It's always amusing when the administration targets other countries it wants to overthrow with sanctions and instigates riots there through the NGO/CIA complex. And then they call these states dysfunctional, states who happen to offer free healthcare to their citizens.
On the other hand 7 year old children have to become entrepreneurs to cover their medical expenses in our non-dysfunctional society:
Are you talking about Cuba or Venezuela (what other counties are associated with CIA conspiracy theories, sanctioned by the US, and praised for their health care)? If so, those are both terrible dictatorships which their own populations are working hard to take down.
I don't want to take the discussion too OT, but I'm curious: out of all the possible countries that the OP could mean (and there are a lot), which would you think of Cuba and Venezuela specifically?
There are not many countries with free-at-point-of-service healthcare. In most cases it's heavily subsidized but still costs money (Japan) or they have a heavily regulated private + public insurance regime (Germany).
China's a good example of de jure vs. de facto differences between what is purportedly offered as opposed to what is actually accessible to Chinese citizens.
Oh god... most euro countries have free or virtually free healthcare.
Heavy regulated does not mean it's not free healthcare.
It's also very easily accessible (although the level of service might be questionable at times especially for non life threatening issues).
Because they have happy, contented (if poor) populations who enjoy better health than Americans, despite the fact that they can't import internationally available health supplies due to crippling sanctions? One suspects that someone feels a little weird about that...
I think because they're the most extreme example of what
you could plausibly be talking about, and I do actually in my personal life see leftists who defend them.
Like most things there are layers of complication. I think a lot of people would admit that say France, Germany, the UK all seem to have better healthcare systems than the US (though not without their flaws). Moving down a bit maybe Iran and China do too and plausibly that might be what you meant, but I'd wager most countries you might be talking about have worse 50th percentile and maybe even 95th percentile outcomes than the US.
All else aside, Cuba actually has a pretty decent healthcare system - in a some ways on par with the US, in some ways better, according to the 2000 WHO survey. [1]
Outcomes in the US are pretty bi-modal, for those who can afford care and those who cannot. This pulls down the country in most rankings, often quite significantly, as many studies weigh access to care in addition to quality for those who can get it. In some ways the system is just objectively bad - it's among the worst for maternal mortality rate in the OECD. [2] I do believe it's improved a bit since then, as that article came out in 2017.
Life expectancy is dropping, and costs are rising. Generally cancer outcomes are regarded as a bright spot for US healthcare but a lot of that is attributable to early detection leading to rosy 5 year survival rates - without commensurate drops in its mortality.
Thanks for throwing that out, because I feel like this is something I sort of knew, but also somehow always slips out of my mind. Maybe some motivated thinking going on? I do think, and maybe this is part of what you mean, but part of the good performance by say Cuba has nothing to do with say access to innovative cancer treatments, but just like cheap, easy medication and frankly nutrition.
I also think I have an impression, and maybe this is motivated thinking again, but that some of the trade off some countries have made is between these sorts of expensive, low impact interventions, vs cheap high impact interventions. Which seems like probably the right tradeoff as a country, but isn't the straight forward better across the board story that I think gets told sometimes
counterpoint. this woman decided to continue with her pregnancy, despite knowing many of the severe medical conditions her child had. why should the state be focused on spending millions of dollars for an infant that never had a shot at life?
health insurance shouldn't mean we'll do whatever it takes to keep somebody alive no matter what
Your comment in no way addresses the OP's stance. It was known there would be issues if they continued with pregnancy, they did, and now they want others to pay for their decision.
We've spent multiple trillions on this pandemic already (look at the national debt). Much more than on the military which has been declining as share of GDP since WW2.
You're off by at least an order of magnitude there. I see estimates from $6 trillion[1] to $8 trillion[2] for the cost of the war on terror. Taking the high estimate and the 2001 population of 285 million (i.e. ignoring population growth since 2001) gives $28k per person, or $1400 per year over 20 years. Accounting for population growth and taking the lower cost estimate decreases the amount further.
The trend is pretty consistently between 3-6% since the early 1970s. When you start looking earlier than 1970, it was much higher due to Vietnam and WWII.
It's not disgusting, it's pro-mercy. It'd be a different thing entirely if our medical tech wasn't still barely above primitive efforts like leeches.
E.G. Star Trek level medical tech where there are gene therapies, cybernetic augments, and guided regeneration of body parts? In that world the baby might be viable and could have a life of reasonable quality.
It sounds like terminating a pregnancy is illegal in Indiana after week 22. One week after the diagnosis.
You're blaming the mother for having to make the most painful decision of her life in a split second after getting what might be the most terrible piece of news in her life. It's really the state that failed her child before and after their birth. This is no fault of the mother's.
It is inconceivable that earlier scans did not pick up the defects. She made her bed, she gets to lie in it, but now she is trying to drag other taxpayers into it with her. Some people, I would argue the vast majority of people, do not understand that actions have consequences.
> "health insurance shouldn't mean we'll do whatever it takes to keep somebody alive no matter what"
Yeah, I bet when it comes to your own healthcare you'll want your provider to do whatever it takes to keep you alive. Because you think your life matters.
You care so much for the value of your own life but so little for the lives of others. You really do think you are some kind of "god" saying who should live and who should die. You need to look in the mirror and realize that you aren't God.
> Yeah, I bet when it comes to your own healthcare you'll want your provider to do whatever it takes to keep you alive. Because you think your life matters.
I don't know. I don't think I would want to be kept alive through a host of crippling medical conditions for a few more months without much hope for a normal life afterwards.
As members of a representative state, we do have the responsibility to decide how people live and die.
People who say they don't want to play god are just saying they're okay with someone else dirtying their hands, because whether in a democracy or an authoritarian government, someone will be making these decisions.
> I bet when it comes to your own healthcare you'll want your provider to do whatever it takes to keep you alive.
I can't say what I'd do with any certainty (hard to predict what people will do when death comes knocking), but I very much hope that I would choose a comfortable death over a shorter period of time, if the alternative is pain and a low quality of life for a somewhat longer period of time.
Please dispense with the "playing god" rhetoric. There are those who believe that any medical interventions at all constitute "playing god". This has nothing to do with playing god, and everything to do with finding the most humane, compassionate outcomes. I dare say the outcome OP and his wife experienced was neither humane nor compassionate, not toward them or toward their child. And on top of that pain, now the couple may be saddled with medical bills that could destroy them financially.
@kelnos I agree what happened was tragic and can't imagine but my comment was to @basedgod, the OP of this comment thread whose comment was so vulgar and devoid of care of the value of human life that it was flagged into the sun. His rhetoric was that of someone who believes they are a god. The idea that this type of thinking would have any support is terrifying and echoes back to some of history's worst atrocities.
i hope you live a life free of events like this. i also hope in the case where you do go through a life-changing traumatic health or financial disaster that people show you more compassion and empathy than you choose to show others when you log into the orange website
for someone who snagged "basedgod" this is extremely, ridiculously not based
Abortion isn't legal in all parts of the world, or even all parts of the USA. Your suggestion would make no sense at all for someone living in Texas, for example. If people are forced to have children they know in advance they can't support, then why shouldn't the government help provide for that child?
This is the cold hard truth, cannot imagine what they've been through as parents but from a purely quantitative perspective this is a totally fair point.
Yeah. I'm disappointed in all the downvotes and flags the parent post got (I briefly managed to resurrect it via a vouch, but it quickly got killed again). It was worded in a terrible, heartless way, but it's not wrong.
The child was doomed from the day they got those test results in. Their doctor was clear with them that the diagnosed condition wasn't something survivable. Why should taxpayers be burdened with medical costs ("millions of dollars", according to OP) in this kind of situation? Why should parents be allowed to cause and prolong the suffering of that poor child, who had to endure so much pain in her short life? I'm sure their intentions were good, but the outcome was so much worse for everyone involved than if they'd terminated the pregnancy. How can we incentivize people to make better decisions in these sorts of situations, when doing the right thing is such a difficult, emotionally-harrowing thing to do?
Maybe the parents would have made a choice you liked if the people of Indiana gave them more than a few days to grieve before taking away the choice to abort.
Oh, I absolutely acknowledge that was a big factor. It's disgusting that the pro-life folks have, yet again, caused suffering through their imposition of their values on others.
I'm sad to say that it does not surprise me at all. HN with some regularity gets issues of morality horribly wrong, the good news is that at least in this case I can't read the GP.
Funny argument from a place where abortion is restricted in many states.
And even if not, you might be in a place or situation where you can't abort, or where you don't know the full truth or you don't know early enough or ...
Many reasons but medical decisions about a living child should not be influenced by whatever reasoning or intention we ascribe to or even know their parents held.
"health insurance shouldn't mean we'll do whatever it takes to keep somebody alive no matter what".
That is a valid thought and a lot of "universal" and "free" healthcare have "costs containment" and even "alternatives" health care (homeopathy) for higher cost diseases[1]
Now the question is when it will come to you or a beloved one will it be ok to me say : "nahh, lets save a lot of money"?
A lot of people think Europe Health system is perfect and universal.
It is when you are young. Once you have a hard cancer Rich people take a flight to US.
I understand the point you're trying to make. I would like to also point out that non-rich people in the US often just die. It's not like the non-rich US-based get the same care that the rich non-US-based fly here to get.
