#healthcare in the usa

[kittypatch]

This is a must listen. It really addresses the failings and how doctors feel about it and how the brave are fighting back.

[macgyvermedical]

How to Go to the Doctor: Accessing Primary Care in the USA as a Regular Human Person

Strap yourselves in for a thrill folks, cause tonight we're gonna be discussing why you should have a doctor and how to get one- preferably before you get sick and have to experience a neigh-vertical learning curve in the lobby of an emergency department.

Step 1: Paying for Your Care:

Like most bass-akward nations, the first thing we have to establish in the US is how you're paying for this healthcare. What method of payment you have access to determines where you can go for care and how much you will end up paying for it.

You have a couple of options:

Self Pay: You pay for the services you need out of pocket. Risky, because you'll never really know what you're going to need to pay until the bill arrives (and healthcare out of pocket is expensive af. Services can range from $100-300 for a basic doctor's visit to $100,000+ for surgeries/hospital stays- and let's face it, most of us don't have that kind of scratch). You're also likely not getting the preventative care you need, like vaccines and cancer screenings, so the likelihood of getting life-threateningly (or otherwise completely bankrupting-ly) sick is higher for those who forego or are unable to access other healthcare plans.

Medicaid: Low income individuals without an option to purchase insurance through an employer can apply for state-sponsored health insurance. This is a healthcare package that includes basic medical services for free. There is usually no monthly fee for this to the individual, though income requirements, coverage, and application process vary wildly between states.

Marketplace Insurance: If you make too much money to qualify for Medicaid but you still can't purchase insurance through your employer, you can buy a health insurance plan online. Many insurance companies have one or more "Marketplace" plans (think of a "plan" as a package of services available to you for a monthly fee (called a "premium"). Note that these services often still cost money until you reach a certain amount paid, but the "plan" allows you access to them at a set price, making it more predictable). The monthly premium is essentially income-based (but it's tied into your taxes to make it nice and complicated).

Employer/Private Insurance: Many companies offer a health insurance plan as a benefit to full time (and occasionally part time) employees. In this arrangement, the employer pays part of a monthly premium and the employee pays the rest. Otherwise, they function similarly to the Marketplace plans where you get a package of "covered" services. These plans tend to be better than similarly-priced Marketplace plans and often provide more freedom than Medicaid.

Medicare: Free or low-cost health insurance available to those over age 65.

Veterans Administration: A nation-wide healthcare system provided for free/limited cost to veterans who have served in specific roles in the US Military.

Indian Health Service: A healthcare system that provides free/limited cost healthcare to Native Americans, available in certain areas of the country.

Step 2: What Is Primary Care?

Assuming the US Healthcare System is functioning as written (which it rarely does but hear me out...), most people should get the majority of their healthcare at a primary care office.

Primary care includes both the specialties of Family Medicine (care throughout the lifespan, often including pre- and post-natal care), Pediatric Primary Care (children's healthcare), and Internal Medicine (generally adult patients only). It can be provided by doctors, physician assistants, and nurse practitioners.

Primary Care offices provide vaccines, screenings, woman's health, chronic disease management, basic mental health care, basic procedures (birth control/IUD insertion, joint injections, skin biopsies, etc...) osteopathic manipulation, wound care, care for basic acute illnesses and injuries, a limited number of lab tests, and more depending on the office.

Other options for care that are NOT Primary Care include Emergency Departments (for things that are life threatening) and Urgent Care Clinics (for things that you would normally go to a primary care doctor about, but it is after hours, on weekends, you know you'll need something like an x-ray that a primary care doc can't do in their office, or you just don't have a primary care doctor yet but need seen for something).

If a patient goes to an emergency department or is admitted to the hospital, they will often have to schedule a follow up for that event with their primary care doc to continue treating them for the problem.

Step 3: How Do I Get A Primary Care Doctor?

Call your insurance company/Medicaid plan manager and ask which providers* your plan covers in your area

Call the providers and ask if they are taking new patients

If a provider is accepting new patients, make a new patient appointment- note that this appointment may be weeks or months away. If you are having a medical problem that you feel can't wait, see if you can be seen sooner for a specific problem and then come back to get established later.

Gather your insurance card, your ID, and your medical history if you have it on paper or other physical media. If your insurance requires a "co-pay" (a fee you pay per visit to the doctors office) you'll also need to bring that (you'll pay it at the office. If you're not sure if you have a co-pay, contact your insurance or the office itself and they should be able to tell you).

Go to the new patient appointment and bring your documents- here you will get established by relaying your medical history, current health problems, and current medications to the doc. Expect lots of questions and health screenings. You'll also get a physical exam, have your vitals checks, and may get orders for screening tests and refills on medications if you are already taking them.

If you have specific problems, one or two may be addressed at this appointment, but most of the time it is just a "get to know you" for you and the doc.

If any tests were ordered, usually you'll make a follow up appointment on the way out of the office.

Get any tests done that couldn't be done in the office and go to the follow up appointment (if applicable) where the test results are explained and the next actions for your health planned.

Congrats! You have a Primary Care Doctor!

*You might also have the option to choose to go to a residency clinic. A "residency" is a 3-7 year training period after medical school where a new doctor (called a Resident) is supervised by a more senior doc who has completed residency (called an Attending) while getting experience in a variety of patient populations. Instead of seeing the same doctor every time, you'll often see multiple different residents depending on who is available first.

Step 4: Why Did I Just Do All That?

Okay so like, you have a primary care doctor, you went to that first visit, and now you'd like to know what all the fuss is about.

