The Medical Thread: We're experts on everything else; why not?

[psych]

Ans there are tons of permutations on how to fund. Germany Switzerland France etc.

thidbis one of my stress of expertise but I’ll wait and be mansplained to by concerned people

Multiple ways to do it, and all seem quite successful- certainly more so than our system.

[psych]

In a broad sense, maybe. Personally I think that there should be a certain level of those items that needs to be socialized, instead of just socializing the entirety of them.

Like, say, preventive care?

[WisconsinWildcard]

Ugh. Is there no screening test available to you?

For better or worse, I work in a field that history and the physical exam are by far the most important element. So my screening test is just that, to localize the problem and then, if appropriate, seek the right imaging (I am actually on the very low end of ordering MRIs in my department as I trained in a hospital system with a high poverty/low insurance population).

I very much have a patient population that consists of atypical presentations of atypical conditions which is intellectually rewarding but makes cases very challenging. There are few of us in the field, and it is almost on a weekly basis I am emailing experts across the country/world to get input on a case. When I call in to do a "peer to peer" there is never anyone who is close to a "peer" on the other end except that we both hold MDs (most of the time). Therefore, I usually am speaking Greek to them and just trying to find the random magic word that fits their actuarial table to get the needed test approved.

Once as a fellow I had a patient with spinal cord impingement. It was obvious on history and exam and they needed a semi-urgent MRI. Insurance denied the MRI. I fought it over 2 weeks and eventually talked to a "peer." I stated the patient was myelopathic (medical term for a spinal cord issue) and my "peer" stated that was not an approved word. I went through a list of things, pleading to get it approved and eventually said a positive babinski sign (which is less specific than myelopathy) and that was a magic word that they approved. MRI approved, but unfortunately, the patient worsened before it could be scheduled, went to the ED which did a full spine MRI (she just needed a cervical spine MRI) and she underwent emergent surgery, all which could have been prevented if the first MRI was approved. I would have saved the system tens of thousands of dollars if not for insurance.

[SJHovey]

Like, say, preventive care?

On a very, very basic level, sure.

The problem with healthcare is this insurance model we've developed. Insurance works fine for protecting you against catastrophic losses, like your house burns down. It doesn't work well for things that you may need more frequently, or think you need more frequently. None of us would choose an insurance model for food or clothing needs for instance. Our food system would quickly be as screwed up as our medical system.

But, unfortunately, we've gone a long, long way down this road and I'm not sure there is a great way out.

Now, admittedly, I take a fairly morbid view of healthcare. At the end of the day it isn't going to save us.

[LynahFan]

Don't people need food and shelter way more than they need healthcare to live?

Yes. And there are literally hundreds of (socialized) government programs to ensure that people don't starve to death.

Sure you want to go down this route?

[SJHovey]

Yes. And there are literally hundreds of (socialized) government programs to ensure that people don't starve to death.

Sure you want to go down this route?

There is a basic safety net, that honestly has more holes in it than netting, to address food needs in this country, but it is a long way away from socialized food. In fact, I'd suggest that the current safety net we have for healthcare, between medicaid and medicare, is probably a stronger and more widespread net than our food net at this time.

[psych]

On a very, very basic level, sure.

The problem with healthcare is this insurance model we've developed. Insurance works fine for protecting you against catastrophic losses, like your house burns down. It doesn't work well for things that you may need more frequently, or think you need more frequently. None of us would choose an insurance model for food or clothing needs for instance. Our food system would quickly be as screwed up as our medical system.

But, unfortunately, we've gone a long, long way down this road and I'm not sure there is a great way out.

Now, admittedly, I take a fairly morbid view of healthcare. At the end of the day it isn't going to save us.

So, according to you, what items should be socialized?
The insurance model is likely here to stay in this country, certainly for the foreseeable future. I doubt you’ll find anyone on this board who disagrees with you that the current setup is perverse and not health-centric for people in any way, shape, or form. But, I’m not so certain insurance companies are beyond the pale of capably handling Americans who aren’t already on some kind of govt. program for healthcare already.

[psych]

There is a basic safety net, that honestly has more holes in it than netting, to address food needs in this country, but it is a long way away from socialized food. In fact, I'd suggest that the current safety net we have for healthcare, between medicaid and medicare, is probably a stronger and more widespread net than our food net at this time.

For all its warts and ****tiness and attempts at strangling it, including by Democrats (not so much in the recent past), SNAP does a fairly admirable job. Medicaid/Medicare are wonderful too.

[Kepler]

Don't people need food and shelter way more than they need healthcare to live?

Your point?

