United Healthcare's CEO murdered this morning

[PsyDr]

https://www.reuters.com/world/us/unitedhealthcare-ceo-fatally-shot-ny-post-reports-2024-12-04/

Who could have imagined that the face of an onerous healthcare system would upset someone?

---

Members don't see this ad.

 

[wellbutrin.girlfriend]

Thoughts and prayers...

 

[Fan_of_Meehl]

https://www.reuters.com/world/us/unitedhealthcare-ceo-fatally-shot-ny-post-reports-2024-12-04/

Who could have imagined that the face of an onerous healthcare system would upset someone?

Good Lord. That's awful.

 

[nexus73]

Shocking/surprising how every place I read about this, the comments are filled with absolute disdain for this dude. Maybe not so surprising, but I guess it just goes to show how much people completely hate health insurance companies. Also makes me wonder about the social acceptance of vigilante justice increasing

 

[Bartelby]

Shocking/surprising how every place I read about this, the comments are filled with absolute disdain for this dude. Maybe not so surprising, but I guess it just goes to show how much people completely hate health insurance companies. Also makes me wonder about the social acceptance of vigilante justice increasing

I had the same reaction. I very much dislike the way some insurance companies operate and suspect this CEO profited from causing quite a bit of pain. Still, this seems like a really bad development especially when paired with the incoming President having faced two assassination attempts during the recent campaign season.

I don't think we have to like the target to understand that this kind of vigilante justice is a big problem. That is especially true for us as psychiatrists, because I'm sure there are patients we have involuntarily committed or refused benzos or whatever else who would like to exact some vigilante "justice."

It seems unsettling that people come across (on SDN, reddit, news article comment feeds) as seeming pretty okay with this.

 

[Merovinge]

I had the same reaction. I very much dislike the way some insurance companies operate and suspect this CEO profited from causing quite a bit of pain. Still, this seems like a really bad development especially when paired with the incoming President having faced two assassination attempts during the recent campaign season.

I don't think we have to like the target to understand that this kind of vigilante justice is a big problem. That is especially true for us as psychiatrists, because I'm sure there are patients we have involuntarily committed or refused benzos or whatever else who would like to exact some vigilante "justice."

It seems unsettling that people come across (on SDN, reddit, news article comment feeds) as seeming pretty okay with this.

I think there's a pretty big line between seemingly okay and unsurprised/expected this to be the outcome. I fall into the latter camp and completely abhor violence and would never advocate for it. But when you have rapidly increasing wealth inequality and pushes towards even more crony capitalism/kleptocracy it would be naive to consider that everything will be fine/as it has been.

I work with my adolescent patients daily on finding ways to positively contribute in the world, I am highly idealistic and love my life/vocation, but I also don't just blindly see the changes happening in the world and think everything is fine and this is a 1-off. It reminds me of a specific group of people that see the escalating natural disasters and think it's just business as usual.

 

[jbomba]

Just as a theoretical discussion, when people say I never agree with violence, do they mean that in absolute terms? Like if we were being taken over by a Nazi-esque regime and people were being sent to camps, would you still be against violence to combat this? This is an extreme example, but is it really so accurate to say violence is never the answer?

I'm not advocating for or condemning violence in this case. Just thinking out loud given the current trajectory of the world.

 

[Bartelby]

Here's my proposal to address the insurance company mess: get rid of protections (like those found in ERISA) that make insurance companies immune to malpractice suits.

If the patient's doctor recommends a treatment and the insurance company swoops in and says "actually, that treatment isn't indicated. You need to do X, Y, Z instead" then the insurance company is practicing medicine. If we are going to allow that, we need to expose them to the same malpractice risk that you, I, and every other physician faces for our decisions. Once juries start awarding big judgments for denied care I think the economics of these kind of obstructionist care-denying policies will shift rapidly. And in the end, the money is what can actually motivate these companies to change.

 

[Merovinge]

Here's my proposal to address the insurance company mess: get rid of protections (like those found in ERISA) that make insurance companies immune to malpractice suits.

If the patient's doctor recommends a treatment and the insurance company swoops in and says "actually, that treatment isn't indicated. You need to do X, Y, Z instead" then the insurance company is practicing medicine. If we are going to allow that, we need to expose them to the same malpractice risk that you, I, and every other physician faces for our decisions. Once juries start awarding big judgments for denied care I think the economics of these kind of obstructionist care-denying policies will shift rapidly. And in the end, the money is what can actually motivate these companies to change.