I assumed it was obvious. I'll translate for you: "the point that you're making is dangerously similar to some well known tenets of Nazi Fascism. If you don't spouse that ideology, maybe you should adjust your rhetoric in order to avoid giving that impression".
I don't think you can logically extrapolate that from the original (now flagged/dead) comment.
Do you really believe that the state should spend literally any amount of money on medical interventions in order to attempt to prolong someone's life, no matter how hopeless the case is or how much suffering it causes? If you do, that's unrealistic and impossible (not to mention IMO often harmful to the patient). If you don't, then it's just a matter of deciding where the line is drawn.
Maybe taxpayers should expect to spend millions of dollars to bring a known-doomed pregnancy to term, and keep an infant alive for a short time, whose quality of life seems to have been mostly negative. I don't think that's a particularly good idea for anyone concerned, but maybe many people do?
This would be a slightly less insane argument (though only slightly) if many states in the US, the state this women lives in for instance, weren’t so puritan about right to abortion. This women had about a week to decide whether to abort—that is clearly not enough.
It's even worse. She would have likely had much less than a week to decide. You don't want to make a major medical decision with getting a second opinion from a doctor who had not been involved up to that point.
She'd have a week to find a new doctor to confirm the diagnosis, and then if confirmed and she instantly decided to abort, schedule an abortion and have it performed--all this during an active pandemic which was slowing medical things down in general.
And let us not forget that the clock does not stop for weekends, so that's two days lost if they can't find an abortion provider that works weekends.
Also, Indiana has an 18 hour waiting period. You must make an in-person visit to the abortion place at least 18 hours before the procedure to receive state mandated information, so that's another day lost (although if they get lucky they might be able to overlap this with a weekend).
There's a cave in Georgia where they found remains of a human being (or some ancestor) with teeth missing. However, it seems the human survived even after losing teeth, which clearly shows someone else was taking care of him/her, as in chewing the food for them etc., in an environment where losing teeth was akin to death sentence.
We as a species have progressed further than anything else because we do not leave the weak ones behind even when they have no chance. This is what makes us human, not the individualism that modern society promotes.
>We as a species have progressed further than anything else because we do not leave the weak ones behind even when they have no chance. This is what makes us human, not the individualism that modern society promotes.
I don't think OP's point was to leave sick/disabled babies to die, but rather to prevent them from being born. There are some people (ie. anti-abortionists) who think the two are equivalent, but there's also people who think they're not.
I think if we see from the mother's point of view, not the child, then the value of empathy can be more justified.
I have a 6mo who is perfect in every way. If I know he wasn't going to be, or that he was going to be terminally ill, would I opt for him not to be born? No way. Even in that case he would have deserved a chance, which is I.
Well, no, as a species we have progressed because we are ruthless, smart, have ridiculous endurance and breed all year round, with social structure being important but coming in last.
I mean, come on, people walk by other homeless people every day with zero care. We, from the "developed" world, bomb the fuck out of poor sods in less fortunate circumstances, regularly.
We let people suffer and kill themselves, considering them weak, unworthy of living. Of course, not out loud.
Modern medicine is great, the modern healthcare system in any country is garbage.
And humans are still, for the most part, garbage. We're living in the best times only thanks to some smart people putting in some good systems in place.
Which is why health insurance is a terrible systemic decision on which to base your society, and, btw, the early 1900's called. They want their Eugenics advocacy back please. Also, the 2150's called, they have a great deal on designer babies and books on the historical consequences of overreliance on statistical multiplexing as applied to societal safety nets.
It's cruel because nearly everyone can be hit with a $2.5M expense, not because it's means tested. It's the fact that it's random and impossible to prepare for that makes it cruel. I don't have any issues with means-testing insurance subsides, food stamps, or rent vouchers, because those are payments that are predicable and won't wipe people out.
OK, you'd like to consider means testing separately from the situation described in TFA, which makes rhetorical sense because apparently the family's income disqualified them from assistance with ruinous medical costs. Clearly this is not an example of how great means testing is.
To speak more generally about means testing, you seem to think that reasonable people oppose means testing because it affects the well-to-do. That isn't the case. The well-to-do have little problem filling out forms or hiring experts in form-filling. Reasonable people oppose means testing because those who can't complete the various clerical tasks entailed are precisely those who need the benefits. And of course the administration of means testing is complicated enough that its costs usually rival those of the benefit programs themselves.
To give an example, some years ago my father helped my grandmother apply to EEOICP, because my grandfather had died with cancer and he had been involved with unsafe incidents while in the employ of the Atomic Energy Commission. We would have been challenged to do it ourselves, but my father located an agent who specialized in such applications. Previously my grandmother didn't know that the program existed, and certainly didn't know the first thing about applying to it. That means that many other AEC widows, who didn't have people around who could help, did not receive the benefits supposedly designated for them. USA has lots of means-tested benefits that serve small fractions of the populations they are marketed to serve. This is by design. The concept of means testing is a story told to make benefit programs less effective.
I think this story and it’s horror masks the banal evil of these systems. Medicaid enrollment and other benefits are demeaning and cruel processes.
Even for a healthy child, you need to go through the humiliating experience of weighing your child at a social services office to prove that you are feeding it, for example. Failure to appear can impact your benefits.
I was glad I had paperwork that outlined my daughter's diagnosis, but it didn't matter.
During the Medicaid application, it asked for a signature to collect medical records on my behalf from the hospital. I signed both, and returned them in our application.
Of four, one of the reasons we were denied Medicaid is because they claim I never signed the paper (or returned, I forget), which was incorrect (I have proof), so they weren't able to collect Medical records. During my hearing, the State weren't able to provide any proof that I didn't sign/return, so it was unfounded, but it didn't change anything, nor did I get an apology.
They're not when it comes to health care. There is a clear majority in favour of universal health care benefits in the electorate on either side of the political duopoly. Most representatives are just not listening to their constituents.
Because the federal system has a strong bias towards states as opposed to people, you need to change the minds of people in the resource extraction states.
>There is a clear majority in favour of universal health care benefits in the electorate on either side of the political duopoly. Most representatives are just not listening to their constituents.
Is there? One obvious question would be how such polls are worded. I'm sure you can get 60% of americans to agree on "universal healthcare", but only 25% agree with universal healthcare proposal A, and 35% agree with universal healthcare proposal B. In the end there isn't enough support for a specific proposal, because it means different things to different people. We saw that with brexit, where the majority voted "leave", but they all had different ideas of what "leave" meant, and none of the concrete proposals had anywhere near 50% approval rating.
We saw this in the 2020 democrat presidential primary. The KEY issue was M4A or not. Ultimately, the more progressive plans (Sanders and Warren) lost out to the more conservative approach of a single payer option.
IDK why this happened, though. WTF "loves" their insurance provider?
Why Biden got the nod is somewhat beyond me. My best guess is that most of the democrats in the primaries figured he was less scary than a socialist for middle of the road voters.
I think this boils down to propaganda. Americans have been taught that the "competitive" private insurance system gives them "choice", even though in reality they have maybe one or three plans from their employer that they can choose from, assuming they are working for an employer that gives them health benefits.
The ACA marketplace does seem to give people choice, though decent, low-deductible plans are pretty expensive and are likely out of reach for most people who get their insurance that way.
The other rationalization -- which I am somewhat sympathetic toward -- is that people don't trust the government to do a good job providing health coverage. They believe it will be riddled with red tape and inefficiencies and bureaucracy, and will cost much more than the private insurance system. And that's even before we get to the "death panels" FUD and other invented nonsense.
> They believe it will be riddled with red tape and inefficiencies and bureaucracy, and will cost much more than the private insurance system.
This is really something that I wish more Americans could just experience.
I've had the fortune (mis?) to experience England's NHS system.
England isn't particularly known for running a bureaucracy free government :D. Yet, the NHS feels like a dream compared to the US healthcare system. I pretty much just filled out a card saying where I lived and that was it. Really bizarre for a non-UK or EU citizen.
After that, no bill, no nothing. IDK if I even needed to fill out the card TBH. Doctors appointments were just like you'd do with a regular doctor in the US. Simply schedule and show up.
A friend needed surgery while there and again, pretty much the same thing, showed up to the emergency room and got seen almost immediately.
All in all, wasn't really any worse than what I'd get in any US hospital.
We see so much paperwork in the US because there are (at least) 3 parties involved in every medical bill. You, your insurance, and the hospital.
Single payer cuts your involvement to 0 which kills pretty much all your paperwork. It also vastly simplifies hospital billing.
It's the technical equivalent to supporting 100s of standards and then dropping down to a single standard. Even if that standard is garbage, eliminates the need to support the 99 standards (even if some are better).
Costwise, it can't help but be less. The fact is, there's a lot of duplicate jobs in each insurance agency as well as some jobs that simply won't exist (no need for accuracy tables, for example).
I can't speak for Indiana, in my circumstances it wasn't that the benefits were 'means-tested' but more that they had a single application for any number of qualifiers.
There were multiple ways to qualify for Medicaid and some of them are purely based on poverty with no disability or medical issues. Those cases needed the carefully documented income, bank accounts, retirement funds, etc. It's a bad system in many ways in and of itself, but at a high level they do need some way to confirm that Elon Musk isn't applying for Medicaid just for shits and giggles.