Well, now that you're established, the nice thing is that you won't have to wait so long for an appointment! If you get sick or injured, call the office and you should be able to be seen in the next day or two depending on availability. Some offices have same day appointments. This is much, much less expensive and more enjoyable than sitting in an emergency department for hours for something that didn't require the resources of an emergency department.

The office also tracks vaccines, screenings, and preventative healthcare so you don't have to keep track of it yourself. Many offices today also have a website or smartphone application where you can access your health records and even text message your provider with questions.

If you have a chronic health condition, require education on a health condition you have, or need help getting assistance in other ways (such as social services, home medical equipment, transportation to medical appointments, etc...) there are often social workers or care managers in larger offices that can help!

[sinecure-dreams]

Apparently I'm too old to be diagnosed with ADD. My insurance won't pay for Ritalin because I am over 18 and this is the first time in taking it. What kind of BS is that? Now I get to spend $250 on a medication I don't even know will help.

[zukapony]

It is now the next morning post-surgery.

Yesterday, the doctor removed a grand total of 8 stones from my right kidney and it’s associated tubes and such, including one large enough that he was unsure how i’ve been able to even walk, much less not been in pain outside of random flare-ups.  And, aside from the expected recovery and side effects, I’m currently doing fine.

But running through my head through all of this has been the fact that I can afford this.  Not just the cost of the surgery itself ($100 + 20% of the total cost, actual dollar amount unknown at this time), but also the fact that I had to be off work yesterday for the surgery, and will be off Sunday at least to recover.  I am hoping to be able to go back to work on Monday, but a lot will depend on how I’m feeling.

I don’t have sick days at work.  I don’t get paid if I don’t work. 

I can afford it.  But there are people out there who can’t and I can’t stop thinking about them.  No one, NO ONE, should have to go through pain or illness or whatever without the option to get treatment.

No

One.

[hellonheelys]

Personally I don't believe healthcare is a right because you don't have the right to a doctor's time without being able to pay. Free healthcare forces others to pay for your health and you don't have a right to that either. However voluntary donations of time and resources are what we as a developed country can offer those who are poor and sick. Teaching hospitals also usually have programs that provide free or reduced price healthcare. There are options that don't force people to do things

Good points, anon. I don’t think we’re ~entitled~ to health care. You pay for what you get when you live in a capitalist country. That’s just how it works. I wish there were more people out there who could afford to volunteer with free clinics, but I also understand that loss of time equals loss of money for doctors who also have their own practices and businesses.

Here’s the kicker, to me: when you’re covered by the existing insurance model (even on a basic plan) and they continue to gouge you for money just because they can, that’s not right. I personally think a lot of blame lies in the choke hold insurance companies have on people who aren’t wealthy and have to go to a doctor often. They know they can drive the prices for co-pays and medication up without complaint, and they have Big Pharma behind them paving the way. Everyone profits, everyone closes ranks when one is threatened.

If we stopped relying on tax-protected bureaucrats who have no idea what it’s like to be poor and unable to afford a doctor’s visit to tell us what medical coverage will and won’t pay for, the system would better cater to the needs of the people who really need it.

[kittypatch]

[zukapony]

The intersection of healthcare and marriage equality

Finally, finally, FINALLY, I have a cause for the intermittent pain I’ve been having!  It’s been going on for over two years, and every so often I get excruciating, debilitating pain in my right side, in the vicinity of my kidney.  Roughly a year and a half ago I went to my family doctor with this complaint, and she essentially brushed it off as being muscular and/or related to my SI joint, even though I told her the pain was higher up and not around the SI joint.  She pretty much ignored what I said, and claimed that she was right because, and I quote - “Well, you are a little chubby, so it can be hard to tell.”

>.<

I didn’t really pursue anything after that because I had really crappy health insurance, and since the pain was only occasionally, and rarely lasted more than 8 hours or so, I lived with it.

Fast forward to October 6th, 2014.  The Supreme Court refused to hear appeals of the 4th Circuit Court’s decision on marriage equality, upholding that lower court’s decision.  Thus, gay marriage becomes legal in Virginia where I live (and elsewhere covered by the 4th Circuit).  My girlfriend of 12 years and I start making plans.  Yes, because we do want to get married, but also because being married would allow me to go on her (much better) health insurance.

We married in January of this year, though had to wait for her insurance open enrollment in June.  Once that was done though, I began pursuing the source of my pain. 

An appointment with a GI specialist set me up for a colonoscapy, which turned out to be unnecessary, though I’m of the opinion it’s better safe than sorry.  However, the urinalysis the doctor ordered ahead of time showed traces of blood, and that led down a path with first my (new, better) general practitioner, and then to a Urologist who finally said what I’d suspected the whole time - I probably had a kidney stone of some sort.  CT scans were done and yes, I apparently have a 7mm stone kicking around in my right kidney that every so often decides to punch me from the inside.

I got a call from that office today, and I have an appointment on friday to discuss options for removal of the stone, and hopefully that will rid me of this pain.  

But if I’d not been able to get married, and not then been able to get on my wife’s health insurance, there is literally no way I would have been able to pay for the various specialist visits and tests I’ve needed to have. 

And it’s just made me more furious that health care and health insurance in this country is so damned broken.  I know there have to be people out there with issues similar to mine who can’t get medical care, or who’s problems are brushed off as being weight related or whatever.  And it makes me sad.  And angry.

And that, if nothing else, is why I make sure to vote, every election.  To do what little I can to get people into the positions of power to try to fix this.