulations that wanted to pretend the pandemic was over when it wasn't, so I ignored university guidelines because I wanted to actually keep myself safe. That's why I wasn't at conferences and wasn't in my lab. Suck it up. Also, I didn't get sick, while I know for a fact that you, pr reviewer, did. So nyah.'

[mamselle]

Filling out my yearly performance review. I hate this so much. I'm putting in every box, 'No, I didn't do as much this year as you would have liked, because your health and safety guidelines were based on politically motivated government regulations that wanted to pretend the pandemic was over when it wasn't, so I ignored university guidelines because I wanted to actually keep myself safe. That's why I wasn't at conferences and wasn't in my lab. Suck it up. Also, I didn't get sick, while I know for a fact that you, pr reviewer, did. So nyah.'

One surmises you're tenured...

M.

[ergative]

Filling out my yearly performance review. I hate this so much. I'm putting in every box, 'No, I didn't do as much this year as you would have liked, because your health and safety guidelines were based on politically motivated government regulations that wanted to pretend the pandemic was over when it wasn't, so I ignored university guidelines because I wanted to actually keep myself safe. That's why I wasn't at conferences and wasn't in my lab. Suck it up. Also, I didn't get sick, while I know for a fact that you, pr reviewer, did. So nyah.'

One surmises you're tenured...

M.

No, actually--but my system doesn't do tenure, and my department is extremely supportive. Or maybe I'm just living dangerously.

[AmLitHist]

Filling out my yearly performance review. I hate this so much. I'm putting in every box, 'No, I didn't do as much this year as you would have liked, because your health and safety guidelines were based on politically motivated government regulations that wanted to pretend the pandemic was over when it wasn't, so I ignored university guidelines because I wanted to actually keep myself safe. . . . '

No, actually--but my system doesn't do tenure, and my department is extremely supportive. Or maybe I'm just living dangerously.

Right there with you, Ergative:  I have tenure, and though the specifics are different, I'm up for my 3-year eval this year and will also report that I haven't done much in the way of service beyond the general "attended department meetings" type of stuff.  I used to be on committees, attend and host campus events, and so on, but between my ADA disability and COVID, they're lucky I show up to teach, let alone do a lot more.

My dean is pretty good about such things, so I hope she continues that for this eval cycle.

(I should add that the best we can score is "satisfactory," which generally only requires not publicly assaulting or killing a student or admin, so the review is a big joke/waste of time at best. I'm never going up for full--too much faculty/inter-department politics for years, with the added bonus of a bat-sh&t crazy admin in recent times, so. . . . nope.)

[apl68]

We'd been complaining to the city for some time about the dumpster at the library having a rusted-out bottom that let some of the trash leak out.  They just delivered a replacement.  It looks about as battle-worn as the one we had.  It does seem to have a bottom in it that you can't see pavement through, at least for the time being.  However, it stinks pretty badly.  I guess it's not so much I who am venting here as the dumpster....

[apl68]

The staff members are all complaining about the stink as they go in and out of the staff entrance beside the dumpster.  Actually it doesn't smell any worse than an ordinary dumpster.  But our dumpster, which had always had little food waste thrown in it, smelled a good deal better than the average dumpster.  It just had holes in it that kept letting the trash leak out.  I guess the moral is, be careful what you complain about, because you might not like the alternative.

If they would have just hosed the old dog food and other mess out of it before dropping it off by our building!

[mamselle]

Yuk.

I see lots of cans of Febreeze in your future....

M.

[mythbuster]

I would suggest a bucket of diluted bleach tossed/sprayed in on a day when you know rain is coming. That way it won't corrode the dumpster itself too badly. 10-20% bleach kills a LOT of the nasty germs and the smells that go with them.

[apl68]

Our smelly dumpster was just taken away and replaced with one that doesn't stink AND appears in much sounder condition.  Somebody on the staff has evidently complained over my head to somebody.  Or perhaps the nasty dumpster was only meant as a temporary fill-in?  Anyway, if this one stays here, we should be good.  Once the lingering funk from the last one has finished dissipating.

[FishProf]

I am so aggravated about news stories decrying the outrageous cost of higher education.  I watch these interviews and it's a BU student (~80K/ year) or Harvard (about the same) complaining that people just can't afford to go to college.

In the meantime, you could do the entire 4-year degree at my school for $30k.  Total.  Including housing.

It's maddening.  Yes, college is expensive.  Some colleges are too expensive.  Don't go to those.

[/rant]