The other qualifiers for Medicaid are medical issues that are detached from income.
The frustration of it all is that there is a single form and while you'd hope there'd be a 'skip this section if you do not qualify based on income' there isn't, and you can end up trying to pull together every financial document you have.
( It can be worth a try to attach a W-2 so they have something and stopping there. They can contact you if they need more )
> It's a bad system in many ways in and of itself, but at a high level they do need some way to confirm that Elon Musk isn't applying for Medicaid just for shits and giggles.
A better system would provide healthcare to everyone and just tax Musk more to pay for it.
> Elon Musk isn't applying for Medicaid just for shits and giggles
I mean, who cares if he is if it means people like this are able to get the care that they need? That would be such a small drop in the bucket compared to all the people who genuinely have been screwed by the system.
The thing is: Who cares if Elon Musk, Bill Gates, or whoever get Medicaid or any government benefit if you tax them accordingly? We certainly had no problem giving Elon Musk government money indirectly in the form of various subsidies.
If Elon Musk uses $2.5 million in healthcare but pays 200x or more than that in taxes I don't see that as a problem.
And excellent counterpoint to the idea the US doesn't need medical coverage reform since the poor get it for free (and usually with that trip, the idea that everyone else without coverage is making that choice)
I don't mean to oversimplify and paint a straw man here: These are literally arguments I hear from some family and friends on the topic without much of any nuance to them.
Do you really honestly believe that the paperwork burden would disappear if the government took over medical care? Can you think of anything else the government runs which is free of mindless bureaucracy?
When you turn 65, you receive Medicare benefits after a pretty painless application form, which is mostly to obtain coordination of benefits information for retiree private plans
Aftwards, you have very little interaction with Medicare, other than if you are placed in a nursing home or rehab, at which point you may need to argue for more benefits as the rehab will try to maximize their revenue by kicking you out after 90 days.
Ever looked at the paperwork burden of private insurance for a child with a rare medical condition? I have. My wife and I spent a year - literally twelve months - filling out reams of paperwork to get a rare medication covered. And eventually failed. There did not appear to be any end to the paperwork. It was itself clearly punitive, they designed it so you would likely fail so they wouldn't have to cover the condition.
This is a false talking point. My mom was a marriage and family therapist until she retired, and the burden of dealing with private insurance paperwork - private insurance - was so onerous that she and other therapists she knew simply had to stop dealing with insurance. Medicare paperwork was simple compared to that.
Would the paperwork disappear? No. But I'd bet it would be a lot less.
My spouse visited a doctor in January 2020, and we recently got yet another Explination of Benefits about that visit, which is probably the 15th time they've sent one. I wish I was exagerating.
As someone who deals with medicaid paperwork as well as private insurance paperwork. It's basically exactly the same from the insuree's POV.
I give the hospital my child's medicaid number, they take it from there. Really pretty much that simple. No prior approval. No crazy paperwork. Just give 'em the number and you are off to the races.
I'm sure it would be worse for elective surgeries, but that's not really what anyone is arguing for.
I think people going bankrupt with medical debt or outright dying through lack of care would still prefer beauracracy and paperwork to nothing at all.
Besides which, unless you have the best gold plated insurance plans or a mediocre plan and never need to go out-of-network, mindless beuracracy and tons of paperwork describes the status quo of private insurance.
And annecdotally, my father on Medicare has far few issues of that sort than I do on my (above average) employer's plan.
There is a stark difference between Medicaid and Medicare. Medicare, for those who can enjoy it (65+ or meeting criteria for chronically disabled), is pretty good insurance. You have your pick of specialists or primary cares, it reimburses providers pretty well, and ironically, processes claims faster than private insurance. There are some glitches that should be fixed sure, but it is definitely viable as a healthcare plan.
Medicaid in comparison, is bare bones - the political reasons I'll let other people comment more, but access to care is severely restricted, it doesn't pay providers enough to keep the lights on, and is not really capable of providing any semblance of the modern standard of care.
Medicaid also varies by state. South Carolina for a long time did not provide any “optional”
coverage, and would advise some people to move in with relatives in New York or Massachusetts to enroll there.
In my state it's precisely the opposite - Medicare is horrible, they only pay 80% until you meet a deductible. Never mind the money - just the hassle of the paperwork of paying all those bills will make anyone crazy.
In contrast Medicaid is awesome - zero copay or deductible, just show up and use your insurance card.
There is also Medicare Advantage, which actually is quite good - and it's private insurance that the government pays for. So maybe we don't need either "for all" programs, but rather a universal subsidy for people to buy their own insurance.
> it doesn't pay providers enough to keep the lights on
That's true about both Medicaid and Medicare, which is why neither will ever be offered to all, not without a salary cut to Doctors.
Not quite, but I'm not sure what your point is. People opposed to such reform often use the arguments I cited, and I specifically use the failure of medicaid in this article article to demonstrate the flaws of those arguments.
Those arguments' flaws aren't corrected with the implementation of a bad system.
That would be a specious argument, then. The failure of Medicaid in this article isn't a failure to get coverage for someone on Medicaid; it was a failure to even get accepted into the Medicaid program in the first place.
If you have Medicare for All, you don't have to worry about getting into the program, because everyone already has it, no?
Looking at the data from gapminder[1], the USA spends more (typically, several times more) per capita than any other country on healthcare, and receives worse outcomes (in terms of life expectancy) than all other rich countries.
Example: USA $8360/person/year, 78.9 years; Singapore $1730/person/year, 82.8 years.
Funnily, it's because of the massive amount of bureaucracy involved.
I say funnily, because the US government is know for being light on bureaucracy. Yet, somehow the US healthcare system has given it a run for it's money.
Every hospital has a significant amount of staff dedicated to billing and negotiating with insurance companies. Every insurance company has a fleet of employees who work on optimizing costs, denying coverage when possible, and negotiating bills with hospitals. And on top of that, a large part of the job of HR for employers is managing healthcare benefits and negotiating with healthcare providers.
Layers upon layers of ultimately waste.
A single payer system ends up saving cost because.
A. There's no negotiating bills with the government. You either accept what they are paying or you don't get paid.
B. Because the government deals with every hospital, they've got very good insight into what things ACTUALLY cost. That makes it hard for a medical provider to play fast and loose with the numbers.
In otherwords, admin costs for Hospitals go completely away and the government admin costs end up being a fraction of what the rest of the insurance industry is doing (because a lot of what private insurance is doing is trying to make money off of premiums in the stock market). Government does not have that incentive in the slightest.
Off-topic but why do people in the US say "we are pregnant" and not "my wife/girlfriend is pregnant". By basically all definitions only a woman can be pregnant so I don't understand why and where this usage emerged?
EDIT: I can see now that the question was either poor taste considering the topic of the article or sensitive by a lot of people. I had no idea that this was a controversial question and I am sorry.
It's not meant to be literal. We all understand basic biology. The reason some of us say "we are pregnant" is because it demonstrates that both people are invested in the pregnancy.
I'm from the US, and this has always been weird to me too. My understanding is it's essentialy a solidarity/personal-investment thing, a pledge from the non-pregnant partner to support the pregnancy and take on as much of the burden as possible, despite being unable to also be physically pregnant.
But to me it's always sounded trite, and a bit like virtue signalling. The only person you need to show your investment to is your partner, and you do that through your actions, not words.
I think it is a way to emphasise that they as a family is expecting to have a baby. Also, even though obviously only the woman carries the child, a pregnancy is something that affects both partners on many levels.
As a dad of three kids, you're right that only the female is literally pregnant, but its generally used to highlight the commitment both parents are making to the child. Further, it's recognizing that pregnancy is not a singular event, but instead an inflection point in their lives that both individuals are entering upon.
It's the event horizon of a black hole that inevitably swallows all of both parents' free time and disposable income.
Thanks! I am not American so I actually didn't know why that expression was used. Considering that my comment got flagged I take it that it's a sensitive topic in the US?
Acknowledging that the most significant part of being pregnant is everything that comes after the birth and not the physical act of carrying a baby. We expect fathers to be parents now too.
Why is this question flagged and/or downvoted. Seems like a totally legitimate question from outside the culture that uses saying. EDIT: Nevermind, it was flagged and fading in to oblivion.
I clearly hit some kind of cultural thing here, I am French Canadian and no one ever says the equivalent to "we are pregnant" ("nous sommes enceintes"?).
Maybe it was also in bad taste to ask this considering the tone of the article, anyway I got plenty of responses. Sorry if I offended anyone :(
Because it's hard work, and it states that both partners are going to do that work.
It can be hard work to get pregnant, hard work to stay pregnant, hard work to carry to term, hard work to deliver and it is unbelievably hard work to raise a child. Two partners trying to get to the finish line have to make incredible sacrifices, and make huge changes to their lives in order to support each other.
Saying we're pregnant and sharing the state of pregnancy vs just saying she's pregnant, acknowledges the the shared work and the shared responsibility that is taken up by both partners, and it acknowledges the shared joy in bringing life into the world. And when you say it to someone other then your pregnant partner, you make it clear to them that you are picking up a huge responsibility and that they should recognize it.
One thing I might have missed in the story -- the reason for attempting to go on Medicaid was due to not having private insurance and the ability to pay for stratospheric out-of-pocket costs, or was it because private insurance immediately rejected a 2.5 million dollar claim?