Interestingly, this is exactly what needs to happen with social media as well. No more protections for algorithmically promoted content if it leads to bad outcomes. They know they are making money sending you material that is worse for your morbidity and mortality and it's time to address the issues. That all said, this is exactly what won't happen in either case as both industries have an iron-fist hold over politics on both sides of the political spectrum.

 

[Stagg737]

Here's my proposal to address the insurance company mess: get rid of protections (like those found in ERISA) that make insurance companies immune to malpractice suits.

If the patient's doctor recommends a treatment and the insurance company swoops in and says "actually, that treatment isn't indicated. You need to do X, Y, Z instead" then the insurance company is practicing medicine. If we are going to allow that, we need to expose them to the same malpractice risk that you, I, and every other physician faces for our decisions. Once juries start awarding big judgments for denied care I think the economics of these kind of obstructionist care-denying policies will shift rapidly. And in the end, the money is what can actually motivate these companies to change.

Not to defend the insurance companies, but there's a difference between saying "this treatment isn't indicated" and "we're not paying for this treatment". I get that there's not really much of a difference to patients, but from a legal argument standpoint I think it would be pretty easy to argue that they're not practicing medicine by denying coverage by just changing some language.

 

[docloufan]

Not to defend the insurance companies, but there's a difference between saying "this treatment isn't indicated" and "we're not paying for this treatment". I get that there's not really much of a difference to patients, but from a legal argument standpoint I think it would be pretty easy to argue that they're not practicing medicine by denying coverage by just changing some language.

I don't read any internet comments, ever, but I hear about them.

The jokes about this man's homicide and the disdain expressed for this man is unreal, unconsiousable, and unjustifiable. Just sick.

This man is essentially a CPA who worked his way up to be a very gloried CFO. People have to know he has no role in individual case determinations and really no role in setting specific medical or mental health coverage policy, limits, or direction. There are layers and layers and layers of MD leadership, individual Medical Directors, and population health researchers and statisticians behind all this. Regarding UBH's Behavioral Health UM practices, some of their policies and decisions are pretty apt and reasonable for the monitoring of outpatient utilization (most psychiatry and mental tx is OP). Not the best. Not the worst. But again, not that this should matter. This is a man. A husband and a father.

There is mass jumping to conclusions here by media and the public. I thought the rule was we start with family/friends, known associates/interests, and work outward from there. Notes left behind? Are you kidding me? 3 to 1 it's a planted red herring.

 

[HemeOncHopeful19]

Not to defend the insurance companies, but there's a difference between saying "this treatment isn't indicated" and "we're not paying for this treatment". I get that there's not really much of a difference to patients, but from a legal argument standpoint I think it would be pretty easy to argue that they're not practicing medicine by denying coverage by just changing some language.

Disagree on this point.

I get denials of care all the time and the letters that they send these patients are all worded such that "your doctor wants to do this but he is supposed to be doing XYZ instead, so we are not going to pay for what he wants to do"

 

[clausewitz2]

Disagree on this point.

I get denials of care all the time and the letters that they send these patients are all worded such that "your doctor wants to do this but he is supposed to be doing XYZ instead, so we are not going to pay for what he wants to do"

Sure, but the legal argument is and has been 'You can pursue any treatment you want, we won't stop you, but we don't have to pay for it.' They don't have an obligation to pay for things that fall outside of the scope of the extremely carefully worded insurance policies they agreed to with their customers.

 

[Stagg737]

Disagree on this point.

I get denials of care all the time and the letters that they send these patients are all worded such that "your doctor wants to do this but he is supposed to be doing XYZ instead, so we are not going to pay for what he wants to do"

I have never seen something like this in psychiatry other than times where I’m starting a expensive med (typically when cheaper alternatives are available) or there’s a pretty obvious deviation, like trying to start TMS or Spravato when a patient has only ever taken Prozac. I’ve never seen a letter saying “your doctor is supposed to do x,y, z” as that seems to be pretty obviously stepping outside their role.