[Swansong]

For better or worse, I work in a field that history and the physical exam are by far the most important element. So my screening test is just that, to localize the problem and then, if appropriate, seek the right imaging (I am actually on the very low end of ordering MRIs in my department as I trained in a hospital system with a high poverty/low insurance population).

I very much have a patient population that consists of atypical presentations of atypical conditions which is intellectually rewarding but makes cases very challenging. There are few of us in the field, and it is almost on a weekly basis I am emailing experts across the country/world to get input on a case. When I call in to do a "peer to peer" there is never anyone who is close to a "peer" on the other end except that we both hold MDs (most of the time). Therefore, I usually am speaking Greek to them and just trying to find the random magic word that fits their actuarial table to get the needed test approved.

Once as a fellow I had a patient with spinal cord impingement. It was obvious on history and exam and they needed a semi-urgent MRI. Insurance denied the MRI. I fought it over 2 weeks and eventually talked to a "peer." I stated the patient was myelopathic (medical term for a spinal cord issue) and my "peer" stated that was not an approved word. I went through a list of things, pleading to get it approved and eventually said a positive babinski sign (which is less specific than myelopathy) and that was a magic word that they approved. MRI approved, but unfortunately, the patient worsened before it could be scheduled, went to the ED which did a full spine MRI (she just needed a cervical spine MRI) and she underwent emergent surgery, all which could have been prevented if the first MRI was approved. I would have saved the system tens of thousands of dollars if not for insurance.

Crazy!

Medicare patients are now subject to a chunk of PAMA (Protecting Access to Medicare Act) that requires the documentation of Clinical Indications of Use, as well as documenting which approved tool you used to determine which specific advanced imaging order you're placing. It was a gigantic undertaking, but the end result is that a provider orders a CT scan and our system generates a score on applicability. Low score = higher chance of denial, and we also offer alternative orders, based on recommendations from the American College of Radiologists. Our docs were apprehensive but seemed to embrace it pretty quickly. All they really need to do "Extra" is choose which CIU. Of course, that isn't attached to the ICD 10 diagnoses (we looked into tying them together but HOLY HELL the cost).

It's odd, despite Trump and the GQP's nonstop meddling, CMS has taken some pretty substantive steps over the last couple of years to streamline and consistify (that totally ought to be a word) reimbursement. Even when I first started, if you pitched a project with "Medicare needs..." you'd get a bunch of groans. Now? Not so much. Meanwhile BCBS refuses to accept the fact that the times are changing and are denying valid claims over and over and over for insane reasons. We're definitely getting our money's worth from our legal department, that's for sure.

[Deutsche Gopher Fan]

I can personally attest to the extreme difficulty getting things approved for covid complications. Basically four MRIs and it was a nightmare to get peer approvals. This will be a nightmare for years.

oh and still no explanation for my issues

[Deutsche Gopher Fan]

concern!

Gotta chime in somewhere when you’re ignoring the fact your party is taking a huge step towards total authoritarianism today

[MissThundercat]

Can we start with a system that doesn't treat teeth and eyes as luxury body parts I must pay extra for?

[dxmnkd316]

Medicare runs at like 3% overhead. Private insurance is like 30%.

**** insurance companies. We'll pay for a quarter of it on executive bonuses alone. God I ****ing hope hell is a CEO who can't afford to care for a family member.

[dxmnkd316]

For better or worse, I work in a field that history and the physical exam are by far the most important element. So my screening test is just that, to localize the problem and then, if appropriate, seek the right imaging (I am actually on the very low end of ordering MRIs in my department as I trained in a hospital system with a high poverty/low insurance population).

I very much have a patient population that consists of atypical presentations of atypical conditions which is intellectually rewarding but makes cases very challenging. There are few of us in the field, and it is almost on a weekly basis I am emailing experts across the country/world to get input on a case. When I call in to do a "peer to peer" there is never anyone who is close to a "peer" on the other end except that we both hold MDs (most of the time). Therefore, I usually am speaking Greek to them and just trying to find the random magic word that fits their actuarial table to get the needed test approved.

Once as a fellow I had a patient with spinal cord impingement. It was obvious on history and exam and they needed a semi-urgent MRI. Insurance denied the MRI. I fought it over 2 weeks and eventually talked to a "peer." I stated the patient was myelopathic (medical term for a spinal cord issue) and my "peer" stated that was not an approved word. I went through a list of things, pleading to get it approved and eventually said a positive babinski sign (which is less specific than myelopathy) and that was a magic word that they approved. MRI approved, but unfortunately, the patient worsened before it could be scheduled, went to the ED which did a full spine MRI (she just needed a cervical spine MRI) and she underwent emergent surgery, all which could have been prevented if the first MRI was approved. I would have saved the system tens of thousands of dollars if not for insurance.

Greg? Dat you?