Not saying it's right, but I'd presume for claims that large you'd probably have to get a lawyer/some form of professional advocate involved even with private insurance.
I don't want to speak for the writer, but I would personally hope that my community (via medicaid) would do a better job taking care of my child than a for-profit private insurer.
Everyone told us to apply, regardless of income. We were told that my private insurance insurance only covers so much and will be capped at X (either $ or hours). Medicaid would supplement the rest.
For instance, my private insurance offered something like 50 nights of care per year. Medicaid offered, I forget, but with Medicaid, unbeknownst to us, there were limitations that didn't apply when using my private insurance, such as only one parent could be in the house, the nurse would need to document exactly what the parent was doing during that time, etc.
OK, just need to put this out there for ANYONE in a similar situation.
It seems relatively unknown, but in the US you can enroll a child with chronic illness into Medicaid through the "Katie Beckett" [1] program, regardless of household income.
Unfortunately, that process is both annoying and semi long (takes a month or so). Part of the process involved applying for and getting denied medicaid coverage.
All this is to say, if you have a child with a severe long term illness/disability, you can get them extremely generous healthcare even if you are pulling in a large salary.
I've had to do this with my own child, so I know it's really rough. But please, take advantage and get your kiddo all the therapy/medical care they need.
Edit: I should note that not every state has this. Many (23) do. It looks like Indiana is one of the states that does not have it :(. States are required to have passed TEFRA. [2]
Thanks for this! Yes, take advantage of any available programs. We were told to even apply even if you don't meet the criteria. It's better to apply and get a "no" then to not apply at all.
Our social worker was knowledgable on IL programs, but not much on any in IN, so we had to do a lot of digging ourselves, even though the hospital is near the IL-IN border. Only when my wife joined an FB group did we find out about the Katie Beckett program.
We were in the process of applying the for the IN A&D Waiver, as it's not income-based (well kinda). Apparently being approved for the A&D Waiver makes it "easier" to get approved for Medicaid as it shows a disability, in addition to other benefits. I think we waited a month for the interview, during the interview I mentioned my child was a very sick newborn, but the interviewer still had to ask whether my child was anxious or depressed, lived a fulfilling life, etc. I think I broke down afterwards. We were still waiting for the response when she passed away, actually, I think we're still waiting for it? It wasn't a fun experience. I understand the need for the questions, but I wish there was the questions were catered to the age of the applicant.
I'm glad there's a way for someone with Chronic illness to get Medicaid in U.S., Thanks for sharing. I wish you and your child the strength to manage the health issues.
I suffer from chronic illness(bone related, had a successful spine surgery couple of years back), Now insurers in India are straight away denying me any health policy and not just any insurers they're top private insurers in tie-up with leading international insurance companies incl. U.S.(There's 100% FDI for insurance industry).
My interactions with the insurers gives me PTSD[1], I understand the business risk for an insurance company in insuring a sick person, So I'm not asking for a charity or even empathy all I'm expecting is for them to take decisions using medical science and common sense.
Say I have bone diseases, I have proven with medical tests(conducted by the insurer) that my heart and other body functions are normal. Now a blanket denial of policy prevents me from getting proper treatment for diseases I don't have; Since my bones aren't normal should I be not covered for COVID too?
The story is not unique to me, I've heard much worse horror stories from the disabled community.
What's worse is blanket denial of health insurance to disabled are against Govt. regulations and supreme court orders; Yet all my complaints went to deaf years. Now I'm left with one option, I'm planning to write to the U.S. Government and other governments about how their companies are acting against the disabled in India.
writing to government(s) isn't going to do much, I believe.
Denial of policy renewal - if thats what you are saying is happening - is indeed illegal. Instead of wasting time, you should file a writ petition in your jurisdictional High Court, and make sure your lawyer does not let the matter go on for "date after date". If you can't afford a lawyer, this is something you can try to file on your own - High courts tend to take dim views of such behaviour by companies, and don't stand too much on ceremony. There are people called "law clerks" that operate on the High court campuses. They are the ones who do all the paper work for all lawyers (excluding actually drafting) - and they tend to be underpaid. Find one of them who is willing to help you unofficially for a small fee - this will help you take care of the basics (you need this form, so much fee stamps, this signature here, etc etc - this is needed to just get the matter before a judge). Once it goes in front of a judge, plead your case in normal speech, respectfully, without theatrics, and state the remedy you are seeking.
I appreciate the comment, I'm sure that I will get a policy if I approach the courts but it will not do anything for others who cannot move to courts.
There have been plenty of precedence which lead to supreme court passing an order urging the Govt. to ensure disabled get health insurance. And govt. made changes to Insurance regulations which states that the insurer should cover pre-existing diseases after maximum of 4 years and blacklisted certain chronic diseases(Mine isn't blacklisted) from being covered; Note: Just the diseases are not covered, Policy is not denied.
So all these insurance companies are advertising 2-4 years to cover existing diseases as per the regulation. I went through lot of effort to apply to all leading insurers and have documented(link in prev. comment) how they ignore the insurance regulation to deny policy, Followed by how my complaints to the insurance regulators on each of these insurers did absolutely nothing.
Journalists from leading media org. approached me to hear the story after I published the blog but they didn't publish any story on how the insurance industry is treating the disabled as they're the leading advertisers especially during COVID. Few independent media did publish my story along with those of others facing similar situation.
I'm of opinion that getting these insurers reprimanded in their home countries for their unethical, immoral and illegal behavior might have great positive effect for the disabled around the world.
The sad truth is people only realize how fucked the US healthcare system is when they or their loved ones get sick. I was the same way until my son got sick (type 1 diabetes.) From then on (~2013) we've spent $20,000+/year to cover health insurance premiums/deductibles/copays. It's truly bonkers.
US, OH here - Most people I know have employer-sponsored health insurance and have no idea what it actually costs. I was self-employed and paid for my own insurance for years (and paid roughly the same that my employer pays now). If people realized how much is getting paid for their health insurance that could be going to their income they might actually care. Except they won't. >sigh<
(Yes, I'm aware that there'd still be cost for universal insurance coverage in the form of taxes-- that's not all lost income. Still, I bet we could do better than the current "system" with single-payer and a real, forthright effort to actually reign-in costs. Oh, and no for-profit insurers.)
>Most people I know have employer-sponsored health insurance and have no idea what it actually costs.
>Yes, I'm aware that there'd still be cost for universal insurance coverage in the form of taxes-- that's not all lost income
Seems like the right way to approach this would be to promise to tax it on the employer side, replacing whatever premiums they had paid before? That way everyone's happy. The workers don't see any increased premiums, and companies pay equal or less taxes (assuming it actually works out cheaper, but that's another debate).
The right way to approach this is to move to a single-payer healthcare system. The administrative overhead of all of these insurance companies is STAGGERING.
I consulted for a franchisee of Blue Cross Blue Shield 15 years ago. They were a "non-profit" org...the CEO made 2.1m/year. That's in a rust-belt city with ~1m metro area population.
edit: They had a 200 person IT department that could have easily been run with 100 competent folks. For illustration, they had 20 people working full time managing the source of truth of their healthcare plans (to feed their claims processing system.) The source of truth was Excel spreadsheets on a shared drive. You can't make this crap up.
You can't really make such a promise in good faith. You're going to need some form of uniform tax, but current premiums are not uniform. Even if we assume the system is less expensive in aggregate, there will be some (probably many) cases where it is more expensive in specific and promising otherwise sets wrong expectations.
> Seems like the right way to approach this would be to promise to tax it on the employer side, replacing whatever premiums they had paid before?
IDK why this couldn't simply be a part of regular income tax and perhaps a bump in the capital gains taxes.
When you think about it, it's a bit silly that employees earning 2 or 3x the salaries of other employees are paying the same for healthcare.
This would also have to happen because not all employers offer healthcare (small businesses or contracting), yet everyone would still (presumably) get healthcare.
In any event, I'd honestly happily pay a bit more in taxes for the more progressive healthcare plans. No deductible and vision/dental? Impossible to break the bank for cancer? No coverage gaps between employment? I could start my own business and not worry about health coverage?
Universal healthcare is a terrific idea that most other nations have. It's not bank breaking and there's no country I know of that's decided to ditch it after implementing it.
>IDK why this couldn't simply be a part of regular income tax and perhaps a bump in the capital gains taxes.
psychological reasons, because you're already accustomed to it. You'll be shocked/outraged if the government randomly fined you $25k, but when the IRS wants $25k of your income you begrudgingly put up with it.
No, I think everyone needs healthcare regardless of income and expenses. However, I think someone making 200,000 is much more capable of paying $1200 monthly than someone earning $30,000 is capable of paying $600 monthly.
And, if you are talking about treating people based on what it costs, then why have insurance in the first place? The entire point of insurance is sharing the cost with others.
>And, if you are talking about treating people based on what it costs, then why have insurance in the first place? The entire point of insurance is sharing the cost with others.
It's not about sharing the "cost", it's sharing the risk. Insurance is all about risk profiling and compensating for that. The cost to treat you is dependent upon your medical profile not how much $$$ you are making. If you are less risky *and* make a lot of money you won't get a higher premium than someone much more riskier and who doesn't make a lot of money.