 

[HemeOncHopeful19]

I have never seen something like this in psychiatry other than times where I’m starting a expensive med (typically when cheaper alternatives are available) or there’s a pretty obvious deviation, like trying to start TMS or Spravato when a patient has only ever taken Prozac. I’ve never seen a letter saying “your doctor is supposed to do x,y, z” as that seems to be pretty obviously stepping outside their role.

I had one this week "your doctor is ordering a scan to check for infection (I wasn't - Radiation Pneumonitis isn't an infection...) and they should be doing that only if you haven't responded to treatment after 2 or 4 weeks"

 

[Fan_of_Meehl]

The idea of paid family 'caregivers' for veterans with mental health conditions (PTSD, depression) is like the zombie that just...won't...die...

Thousands More Could Be Eligible for VA Family Caregiver Program Under Proposed Overhaul

The program required a review following a lawsuit, as well as eligibility changes instituted in 2021 that would have dismissed thousands of original participants.

www.military.com

When they originally rolled it out 10+ years ago...yup, paid family caregivers for conditions like PTSD/depression/mTBI (history of concussion) is a bad idea...we are going to be having to pull all this back in a few years.

Sure enough, a few years later, they had to pull it back.

Now, it looks like the political momentum is building to reverse that reversal.

Meanwhile, clinics are full of cases wanting clinicians to endorse the need for a family member to be a 'full time caregiver' in order to 'calm down' the veteran when they get angry so they don't haul off and murder someone. And it looks like, once again, they are maneuvering the clinician/provider to be the one who has to say 'no' to this rather than addressing the issue systemically.

 

[ridethecliche]

Didn't blue cross, or whatever shiet insurance company it was, backtrack on charging for anesthesia time that went over their self determined arbitrary time cutoff right after this news came out?

 

[Merovinge]

Didn't blue cross, or whatever shiet insurance company it was, backtrack on charging for anesthesia time that went over their self determined arbitrary time cutoff right after this news came out?

Yup, they did

 

[Stagg737]

I had one this week "your doctor is ordering a scan to check for infection (I wasn't - Radiation Pneumonitis isn't an infection...) and they should be doing that only if you haven't responded to treatment after 2 or 4 weeks"

That’s pretty messed up and seems much less ambiguous than what I’ve seen.

 

[ussmediprise]

The UHC lawsuit over using AI to deny coverage is the more wild story, imo. Sad for the guy, he didn't deserve to die, but neither did all the other people who died because they couldn't get treatments due to healthcare costs and insurance dropping them.

In case people didn't know, health insurance companies can arbitrarily change how much they reimburse doctors, hospitals, etc and they can stop covering areas of the US just as easily (they know where the high utilizers live). Health insurance is supposed to be there to provide a pool of money that people who need them can draw from, not a money making enterprise for investors.

 

[ridethecliche]

The UHC lawsuit over using AI to deny coverage is the more wild story, imo. Sad for the guy, he didn't deserve to die, but neither did all the other people who died because they couldn't get treatments due to healthcare costs and insurance dropping them.

In case people didn't know, health insurance companies can arbitrarily change how much they reimburse doctors, hospitals, etc and they can stop covering areas of the US just as easily (they know where the high utilizers live). Health insurance is supposed to be there to provide a pool of money that people who need them can draw from, not a money making enterprise for investors.

Except that's what it has morphed into with no end in sight. And because they hide away from patient care we end up being the evil face of care denial.

 

[ussmediprise]

Except that's what it has morphed into with no end in sight. And because they hide away from patient care we end up being the evil face of care denial.

Right. Nothing like the patient asking, "can you call them and ask?" or "why can't you do anything about it?" Like the MD/DO is powerful but not that powerful. We are increasingly at the whim of hospital admins and insurance companies that try to dictate how we deliver care and are ruining the field for us. No one wants the pay of a single payer healthcare system but what we got ain't working. either. I think other countries have figured out that there's not supposed to be money in healthcare.

 

[ridethecliche]

I really think this is worth reading. The last words from the alleged killer.

https://archive.is/7jUsF

Edit: leaving this up but it might be fake. Can't find a reference anywhere via news.

 

[Sushirolls]

I have had personally, and been paneled with an insurance company that is a not-for-profit, founded by physicians. Easily get real live people on the phone, pays well, comparable premiums, too. But they weren't expanding and taking over the market share, of employers selecting it. Love working with this company when compared to all the others.

