Is medical care harder to get in the US?

Overall, it may not be 'harder' in the US, but it's such a hodge-podge that it borders on insanity. No one would have designed it this way unless they were either psychopaths or schizophrenics. So much seems to depend on what state one lives in, and which centers are nearby.

I feel for the GP's. They are the expected gatekeepers of the whole mess, and there is no way they can do a good job with the mandated 15 minute office visits. Solutions? Well, we'd have to agree on which problem to fix first. Challenge is, that the whole rickety structure depends on every single piece being in place. Like a giant Jenga pile. Pull out one block, and the whole thing tumbles down.

Mel:
Good question. I'm not sure, but it may be that the docs they list as "in-network" have to take the BC/BS insurance. And maybe the plan will gladly pay out-of-network docs, but those docs may not be obligated to take me as a patient for the BC/BS payment. Just a guess.

Two years ago this BC/BS plan had higher co-pays for out of network, but as of last year they changed to the same co-pays for either in or out of network.

I review available plans in my area every year and most of them are either HMO plans or plans have none of my or my wife's doctors listed. When my ex-wife retired a few years ago she signed up for one of the alleged "free" Medicare Advantage plans that had no monthly premium. She soon found that she had to find new doctors -- and none of them were at the U Mass Medical Center affiliated hospitals. She also found she was being hammered with bills due to a high deductible and high co-pays. The next year she switched to a plan more like the one I and my current wife (I better not let her catch me calling her that) are on.

Also I switched two years ago from the "Premium" to the "Value" BC/BS plan because other than slightly higher co-pays both had similar coverage (and yes, both now have a $4,900 max out of pocket), and in some categories the Value plan actually has better coverage. Go figure. All I know is I have to comb through the details every year when open enrollment comes around to find what the right hand giveth while the left hand taketh away.

Jim

Medicare C plans always have networks as it is an entirely private coverage. For those that choose regular Medicare A,B,D and a supplement the only requirement for the supplement is that the provider(s) take Medicare. In Georgia, the choices for C were not attractive to me so I went the supplement route and chose the G plan. Essentially plan F, but I pay the B deductible of $166.00 and save some $400.00 a year in premium compared to F. I am in my first year and will see how it goes.

halbert said...
Harder than where? As others have pointed out, getting top notch specialized care for serious conditions isn't all that difficult, particularly if relatively short waits (a few weeks) are acceptable. The issue is access to primary care. There aren't enough PCP's for the population, and particularly in urban areas, the ER's are severely overcrowded.

In other countries, it's flipped. Access to specialized care is the bottleneck. Unless you're in the third world, where there is only care for the plutocrats.

Actually, in Thailand, they have a universal health care system that costs 30 Baht per visit (less than one dollar), regardless of whether you are there for heart surgery, or the flu. And if you don't want to bother going to the hospital, it seems like every neighborhood has got a little clinic, which is walk-in, about 30 minutes wait time to see the doctor. The charge is only a few dollars, plus medication, if any, and the drugs are very cheap there.

Here, when I went to the ER for kidney stones in September, the wait was less than 5 minutes. At the HMO-run hospital nearby, where I was a member for decades, the ER wait was never less than several hours, unless it was 3 or 4 AM. The ER there is always full of Mexican ladies with kids.

The bill for my ER visit was aprox $17K. I was there for 3 hours. The first hour they did nothing, in spite of the fact I was in tears, begging for pain meds. Medicare paid them $984 out of the $17K, and the supplemental carrier paid $254. So the hospital billed $17K, and got paid only $1238. It's no wonder that a lot of doctors don't accept Medicare.

At the moment, my back is killing me, after a hard day's work today. I haven't been to the chiropractor since August, 'cause Medicare stiffed him for the last 3 visits I made to him. He got $0. Plus, Medicare says I don't owe him anything, since they didn't approve his billing. Furthermore, Medicare states that if I pay him out of my own pocket, they will never pay him anything for future visits. On top of which, they will not give a reason why they didn't pay him ( they had paid previously). BTW, my "Medicare & You 2016" guidebook says chiropractor visits are covered. Dealing with the govt on the phone is really hard, as they will not tell you anything, just talking in circles, while being careful not to say anything relevant, they simply refuse to answer pointed questions. I don't know what to do. Guess I am just going to have to dig into my pocket, but it just doesn't seem right, when their official rule book say they are supposed to pay for it, and I have worked a lifetime for Medicare coverage, which is not free, and I continue to pay the payroll taxes for it.

An aside....we've managed to have this conversation without veering into significant political argument. Good for us.

There is no doubt the system is broken. Problem is, there are so freaking many moving parts, that fixing it in one area will almost automatically break it worse somewhere else.

Halbert,

You have put your finger on the problem, ".... so freaking many moving parts", each with their own rules and bureaucracy to support. Medicare differs from Medicaid, differs from Obamacare, differs from state programs differs from the multitude of private insurance policies (which have different policies for every state and/or company), each doctors office/hospital has different rates for the same procedure, etc. etc.

With the number of middle men in our system is it any wonder that US medical costs are the largest in the world? ( .... granted, there also are other reasons for our high costs).

You would lose your job if you presented our "system" to your boss/client and said it was the best you could come up with.

Post Edited (RCS) : 2/9/2016 11:25:21 AM (GMT-7)

My thought for what it is worth is that as long as the protection of one's turf is the primary goal and not what is best for all, nothing will really change in healthcare in the United States.

Look at Obamacare, for example. Lots of opposition even though the pre-existing coverage is important to many. I know that for a fact as I had heart bypass surgery in 2009 and that gave me an uninsurable for future coverage rating by insurance companies. Two months later a follow-up on a high PSA reading led to a prostate cancer diagnosis. A month after I got the cancer diagnosis, the company I worked for for around 37 years was closed up by the investment outfit that bought out the company. I was out of a job at age 62 1/2 during a deep economic recession, declared uninsurable by insurance companies, and needing treatment for cancer. You can be sure that no insurance company offered me anything at all in the way of insurance coverage at that time. COBRA was my only option and I used it for my cancer treatment. Don't forget that this was before Obamacare became law.

As long as protecting one's turf and the money it brings in is job number one, things will not change.