> No, I think everyone needs healthcare regardless of income and expenses. However, I think someone making 200,000 is much more capable of paying $1200 monthly than someone earning $30,000 is capable of paying $600 monthly.
Okay, but then what? Cross-subsidization is a inherently unfair practice.
> It's not about sharing the "cost", it's sharing the risk.
The "risk" is a high cost event.
For insurance to work, there has to be winners and losers. The price the losers pay isn't exactly fair to them, is it?
> If you are less risky and make a lot of money you won't get a higher premium than someone much more riskier and who doesn't make a lot of money.
Not how it works in the US (particularly with Obamacare regulations) the only risk profiles insurance companies are allowed to consider for health is age and smoking. Prior to Obamacare there were preconditions they could evaluate to offer different insurance premiums. Those are all out the door.
> Okay, but then what? Cross-subsidization is a inherently unfair practice.
And? I don't understand why it matters to be absolutely "fair" to the wealthy. The wealthy achieved their wealth by means of a great society powering their empires. Why is it a wrong to expect them to pay more to improve the society around them?
And, importantly, the US wouldn't be the first nation to do this. Progressive taxation exists in pretty much ever successful country. And, besides the US, all of those countries will have some form of Universal healthcare funded by that taxation.
>For insurance to work, there has to be winners and losers. The price the losers pay isn't exactly fair to them, is it?
Right, but there's a difference between you paying your expected value in costs (imperfect as it might be, because of the attributes insurance companies are allowed to consider), compared to you paying 3x the expected value on the basis of your income.
Why is it silly? A Big Mac costs the same to me, regardless is my salary.
I think other issues in health care need to be fixed before throwing more money at it.
A huge portion of someone's income making $30,000 is going to housing and food. Things that cost the same regardless of income.
For someone making 100,000, 200,000, etc, they have a much higher amount of disposable income.
Even if we are talking about fixing other aspects of healthcare, when it comes down to it, those with more assets can afford to pay more without impacting their lifestyle.
Of note, ironic that the writer seems to think Indiana govt "cares" about his child. The likely author of a lot of Indiana Medicaid rules was likely Seema Verma. She most emphatically does not care.
Yes - I guess I should have rephrased my comment (or read things the first time more carefully) - thanks for pointing out the inconsistencies so poignantly...
this is so sad. I am sorry for your loss and this tragic story reinforces my thinking that the American health insurance system is a Kafkaesque nightmare.
I work in healthcare tech working on tools to explicitly lower readmission rates and frequently wonder if my work helps to make it easier for healthcare systems to KYA (well, KTA) and streamline "bulk-handling" patients as opposed to effectively providing care for each individual patient.
But really it seems insurance companies are legit the devil and in this case, the opaque bureaucracy of the US Medicaid system
This letter tugs at my heartstrings enough that ideally I would to rant for several paragraphs about the broken US healthcare system and the terrible political parties that make it so, but since that's not what HN is for [1]...
...are there companies or organizations that are trying to solve this sort of situation from the point of view of “We learn all the obscure healthcare laws in each state so each individual patient doesn't have to?” I have heard of Better, and had previously heard of Remedy [2], which seems to have folded [3].
I wonder if the insurance behemoths are just so big that the capitalist response of a competing organization to serve from the patient's side simply doesn't scale up quickly enough. And yet, I hear horrifying stories like this often enough that it seems like it should.
I agree - it's as if it's kept difficult on purpose. I got fatigued reading about all the programs, only to realise I'm reading about old programs or about a program in different a state, etc.
I wish there was a site I could visit, fill out some info, and get info on programs I may be eligible for. I've been considering hacking something together myself, but it's almost too much for one person to achieve. Another user posted this site: https://www.kidswaivers.org, it looks like a great resource I wish I found sooner
I am Kingsley and the letter was in response for my daughter Sterling. Thanks for posting OP/ivanech.
This comment was for a post that was deleted, just posting it here so it's not lost forever.
We were late to get an appointment as it was early into the pandemic. I was barely able to be in the room for the ~18 week scan, I wasn't allowed in the 20 week scan (at 21 weeks) so my wife FaceTimed me. No one mentioned anything was wrong at that scan, just that we need better tests at UIC. My wife had more tests there, I had to wait in the car as I wasn't allowed to go with her for those tests, during that test a Dr told my wife my baby had a heart defect, but it wasn't until the following appointment that we were told our baby had Hypoplastic Left Heart syndrome. We passed the date for a termination in IN, and were fast approaching it in IL. I think we had like 5-6 days until it was too late in IL, too.
We were told it's a rough start, but do a Google search, look at Facebook groups, plenty of kids live "healthy", normal lives, after their surgeries. My mom & my wife's dad lived to be 40, I thought if I could give my child 20-40 years, it was better than 0. The oldest person with HLHS is in their 30s (as long as the surgeries have been around). We thought Sterling would be the same.
An amniocentesis ruled out the trisomies, and a few other common abnormalities. My wife and I agreed that a positive result on a genetic condition would likely sway our decision for a termination.
Some babies are born without their heart disease being discovered until after the baby is at home. Their brains are often starved of oxygen during that time, leading to other serious complications, so we were happy at least we found out and could prepare.
It wasn't until after Sterling was born though did we discover there was more to her story. She received a new diagnosis every week, until she was 3 months old, only after genetic testing was carried out on us all did we discover Sterling had a very rare genetic condition called Kabuki syndrome. It was Kabuki syndrome + isomerism + HLHS that ultimately made it impossible for her to thrive & live a "normal" life.
I've never experienced that kind of unconditional love before and until you're in that situation, you don't know how you would handle it either. We were going by the best info we had at the time.
I agree, I likely caused my daughter to suffer immensely and I have to live with that guilt for the rest of my life. There were good, happy, fun days in-between the sad/bad days. I have lasting PTSD from watching my daughter code in front of me, then watch as chest compressions break her ribs, then to turn off life support. If I knew then, what I know know, things would be different.
Ultimately, it's made me want to bring change. Parents should have all tools at their fingertips. If they're testing for the trisomies, why not test for all other known defects, too? Surely it's "cheaper" to do thorough genetic testing early, then it is for x surgeries, x days in the ICU, etc. Insurance doesn't cover it, and it's likely $10k+ out of pocket. That way, parents can make an informed decision. Same with Medicaid, if you're limiting when we can terminate, surely making life easier for us isn't too much to ask? I wasn't asking for a handout, just trying to avoid financial ruin, and do the best for my child, without killing myself in the process. 40% of parents of disabled children end up getting divorced. I found out some of those are likely due to earning too much to qualify for Medicaid as a married couple.
The love, joy, appreciation, that my little girl was able to bring out of people is truly beautiful, especially during the pandemic. She's made people enjoy the little things, appreciate their lives, their families, their health, their kids health, hug and love their kids harder, etc.
Sterling received 2.25 times the volume of blood in her body...
160 comments
[ 2.4 ms ] story [ 439 ms ] threadOn the other hand 7 year old children have to become entrepreneurs to cover their medical expenses in our non-dysfunctional society:
https://www.cbs42.com/news/local/i-hope-i-make-it-7-year-old...
China's a good example of de jure vs. de facto differences between what is purportedly offered as opposed to what is actually accessible to Chinese citizens.
Like most things there are layers of complication. I think a lot of people would admit that say France, Germany, the UK all seem to have better healthcare systems than the US (though not without their flaws). Moving down a bit maybe Iran and China do too and plausibly that might be what you meant, but I'd wager most countries you might be talking about have worse 50th percentile and maybe even 95th percentile outcomes than the US.
Outcomes in the US are pretty bi-modal, for those who can afford care and those who cannot. This pulls down the country in most rankings, often quite significantly, as many studies weigh access to care in addition to quality for those who can get it. In some ways the system is just objectively bad - it's among the worst for maternal mortality rate in the OECD. [2] I do believe it's improved a bit since then, as that article came out in 2017.
Life expectancy is dropping, and costs are rising. Generally cancer outcomes are regarded as a bright spot for US healthcare but a lot of that is attributable to early detection leading to rosy 5 year survival rates - without commensurate drops in its mortality.
[1] https://en.wikipedia.org/wiki/World_Health_Organization_rank...
[2] https://www.npr.org/2017/05/12/528098789/u-s-has-the-worst-r...
I also think I have an impression, and maybe this is motivated thinking again, but that some of the trade off some countries have made is between these sorts of expensive, low impact interventions, vs cheap high impact interventions. Which seems like probably the right tradeoff as a country, but isn't the straight forward better across the board story that I think gets told sometimes
https://news.ycombinator.com/newsguidelines.html
https://news.ycombinator.com/newsguidelines.html
health insurance shouldn't mean we'll do whatever it takes to keep somebody alive no matter what
https://www.pogo.org/analysis/2019/05/making-sense-of-the-1-...
[1] https://www.vox.com/22654167/cost-deaths-war-on-terror-afgha...
[2] https://www.brown.edu/news/2021-09-01/costsofwar
This was true until we started two different wars following 9/11.
E.G. Star Trek level medical tech where there are gene therapies, cybernetic augments, and guided regeneration of body parts? In that world the baby might be viable and could have a life of reasonable quality.
You're blaming the mother for having to make the most painful decision of her life in a split second after getting what might be the most terrible piece of news in her life. It's really the state that failed her child before and after their birth. This is no fault of the mother's.