UHC routinely gets companies picking it, because they are cheaper for the OOP expense to the employer, so the ills of the total health system aren't entirely just the insurance company but also some with the selection by the employer, and even unions that push for their benefits to be with companies XYZ over ABC.

 

[tr]

No one wants the pay of a single payer healthcare system but what we got ain't working. either. I think other countries have figured out that there's not supposed to be money in healthcare.

We actually pay more for our health care, and get fewer years of life in return, than other developed nations with single payer systems. We just call it "premiums" while they call it "tax".

That said, and while I'm a fervent advocate of single payer/Medicare for All, it wouldn't solve the problem of some treatments just being more than the paying entity can afford. There's unavoidable care rationing in all systems.

Single payer with elimination of profit motive would, however, reduce the bureaucratic overhead and eliminate the nonsensical costs of paying specialists to figure out how to better deny care (aka minimize"medical loss").

 

[calvnandhobbs68]

We actually pay more for our health care, and get fewer years of life in return, than other developed nations with single payer systems. We just call it "premiums" while they call it "tax".

That said, and while I'm a fervent advocate of single payer/Medicare for All, it wouldn't solve the problem of some treatments just being more than the paying entity can afford. There's unavoidable care rationing in all systems.

Single payer with elimination of profit motive would, however, reduce the bureaucratic overhead and eliminate the nonsensical costs of paying specialists to figure out how to better deny care (aka minimize"medical loss").

Absolutely but (and I get the sense you also recognize this) what people don't recognize is that in our private system that's not much of an argument when you have United posting $22 billion in profits last year. The crying poverty argument doesn't really work so well when your profit alone is equivalent to the GDP of a small country.

 

[Stagg737]

We actually pay more for our health care, and get fewer years of life in return, than other developed nations with single payer systems. We just call it "premiums" while they call it "tax".

That said, and while I'm a fervent advocate of single payer/Medicare for All, it wouldn't solve the problem of some treatments just being more than the paying entity can afford. There's unavoidable care rationing in all systems.

Single payer with elimination of profit motive would, however, reduce the bureaucratic overhead and eliminate the nonsensical costs of paying specialists to figure out how to better deny care (aka minimize"medical loss").

There's only 2 true single-payer systems in the world (Canada and Taiwan), so not exactly much of an n for comparison. Single payer and universal are very different things. I'm all for a universal system (which most developed countries have), but single payer in the US would likely be a total disaster.

The bolded sounds like someone who's never worked in a VA...

 

[PsyDr]

....

This man is essentially a CPA who worked his way up to be a very gloried CFO. People have to know he has no role in individual case determinations and really no role in setting specific medical or mental health coverage policy, limits, or direction.

"Thompson also drew attention in 2021 when the insurer, like its competitors, was widely criticized for a plan to start denying payment for what it deemed non-critical visits to hospital emergency rooms."

AHA Expresses Concern with UnitedHealthcare Policy to Allow for Retroactive Denial of Coverage | AHA

The AHA expresses concern to UnitedHealthcare regarding its recent policy announcement to allow for the retroactive denial of coverage for emergency-level care in facilities.

www.aha.org

 

[tr]

There's only 2 true single-payer systems in the world (Canada and Taiwan), so not exactly much of an n for comparison. Single payer and universal are very different things. I'm all for a universal system (which most developed countries have), but single payer in the US would likely be a total disaster.

UK and Australia also have single payer I believe.
I'm not opposed to more complex/tiered systems like Germany etc have but as a practical matter, I think the most straightforward step for the US to get from here to there would be to just expand Medicare.

The bolded sounds like someone who's never worked in a VA...

I did actually work in a VA during my training (not since) and frankly I thought the access to care was incredible compared to what most Americans are dealing with. Although I'm not sure many of the veterans actually appreciated that, they did seem to take it somewhat for granted.
There are plenty of issues with the VA but I don't think they are at all related to (or nearly as bad as) the ones that plague for-profit health insurance. A lot of them are more related to perverse incentives that are specific to other aspects of that system and patient population.

 

[comp1]

The VA provides objectively better and cheaper care than the private sector when both are taken as a whole. You can certainly find outlier hospitals in each (and the VA always makes national news with every miss), but single payer and provider always has been the way to go. I do agree that there are perverse incentives, particularly around disability payments and there's definitional adverse selection. Both of these definitely bring down some VA metrics, but these would not be present in a non-veteran system and the VA STILL outperforms even with these present.