Shame.
Is it? So are you accusing her of lying about when the diagnosis occurred?
> "health insurance shouldn't mean we'll do whatever it takes to keep somebody alive no matter what"
Yeah, I bet when it comes to your own healthcare you'll want your provider to do whatever it takes to keep you alive. Because you think your life matters.
You care so much for the value of your own life but so little for the lives of others. You really do think you are some kind of "god" saying who should live and who should die. You need to look in the mirror and realize that you aren't God.
I don't know. I don't think I would want to be kept alive through a host of crippling medical conditions for a few more months without much hope for a normal life afterwards.
People who say they don't want to play god are just saying they're okay with someone else dirtying their hands, because whether in a democracy or an authoritarian government, someone will be making these decisions.
I can't say what I'd do with any certainty (hard to predict what people will do when death comes knocking), but I very much hope that I would choose a comfortable death over a shorter period of time, if the alternative is pain and a low quality of life for a somewhat longer period of time.
Please dispense with the "playing god" rhetoric. There are those who believe that any medical interventions at all constitute "playing god". This has nothing to do with playing god, and everything to do with finding the most humane, compassionate outcomes. I dare say the outcome OP and his wife experienced was neither humane nor compassionate, not toward them or toward their child. And on top of that pain, now the couple may be saddled with medical bills that could destroy them financially.
for someone who snagged "basedgod" this is extremely, ridiculously not based
The child was doomed from the day they got those test results in. Their doctor was clear with them that the diagnosed condition wasn't something survivable. Why should taxpayers be burdened with medical costs ("millions of dollars", according to OP) in this kind of situation? Why should parents be allowed to cause and prolong the suffering of that poor child, who had to endure so much pain in her short life? I'm sure their intentions were good, but the outcome was so much worse for everyone involved than if they'd terminated the pregnancy. How can we incentivize people to make better decisions in these sorts of situations, when doing the right thing is such a difficult, emotionally-harrowing thing to do?
I think you said we got it wrong, how wrong did we get it?
https://news.ycombinator.com/item?id=29236092
Insensitive, but imo, logical. Probably why I'm banned lol
And even if not, you might be in a place or situation where you can't abort, or where you don't know the full truth or you don't know early enough or ...
Many reasons but medical decisions about a living child should not be influenced by whatever reasoning or intention we ascribe to or even know their parents held.
That is a valid thought and a lot of "universal" and "free" healthcare have "costs containment" and even "alternatives" health care (homeopathy) for higher cost diseases[1]
Now the question is when it will come to you or a beloved one will it be ok to me say : "nahh, lets save a lot of money"?
A lot of people think Europe Health system is perfect and universal. It is when you are young. Once you have a hard cancer Rich people take a flight to US.
[1] - https://www.commonwealthfund.org/international-health-policy...
Speaking for myself I'm super happy that I was never in these poor people's shoes.
Do you really believe that the state should spend literally any amount of money on medical interventions in order to attempt to prolong someone's life, no matter how hopeless the case is or how much suffering it causes? If you do, that's unrealistic and impossible (not to mention IMO often harmful to the patient). If you don't, then it's just a matter of deciding where the line is drawn.
Maybe taxpayers should expect to spend millions of dollars to bring a known-doomed pregnancy to term, and keep an infant alive for a short time, whose quality of life seems to have been mostly negative. I don't think that's a particularly good idea for anyone concerned, but maybe many people do?
She'd have a week to find a new doctor to confirm the diagnosis, and then if confirmed and she instantly decided to abort, schedule an abortion and have it performed--all this during an active pandemic which was slowing medical things down in general.
And let us not forget that the clock does not stop for weekends, so that's two days lost if they can't find an abortion provider that works weekends.
Also, Indiana has an 18 hour waiting period. You must make an in-person visit to the abortion place at least 18 hours before the procedure to receive state mandated information, so that's another day lost (although if they get lucky they might be able to overlap this with a weekend).
We as a species have progressed further than anything else because we do not leave the weak ones behind even when they have no chance. This is what makes us human, not the individualism that modern society promotes.
(Edit) Source: https://www.scientificamerican.com/article/toothless-skull-r...
I don't think OP's point was to leave sick/disabled babies to die, but rather to prevent them from being born. There are some people (ie. anti-abortionists) who think the two are equivalent, but there's also people who think they're not.
I have a 6mo who is perfect in every way. If I know he wasn't going to be, or that he was going to be terminally ill, would I opt for him not to be born? No way. Even in that case he would have deserved a chance, which is I.
I mean, come on, people walk by other homeless people every day with zero care. We, from the "developed" world, bomb the fuck out of poor sods in less fortunate circumstances, regularly.
We let people suffer and kill themselves, considering them weak, unworthy of living. Of course, not out loud.
Modern medicine is great, the modern healthcare system in any country is garbage.
And humans are still, for the most part, garbage. We're living in the best times only thanks to some smart people putting in some good systems in place.
To speak more generally about means testing, you seem to think that reasonable people oppose means testing because it affects the well-to-do. That isn't the case. The well-to-do have little problem filling out forms or hiring experts in form-filling. Reasonable people oppose means testing because those who can't complete the various clerical tasks entailed are precisely those who need the benefits. And of course the administration of means testing is complicated enough that its costs usually rival those of the benefit programs themselves.
To give an example, some years ago my father helped my grandmother apply to EEOICP, because my grandfather had died with cancer and he had been involved with unsafe incidents while in the employ of the Atomic Energy Commission. We would have been challenged to do it ourselves, but my father located an agent who specialized in such applications. Previously my grandmother didn't know that the program existed, and certainly didn't know the first thing about applying to it. That means that many other AEC widows, who didn't have people around who could help, did not receive the benefits supposedly designated for them. USA has lots of means-tested benefits that serve small fractions of the populations they are marketed to serve. This is by design. The concept of means testing is a story told to make benefit programs less effective.
Even for a healthy child, you need to go through the humiliating experience of weighing your child at a social services office to prove that you are feeding it, for example. Failure to appear can impact your benefits.
I was glad I had paperwork that outlined my daughter's diagnosis, but it didn't matter.
During the Medicaid application, it asked for a signature to collect medical records on my behalf from the hospital. I signed both, and returned them in our application.
Of four, one of the reasons we were denied Medicaid is because they claim I never signed the paper (or returned, I forget), which was incorrect (I have proof), so they weren't able to collect Medical records. During my hearing, the State weren't able to provide any proof that I didn't sign/return, so it was unfounded, but it didn't change anything, nor did I get an apology.
Because the federal system has a strong bias towards states as opposed to people, you need to change the minds of people in the resource extraction states.
Is there? One obvious question would be how such polls are worded. I'm sure you can get 60% of americans to agree on "universal healthcare", but only 25% agree with universal healthcare proposal A, and 35% agree with universal healthcare proposal B. In the end there isn't enough support for a specific proposal, because it means different things to different people. We saw that with brexit, where the majority voted "leave", but they all had different ideas of what "leave" meant, and none of the concrete proposals had anywhere near 50% approval rating.
IDK why this happened, though. WTF "loves" their insurance provider?
Why Biden got the nod is somewhat beyond me. My best guess is that most of the democrats in the primaries figured he was less scary than a socialist for middle of the road voters.
I think this boils down to propaganda. Americans have been taught that the "competitive" private insurance system gives them "choice", even though in reality they have maybe one or three plans from their employer that they can choose from, assuming they are working for an employer that gives them health benefits.
The ACA marketplace does seem to give people choice, though decent, low-deductible plans are pretty expensive and are likely out of reach for most people who get their insurance that way.
The other rationalization -- which I am somewhat sympathetic toward -- is that people don't trust the government to do a good job providing health coverage. They believe it will be riddled with red tape and inefficiencies and bureaucracy, and will cost much more than the private insurance system. And that's even before we get to the "death panels" FUD and other invented nonsense.
This is really something that I wish more Americans could just experience.
I've had the fortune (mis?) to experience England's NHS system.
England isn't particularly known for running a bureaucracy free government :D. Yet, the NHS feels like a dream compared to the US healthcare system. I pretty much just filled out a card saying where I lived and that was it. Really bizarre for a non-UK or EU citizen.
After that, no bill, no nothing. IDK if I even needed to fill out the card TBH. Doctors appointments were just like you'd do with a regular doctor in the US. Simply schedule and show up.
A friend needed surgery while there and again, pretty much the same thing, showed up to the emergency room and got seen almost immediately.
All in all, wasn't really any worse than what I'd get in any US hospital.
We see so much paperwork in the US because there are (at least) 3 parties involved in every medical bill. You, your insurance, and the hospital.
Single payer cuts your involvement to 0 which kills pretty much all your paperwork. It also vastly simplifies hospital billing.
It's the technical equivalent to supporting 100s of standards and then dropping down to a single standard. Even if that standard is garbage, eliminates the need to support the 99 standards (even if some are better).
Costwise, it can't help but be less. The fact is, there's a lot of duplicate jobs in each insurance agency as well as some jobs that simply won't exist (no need for accuracy tables, for example).
There were multiple ways to qualify for Medicaid and some of them are purely based on poverty with no disability or medical issues. Those cases needed the carefully documented income, bank accounts, retirement funds, etc. It's a bad system in many ways in and of itself, but at a high level they do need some way to confirm that Elon Musk isn't applying for Medicaid just for shits and giggles.
The other qualifiers for Medicaid are medical issues that are detached from income.
The frustration of it all is that there is a single form and while you'd hope there'd be a 'skip this section if you do not qualify based on income' there isn't, and you can end up trying to pull together every financial document you have.
( It can be worth a try to attach a W-2 so they have something and stopping there. They can contact you if they need more )
A better system would provide healthcare to everyone and just tax Musk more to pay for it.
I mean, who cares if he is if it means people like this are able to get the care that they need? That would be such a small drop in the bucket compared to all the people who genuinely have been screwed by the system.
If Elon Musk uses $2.5 million in healthcare but pays 200x or more than that in taxes I don't see that as a problem.
I don't mean to oversimplify and paint a straw man here: These are literally arguments I hear from some family and friends on the topic without much of any nuance to them.
When you turn 65, you receive Medicare benefits after a pretty painless application form, which is mostly to obtain coordination of benefits information for retiree private plans
Aftwards, you have very little interaction with Medicare, other than if you are placed in a nursing home or rehab, at which point you may need to argue for more benefits as the rehab will try to maximize their revenue by kicking you out after 90 days.
My spouse visited a doctor in January 2020, and we recently got yet another Explination of Benefits about that visit, which is probably the 15th time they've sent one. I wish I was exagerating.
I give the hospital my child's medicaid number, they take it from there. Really pretty much that simple. No prior approval. No crazy paperwork. Just give 'em the number and you are off to the races.
I'm sure it would be worse for elective surgeries, but that's not really what anyone is arguing for.
Besides which, unless you have the best gold plated insurance plans or a mediocre plan and never need to go out-of-network, mindless beuracracy and tons of paperwork describes the status quo of private insurance.
And annecdotally, my father on Medicare has far few issues of that sort than I do on my (above average) employer's plan.
There is a stark difference between Medicaid and Medicare. Medicare, for those who can enjoy it (65+ or meeting criteria for chronically disabled), is pretty good insurance. You have your pick of specialists or primary cares, it reimburses providers pretty well, and ironically, processes claims faster than private insurance. There are some glitches that should be fixed sure, but it is definitely viable as a healthcare plan.
Medicaid in comparison, is bare bones - the political reasons I'll let other people comment more, but access to care is severely restricted, it doesn't pay providers enough to keep the lights on, and is not really capable of providing any semblance of the modern standard of care.
In contrast Medicaid is awesome - zero copay or deductible, just show up and use your insurance card.
There is also Medicare Advantage, which actually is quite good - and it's private insurance that the government pays for. So maybe we don't need either "for all" programs, but rather a universal subsidy for people to buy their own insurance.
> it doesn't pay providers enough to keep the lights on
That's true about both Medicaid and Medicare, which is why neither will ever be offered to all, not without a salary cut to Doctors.
Those arguments' flaws aren't corrected with the implementation of a bad system.
If you have Medicare for All, you don't have to worry about getting into the program, because everyone already has it, no?
Example: USA $8360/person/year, 78.9 years; Singapore $1730/person/year, 82.8 years.
People who don't have health insurance are often shafted, but even people who do have health insurance are too: https://slatestarcodex.com/2020/04/24/employer-provided-heal...
Healthcare is probably the single most broken part of US society/economy.
[1]: https://www.gapminder.org/tools/#$model$markers$bubble$encod...
I say funnily, because the US government is know for being light on bureaucracy. Yet, somehow the US healthcare system has given it a run for it's money.
Every hospital has a significant amount of staff dedicated to billing and negotiating with insurance companies. Every insurance company has a fleet of employees who work on optimizing costs, denying coverage when possible, and negotiating bills with hospitals. And on top of that, a large part of the job of HR for employers is managing healthcare benefits and negotiating with healthcare providers.
Layers upon layers of ultimately waste.
A single payer system ends up saving cost because.
A. There's no negotiating bills with the government. You either accept what they are paying or you don't get paid.
B. Because the government deals with every hospital, they've got very good insight into what things ACTUALLY cost. That makes it hard for a medical provider to play fast and loose with the numbers.
In otherwords, admin costs for Hospitals go completely away and the government admin costs end up being a fraction of what the rest of the insurance industry is doing (because a lot of what private insurance is doing is trying to make money off of premiums in the stock market). Government does not have that incentive in the slightest.
EDIT: I can see now that the question was either poor taste considering the topic of the article or sensitive by a lot of people. I had no idea that this was a controversial question and I am sorry.
But to me it's always sounded trite, and a bit like virtue signalling. The only person you need to show your investment to is your partner, and you do that through your actions, not words.
It's the event horizon of a black hole that inevitably swallows all of both parents' free time and disposable income.
Maybe it was also in bad taste to ask this considering the tone of the article, anyway I got plenty of responses. Sorry if I offended anyone :(
It can be hard work to get pregnant, hard work to stay pregnant, hard work to carry to term, hard work to deliver and it is unbelievably hard work to raise a child. Two partners trying to get to the finish line have to make incredible sacrifices, and make huge changes to their lives in order to support each other.
Saying we're pregnant and sharing the state of pregnancy vs just saying she's pregnant, acknowledges the the shared work and the shared responsibility that is taken up by both partners, and it acknowledges the shared joy in bringing life into the world. And when you say it to someone other then your pregnant partner, you make it clear to them that you are picking up a huge responsibility and that they should recognize it.
Not saying it's right, but I'd presume for claims that large you'd probably have to get a lawyer/some form of professional advocate involved even with private insurance.
For instance, my private insurance offered something like 50 nights of care per year. Medicaid offered, I forget, but with Medicaid, unbeknownst to us, there were limitations that didn't apply when using my private insurance, such as only one parent could be in the house, the nurse would need to document exactly what the parent was doing during that time, etc.
I wish you the best.
It seems relatively unknown, but in the US you can enroll a child with chronic illness into Medicaid through the "Katie Beckett" [1] program, regardless of household income.
Unfortunately, that process is both annoying and semi long (takes a month or so). Part of the process involved applying for and getting denied medicaid coverage.
All this is to say, if you have a child with a severe long term illness/disability, you can get them extremely generous healthcare even if you are pulling in a large salary.
I've had to do this with my own child, so I know it's really rough. But please, take advantage and get your kiddo all the therapy/medical care they need.
Edit: I should note that not every state has this. Many (23) do. It looks like Indiana is one of the states that does not have it :(. States are required to have passed TEFRA. [2]
[1] https://dhcfp.nv.gov/Pgms/LTSS/LTSSKatieBeckett/
[2] https://www.kidswaivers.org/full-list/
Our social worker was knowledgable on IL programs, but not much on any in IN, so we had to do a lot of digging ourselves, even though the hospital is near the IL-IN border. Only when my wife joined an FB group did we find out about the Katie Beckett program.
We were in the process of applying the for the IN A&D Waiver, as it's not income-based (well kinda). Apparently being approved for the A&D Waiver makes it "easier" to get approved for Medicaid as it shows a disability, in addition to other benefits. I think we waited a month for the interview, during the interview I mentioned my child was a very sick newborn, but the interviewer still had to ask whether my child was anxious or depressed, lived a fulfilling life, etc. I think I broke down afterwards. We were still waiting for the response when she passed away, actually, I think we're still waiting for it? It wasn't a fun experience. I understand the need for the questions, but I wish there was the questions were catered to the age of the applicant.
I suffer from chronic illness(bone related, had a successful spine surgery couple of years back), Now insurers in India are straight away denying me any health policy and not just any insurers they're top private insurers in tie-up with leading international insurance companies incl. U.S.(There's 100% FDI for insurance industry).
My interactions with the insurers gives me PTSD[1], I understand the business risk for an insurance company in insuring a sick person, So I'm not asking for a charity or even empathy all I'm expecting is for them to take decisions using medical science and common sense.
Say I have bone diseases, I have proven with medical tests(conducted by the insurer) that my heart and other body functions are normal. Now a blanket denial of policy prevents me from getting proper treatment for diseases I don't have; Since my bones aren't normal should I be not covered for COVID too?
The story is not unique to me, I've heard much worse horror stories from the disabled community.
What's worse is blanket denial of health insurance to disabled are against Govt. regulations and supreme court orders; Yet all my complaints went to deaf years. Now I'm left with one option, I'm planning to write to the U.S. Government and other governments about how their companies are acting against the disabled in India.
[1] https://abishekmuthian.com/insurers-are-putting-the-lives-of...
Denial of policy renewal - if thats what you are saying is happening - is indeed illegal. Instead of wasting time, you should file a writ petition in your jurisdictional High Court, and make sure your lawyer does not let the matter go on for "date after date". If you can't afford a lawyer, this is something you can try to file on your own - High courts tend to take dim views of such behaviour by companies, and don't stand too much on ceremony. There are people called "law clerks" that operate on the High court campuses. They are the ones who do all the paper work for all lawyers (excluding actually drafting) - and they tend to be underpaid. Find one of them who is willing to help you unofficially for a small fee - this will help you take care of the basics (you need this form, so much fee stamps, this signature here, etc etc - this is needed to just get the matter before a judge). Once it goes in front of a judge, plead your case in normal speech, respectfully, without theatrics, and state the remedy you are seeking.