 

[tr]

The VA provides objectively better and cheaper care than the private sector when both are taken as a whole. You can certainly find outlier hospitals in each, but single payer and provider always has been the way to go. I do agree that there are perverse incentives, particularly around disability payments and there's definitional adverse selection. Both of these definitely bring down some VA metrics, but these would not be present in a non-veteran system and the VA STILL outperforms even with these present.

The single payer/single provider system (VA, Kaiser) has a lot of advantages but seems like way too heavy a lift to implement on a nationwide basis given we are starting from our current piecemeal system.
It would require us to retool our entire hospital, clinic, medical education system - everything.
Expanding Medicare (single payer, multiple providers) would be a much more straightforward process in comparison.

 

[comp1]

I agree, Medicare first. Second step is mandating absolute 100% information sharing between EMRs. No EMR should be considered HIPAA compliant if it does not share information with other system's EMRs to the identical extent and manner it shares information locally. Then...we'll start to be in a better position for single provider.

 

[Merovinge]

I agree, Medicare first. Second step is mandating absolute 100% information sharing between EMRs. No EMR should be considered HIPAA compliant if it does not share information with other system's EMRs to the identical extent and manner it shares information locally. Then...we'll start to be in a better position for single provider.

Yes please, I'm sure Epic will block this, but we need to do this so badly. People are absolutely and literally dying due to this problem.

 

[tr]

I agree, Medicare first. Second step is mandating absolute 100% information sharing between EMRs. No EMR should be considered HIPAA compliant if it does not share information with other system's EMRs to the identical extent and manner it shares information locally. Then...we'll start to be in a better position for single provider.

To the above point, this is one of the things that works extremely well in the VA system.
Luddite that I am, I *loved* CPRS.

 

[clozareal]

I have had personally, and been paneled with an insurance company that is a not-for-profit, founded by physicians. Easily get real live people on the phone, pays well, comparable premiums, too. But they weren't expanding and taking over the market share, of employers selecting it. Love working with this company when compared to all the others.

Is this Physicians Mutual?

 

[Stagg737]

UK and Australia also have single payer I believe.
I'm not opposed to more complex/tiered systems like Germany etc have but as a practical matter, I think the most straightforward step for the US to get from here to there would be to just expand Medicare.

I wrote an MBA paper ~10 years ago on Australia's system and they're barely universal. They have universal care for primary care, but most specialists aren't covered and require purchasing supplemental insurance. I used to be a huge advocate for their two-tier system until it almost collapsed several years ago.

UK is much closer but still not truly single payer and varies between then individual countries (ie Englad vs Scotland). For example, in England you have to separately purchase prescription coverage (like Part D in the US) and some prescriptions aren't covered even when available. NHS also requires private insurance for coverage of dental, vision, etc.

Canada as a single payer system is actually somewhat debatable too, as they defer a lot of their processes to the provincial level and quality of system varies significantly between provinces. One of my co-residents on my IM rotation was Canadian and asked me about ECT in the US as her dad was admitted for catatonic depression. He'd been inpatient psych for 3 months at that point and was still waiting just for approval despite them having it readily available.

I'm all for Medicare expansion if they could do it right.

 

[splik]

UK is much closer but still not truly single payer and varies between then individual countries (ie Englad vs Scotland). For example, in England you have to separately purchase prescription coverage (like Part D in the US) and some prescriptions aren't covered even when available. NHS also requires private insurance for coverage of dental, vision, etc.

This is false. There is no "prescription coverage" purchase. Most people don't pay anything for prescriptions in the UK but if they do, there is a nominal fee for prescriptions (under 10 pounds) and you can pre-pay for a very reasonable price if you have a lot of prescriptions (this is just in England - prescriptions are free elsewhere in the UK for everyone). Under 18s and over 60 never pay. It is not anything like Part D medicare. You are correct that the NHS no longer covers most dental or vision services for adults but it is rare for people to have private insurance for dental and vision. The cost of an eye exam is about 30 pounds at most.

 

[Stagg737]

I did actually work in a VA during my training (not since) and frankly I thought the access to care was incredible compared to what most Americans are dealing with. Although I'm not sure many of the veterans actually appreciated that, they did seem to take it somewhat for granted.
There are plenty of issues with the VA but I don't think they are at all related to (or nearly as bad as) the ones that plague for-profit health insurance. A lot of them are more related to perverse incentives that are specific to other aspects of that system and patient population.

Access is variable within the system. Some resources are fantastic, other basic ones are shockingly bad. The major metro I was at had zero sleep specialists and maybe 2 urologists between 2 hospitals and probably 10 CBOCs. Endocrine was excessively available though to the point we could get same week and sometimes day after discharge appointments.

My biggest critique of letting the VA run everything is that a lot of VAs are very dependent on referring patients out to community docs. I actually did this quite a bit for pain patients as that was another huge area lacking at my VA and community docs could get people in a lot quicker (3-4 weeks vs 3-4 months). Also, as much as I hate to say it a good number of the docs I worked with there were terrible. They went there once they were burnt out to collect benefits or for surgeons because no one else would hire them. Not really where I'd want to get care.

The VA provides objectively better and cheaper care than the private sector when both are taken as a whole. You can certainly find outlier hospitals in each (and the VA always makes national news with every miss), but single payer and provider always has been the way to go. I do agree that there are perverse incentives, particularly around disability payments and there's definitional adverse selection. Both of these definitely bring down some VA metrics, but these would not be present in a non-veteran system and the VA STILL outperforms even with these present.

Sorry, but the "objectively better" part is highly suspect to me. I rotated through a 5-star rated VA for 1 rotation where I literally would not allow a dying rat to be treated. Some of the horror stories I have are beyond unacceptable (patient on tele having an active STEMI for 6 hours and nurses/night doc just silenced the alarms, for example), yet that hospital has gotten multiple awards and recognition. So I don't buy their metrics.

The single payer/single provider system (VA, Kaiser) has a lot of advantages but seems like way too heavy a lift to implement on a nationwide basis given we are starting from our current piecemeal system.
It would require us to retool our entire hospital, clinic, medical education system - everything.
Expanding Medicare (single payer, multiple providers) would be a much more straightforward process in comparison.

This is the big issue and even creating a tiered Medicare-for-all system would be difficult. I would guess that doing so would tank reimbursements closer to Medicaid level and lead to many docs opting out if they could. Would just bring up a similar problem to what we see with insurance that coverage =/= care.

I agree, Medicare first. Second step is mandating absolute 100% information sharing between EMRs. No EMR should be considered HIPAA compliant if it does not share information with other system's EMRs to the identical extent and manner it shares information locally. Then...we'll start to be in a better position for single provider.

I'd actually flip those. I think a unified EMR would be the single most beneficial and impactful thing that would immediately improve American healthcare. As slow and clunky as CPRS is, there's absolutely something to be said for a 20+ year old system that's still functioning and honestly better than some other major EMRs out there. I know how unrealistic this wish is though given the joke that Cerner/Oracle has been with their VA contract.

 

[Stagg737]

This is false. There is no "prescription coverage" purchase. Most people don't pay anything for prescriptions in the UK but if they do, there is a nominal fee for prescriptions (under 10 pounds) and you can pre-pay for a very reasonable price if you have a lot of prescriptions (this is just in England - prescriptions are free elsewhere in the UK for everyone). Under 18s and over 60 never pay. It is not anything like Part D medicare. You are correct that the NHS no longer covers most dental or vision services for adults but it is rare for people to have private insurance for dental and vision. The cost of an eye exam is about 30 pounds at most.

There absolutely is:

NHS Prescription Prepayment Certificate (PPC) | NHSBSA

A PPC could save you money if you pay for your NHS prescriptions. The certificate covers all your NHS prescriptions for a set price. You will save money if you need more than 3 items in 3 months, or 11 items in 12 months. The prescription charge in England is £9.90. A PPC costs:

www.nhsbsa.nhs.uk

I think you're arguing semantics over my point that you have to pay for PPC separate to obtain certain services including many prescriptions. You're correct that these are still typically far cheaper than in the US though.

That said, how much would this cost in the US? Brits pay on average around 8% of their total income in taxes just for healthcare system. Would the US be able to create similar treatment and care for that cost or would it be more? Idk, but worth pondering how much we'd be willing to pay in taxes to create that system.

 

[Sushirolls]

After Covid and how things were handled, a massive chunk of the country has no interest in further expansion of government into health care. Those abuses, those sins won't be forgotten.