There have been plenty of precedence which lead to supreme court passing an order urging the Govt. to ensure disabled get health insurance. And govt. made changes to Insurance regulations which states that the insurer should cover pre-existing diseases after maximum of 4 years and blacklisted certain chronic diseases(Mine isn't blacklisted) from being covered; Note: Just the diseases are not covered, Policy is not denied.
So all these insurance companies are advertising 2-4 years to cover existing diseases as per the regulation. I went through lot of effort to apply to all leading insurers and have documented(link in prev. comment) how they ignore the insurance regulation to deny policy, Followed by how my complaints to the insurance regulators on each of these insurers did absolutely nothing.
Journalists from leading media org. approached me to hear the story after I published the blog but they didn't publish any story on how the insurance industry is treating the disabled as they're the leading advertisers especially during COVID. Few independent media did publish my story along with those of others facing similar situation.
I'm of opinion that getting these insurers reprimanded in their home countries for their unethical, immoral and illegal behavior might have great positive effect for the disabled around the world.
(Yes, I'm aware that there'd still be cost for universal insurance coverage in the form of taxes-- that's not all lost income. Still, I bet we could do better than the current "system" with single-payer and a real, forthright effort to actually reign-in costs. Oh, and no for-profit insurers.)
>Yes, I'm aware that there'd still be cost for universal insurance coverage in the form of taxes-- that's not all lost income
Seems like the right way to approach this would be to promise to tax it on the employer side, replacing whatever premiums they had paid before? That way everyone's happy. The workers don't see any increased premiums, and companies pay equal or less taxes (assuming it actually works out cheaper, but that's another debate).
I consulted for a franchisee of Blue Cross Blue Shield 15 years ago. They were a "non-profit" org...the CEO made 2.1m/year. That's in a rust-belt city with ~1m metro area population.
edit: They had a 200 person IT department that could have easily been run with 100 competent folks. For illustration, they had 20 people working full time managing the source of truth of their healthcare plans (to feed their claims processing system.) The source of truth was Excel spreadsheets on a shared drive. You can't make this crap up.
IDK why this couldn't simply be a part of regular income tax and perhaps a bump in the capital gains taxes.
When you think about it, it's a bit silly that employees earning 2 or 3x the salaries of other employees are paying the same for healthcare.
This would also have to happen because not all employers offer healthcare (small businesses or contracting), yet everyone would still (presumably) get healthcare.
In any event, I'd honestly happily pay a bit more in taxes for the more progressive healthcare plans. No deductible and vision/dental? Impossible to break the bank for cancer? No coverage gaps between employment? I could start my own business and not worry about health coverage?
Universal healthcare is a terrific idea that most other nations have. It's not bank breaking and there's no country I know of that's decided to ditch it after implementing it.
psychological reasons, because you're already accustomed to it. You'll be shocked/outraged if the government randomly fined you $25k, but when the IRS wants $25k of your income you begrudgingly put up with it.
You think it costs more to treat someone who makes more money?
And, if you are talking about treating people based on what it costs, then why have insurance in the first place? The entire point of insurance is sharing the cost with others.
It's not about sharing the "cost", it's sharing the risk. Insurance is all about risk profiling and compensating for that. The cost to treat you is dependent upon your medical profile not how much $$$ you are making. If you are less risky *and* make a lot of money you won't get a higher premium than someone much more riskier and who doesn't make a lot of money.
> No, I think everyone needs healthcare regardless of income and expenses. However, I think someone making 200,000 is much more capable of paying $1200 monthly than someone earning $30,000 is capable of paying $600 monthly.
Okay, but then what? Cross-subsidization is a inherently unfair practice.
The "risk" is a high cost event.
For insurance to work, there has to be winners and losers. The price the losers pay isn't exactly fair to them, is it?
> If you are less risky and make a lot of money you won't get a higher premium than someone much more riskier and who doesn't make a lot of money.
Not how it works in the US (particularly with Obamacare regulations) the only risk profiles insurance companies are allowed to consider for health is age and smoking. Prior to Obamacare there were preconditions they could evaluate to offer different insurance premiums. Those are all out the door.
> Okay, but then what? Cross-subsidization is a inherently unfair practice.
And? I don't understand why it matters to be absolutely "fair" to the wealthy. The wealthy achieved their wealth by means of a great society powering their empires. Why is it a wrong to expect them to pay more to improve the society around them?
And, importantly, the US wouldn't be the first nation to do this. Progressive taxation exists in pretty much ever successful country. And, besides the US, all of those countries will have some form of Universal healthcare funded by that taxation.
Right, but there's a difference between you paying your expected value in costs (imperfect as it might be, because of the attributes insurance companies are allowed to consider), compared to you paying 3x the expected value on the basis of your income.
A huge portion of someone's income making $30,000 is going to housing and food. Things that cost the same regardless of income.
For someone making 100,000, 200,000, etc, they have a much higher amount of disposable income.
Even if we are talking about fixing other aspects of healthcare, when it comes down to it, those with more assets can afford to pay more without impacting their lifestyle.
"every life matters", "think about the kids" or "what about the children" is only relevant when it's about healthy kids, I guess.
I work in healthcare tech working on tools to explicitly lower readmission rates and frequently wonder if my work helps to make it easier for healthcare systems to KYA (well, KTA) and streamline "bulk-handling" patients as opposed to effectively providing care for each individual patient.
But really it seems insurance companies are legit the devil and in this case, the opaque bureaucracy of the US Medicaid system
...are there companies or organizations that are trying to solve this sort of situation from the point of view of “We learn all the obscure healthcare laws in each state so each individual patient doesn't have to?” I have heard of Better, and had previously heard of Remedy [2], which seems to have folded [3].
I wonder if the insurance behemoths are just so big that the capitalist response of a competing organization to serve from the patient's side simply doesn't scale up quickly enough. And yet, I hear horrifying stories like this often enough that it seems like it should.
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[1] https://news.ycombinator.com/item?id=29233883
[2] https://getbetter.co/
[3] https://www.bizjournals.com/austin/news/2020/10/29/health-te...
I wish there was a site I could visit, fill out some info, and get info on programs I may be eligible for. I've been considering hacking something together myself, but it's almost too much for one person to achieve. Another user posted this site: https://www.kidswaivers.org, it looks like a great resource I wish I found sooner
This comment was for a post that was deleted, just posting it here so it's not lost forever.
We were late to get an appointment as it was early into the pandemic. I was barely able to be in the room for the ~18 week scan, I wasn't allowed in the 20 week scan (at 21 weeks) so my wife FaceTimed me. No one mentioned anything was wrong at that scan, just that we need better tests at UIC. My wife had more tests there, I had to wait in the car as I wasn't allowed to go with her for those tests, during that test a Dr told my wife my baby had a heart defect, but it wasn't until the following appointment that we were told our baby had Hypoplastic Left Heart syndrome. We passed the date for a termination in IN, and were fast approaching it in IL. I think we had like 5-6 days until it was too late in IL, too.
We were told it's a rough start, but do a Google search, look at Facebook groups, plenty of kids live "healthy", normal lives, after their surgeries. My mom & my wife's dad lived to be 40, I thought if I could give my child 20-40 years, it was better than 0. The oldest person with HLHS is in their 30s (as long as the surgeries have been around). We thought Sterling would be the same.
An amniocentesis ruled out the trisomies, and a few other common abnormalities. My wife and I agreed that a positive result on a genetic condition would likely sway our decision for a termination.
Some babies are born without their heart disease being discovered until after the baby is at home. Their brains are often starved of oxygen during that time, leading to other serious complications, so we were happy at least we found out and could prepare.
It wasn't until after Sterling was born though did we discover there was more to her story. She received a new diagnosis every week, until she was 3 months old, only after genetic testing was carried out on us all did we discover Sterling had a very rare genetic condition called Kabuki syndrome. It was Kabuki syndrome + isomerism + HLHS that ultimately made it impossible for her to thrive & live a "normal" life.
I've never experienced that kind of unconditional love before and until you're in that situation, you don't know how you would handle it either. We were going by the best info we had at the time.
I agree, I likely caused my daughter to suffer immensely and I have to live with that guilt for the rest of my life. There were good, happy, fun days in-between the sad/bad days. I have lasting PTSD from watching my daughter code in front of me, then watch as chest compressions break her ribs, then to turn off life support. If I knew then, what I know know, things would be different.
Ultimately, it's made me want to bring change. Parents should have all tools at their fingertips. If they're testing for the trisomies, why not test for all other known defects, too? Surely it's "cheaper" to do thorough genetic testing early, then it is for x surgeries, x days in the ICU, etc. Insurance doesn't cover it, and it's likely $10k+ out of pocket. That way, parents can make an informed decision. Same with Medicaid, if you're limiting when we can terminate, surely making life easier for us isn't too much to ask? I wasn't asking for a handout, just trying to avoid financial ruin, and do the best for my child, without killing myself in the process. 40% of parents of disabled children end up getting divorced. I found out some of those are likely due to earning too much to qualify for Medicaid as a married couple.
The love, joy, appreciation, that my little girl was able to bring out of people is truly beautiful, especially during the pandemic. She's made people enjoy the little things, appreciate their lives, their families, their health, their kids health, hug and love their kids harder, etc.
Sterling received 2.25 times the volume of blood in her body...