Things are crumbling around us.
People don't even want allopathy.
ARNPs are rising. DCs too. NDs thrice.
Anti vaxers are now equally left leaning and right leaning politically.
Woke scat in medicine, too, is turning a lot of people off and lowering the level of trust they have in their doctors.
Things are only going to get worse.
The entropic pull to shamanism is strong, and that's the future of medicine the way things are going.

 

[comp1]

See this really grates on me when people talk about their own personal bad experience at one VA (often in training). I'm talking about the VA as a whole. There are bad hospitals EVERYWHERE. Horrible non-VA hospitals just don't make the national news or stick in people's heads because they aren't a monolithic federal entity. When you look at the VA as a whole, it's just simply better than the private sector. I mean here's just one random study on COVID. This is kind of stuff I'm talking about:

Comparison of the Impact of COVID-19 on Veterans Affairs and Non-federal Hospitals: a Survey of Infection Prevention Specialists - PubMed

In our survey-based national study, lead infection preventionists noted several distinct advantages in VA versus non-federal hospitals in their ability to expand bed capacity, retain staff, mitigate supply shortages, and avoid financial hardship. While these benefits appear to be inherent to the...

pubmed.ncbi.nlm.nih.gov

 

[Stagg737]

See this really grates on me when people talk about their own personal bad experience at one VA (often in training). I'm talking about the VA as a whole. There are bad hospitals EVERYWHERE. Horrible non-VA hospitals just don't make the national news because they aren't a federal entity. When you look at the VA as a whole, it's just simply better than the private sector. I mean here's just one random study on COVID. This is kind of stuff I'm talking about:

Comparison of the Impact of COVID-19 on Veterans Affairs and Non-federal Hospitals: a Survey of Infection Prevention Specialists - PubMed

In our survey-based national study, lead infection preventionists noted several distinct advantages in VA versus non-federal hospitals in their ability to expand bed capacity, retain staff, mitigate supply shortages, and avoid financial hardship. While these benefits appear to be inherent to the...

pubmed.ncbi.nlm.nih.gov

I won't detract a ton, but we've had this discussion before. I've been through 6 different VAs/CBOCs in multiple states (3-4). I'm familiar with multiple VISNs and the system. Yes there is a ton a variation, obviously, but there are plenty of problems with are an issue across many VAs (the need for community referrals, burnt out staff, etc). There's plenty of great VAs too. My points are the same as they've always been, and I think the issues would only be worse if the system had to expand to cover the full populace.

ETA: I'm not claiming to be some kind of expert on the VA, but I have more exposure than just one location during training and have a bit more experience with "the VA as a whole" than a lot of docs.

 

[smalltownpsych]

After Covid and how things were handled, a massive chunk of the country has no interest in further expansion of government into health care. Those abuses, those sins won't be forgotten.

Things are crumbling around us.
People don't even want allopathy.
ARNPs are rising. DCs too. NDs thrice.
Anti vaxers are now equally left leaning and right leaning politically.
Woke scat in medicine, too, is turning a lot of people off and lowering the level of trust they have in their doctors.
Things are only going to get worse.
The entropic pull to shamanism is strong, and that's the future of medicine the way things are going.

Despite this post being hyperbolic, it is probably still closer to reality than the more reasonable sounding thought that expansion of federal government into healthcare would be an improvement.
Then again, I have always said that the only thing worse than a totally government run system is a private system in cahoots with the government which is about what we have now where large insurers and the federal government work together to “improve” things.

 

[Sushirolls]

No my post was not hyperbole, with the exception of shamanism, but even that is half truth / half hyperbole.

 

[Merovinge]

There absolutely is:

NHS Prescription Prepayment Certificate (PPC) | NHSBSA

A PPC could save you money if you pay for your NHS prescriptions. The certificate covers all your NHS prescriptions for a set price. You will save money if you need more than 3 items in 3 months, or 11 items in 12 months. The prescription charge in England is £9.90. A PPC costs:

www.nhsbsa.nhs.uk

I think you're arguing semantics over my point that you have to pay for PPC separate to obtain certain services including many prescriptions. You're correct that these are still typically far cheaper than in the US though.

That said, how much would this cost in the US? Brits pay on average around 8% of their total income in taxes just for healthcare system. Would the US be able to create similar treatment and care for that cost or would it be more? Idk, but worth pondering how much we'd be willing to pay in taxes to create that system.

Oh come on, that's $140 bucks a year if you are a high utilizer to reduce your costs. You don't need to purchase it and most people who aren't taking a ton of meds don't require anything for Rx coverage in England.

My company +myself pays $20k a year for a medium quality healthcare plan for 2 adults and 1 child. Yes that is less than 8% of my salary as a doctor but it's WAY more than 8% of the median household. That's not even counting the medicare tax already taken out of my pay...

 

[Stagg737]

Oh come on, that's $140 bucks a year if you are a high utilizer to reduce your costs. You don't need to purchase it and most people who aren't taking a ton of meds don't require anything for Rx coverage in England.

My company +myself pays $20k a year for a medium quality healthcare plan for 2 adults and 1 child. Yes that is less than 8% of my salary as a doctor but it's WAY more than 8% of the median household. That's not even counting the medicare tax already taken out of my pay...

You’re missing the point. I’m not saying it isn’t a cheaper option for patients, I’m just saying it’s not a single payer as pharmacies are privately owned and paying for meds is based on their pricing or contracting with the gov separately to reduce costs (ie PPCS).

 

[calvnandhobbs68]

UK is much closer but still not truly single payer and varies between then individual countries (ie Englad vs Scotland). For example, in England you have to separately purchase prescription coverage (like Part D in the US) and some prescriptions aren't covered even when available. NHS also requires private insurance for coverage of dental, vision, etc.

Canada as a single payer system is actually somewhat debatable too, as they defer a lot of their processes to the provincial level and quality of system varies significantly between provinces. One of my co-residents on my IM rotation was Canadian and asked me about ECT in the US as her dad was admitted for catatonic depression. He'd been inpatient psych for 3 months at that point and was still waiting just for approval despite them having it readily available.

You’re missing the point. I’m not saying it isn’t a cheaper option for patients, I’m just saying it’s not a single payer as pharmacies are privately owned and paying for meds is based on their pricing or contracting with the gov separately to reduce costs (ie PPCS).

Are you basing what you consider to be "single payer" partially on if there's free prescription drugs though? Because then Canada's even less so...

Skipping doses and delaying filling: For many, prescription medications come at a cost - Statistics Canada

For many Canadians, prescription medications are essential in the management of many health issues and chronic conditions. In 2021, over two-thirds (67%) of Canadians reported taking or being prescribed medication in the last 12 months.

www.statcan.gc.ca

"Unlike every other developed country with universal health care, Canada does not have universal coverage of prescription medication (i.e., universal pharmacare)."

UK seems much more "single payer"-ish with a known flat fee for all meds and what you're referring to above is basically a discount program for this. How is "paying for meds" based on the pharmacy pricing? You just pay a flat 9.9 pounds per prescription item or 114 per year pre-pay for unlimited prescriptions. It isn't based on drug costs whatsoever.

 

[bGMx]

Might be a fantasy of mine, or perhaps not, but how much of the United States' expensive healthcare is insurance subsidizing "big pharma" to invest in R&D so that new pharmaceuticals can be developed, benefiting the rest of the world by proximity? How many new pharmaceuticals are developed, tested, and to be sold for the US market vs the rest of the world? If private insurance is a necessary evil for R&D, that seems better than the traditional method (war).

 

[allantois]

Might be a fantasy of mine, or perhaps not, but how much of the United States' expensive healthcare is insurance subsidizing "big pharma" to invest in R&D so that new pharmaceuticals can be developed, benefiting the rest of the world by proximity? How many new pharmaceuticals are developed, tested, and to be sold for the US market vs the rest of the world? If private insurance is a necessary evil for R&D, that seems better than the traditional method (war).

I am certain the insurance industry does not care about subsiding RD of new drugs

 

[smalltownpsych]

I am certain the insurance industry does not care about subsiding RD of new drugs

Of course they don’t “care” about it. They are motivated by profit. Doesn’t mean that it is not how it works. This whole concept of care is an interesting one and how it gets thrust into the debate so much. Some people are very caring and altruistic and some people are greedy slimy bastards and most of us are somewhere between the extremes. Systems are a different story altogether and I have seen some very toxic systems made up of caring people.