Author Topic: UK's healthcare top of league table out of 11 western countries. US = last  (Read 4691 times)

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Offline Jack

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Not sure I understand your question. Haven't ever known anyone receiving regular psychotherapy, so this is more curiosity than anything. Are people on disability benefits afforded therapy every week?
Whether or not they are on disability benefits, as odeon said, it's determined by the health professionals how often they need to be seen.  Weekly or every other week is pretty standard for talk therapy.
Was asking if people who are on disability are provided by the government with more visits for psychiatric care than people with insurance limits of once per month.

Offline Jack

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Have known people with overwhelming medical bills, and they filed medical bankruptcy without having to forfeit any personal assets. From my understanding that's not uncommon practice to get medical bills off people's back, and part of the reason for the high general cost of care. Also lost a family member to cancer a couple of years ago and their medications were obtained by the doctors directly from the pharma company at no cost.

Interesting... I didn't know either of these things were possible.

To get into the disability system, as far as I know, you have to have a doctor certify that you are permanently and totally disabled. I think the key word there is permamently - with cancer treatments you can have cases where the person is unable to work for a year or so, or whatever the length of the treatment, and then they go into remission and become recovered enough to work again.
Was responding specifically to your comments, which were specific to complex cancer treatments and organ donation. Those people generally do qualify; read kidney patients are pretty much automatic. Also ended up on the site of an institution which actually performs transplants. Of course they want to get paid, so their staffed financial advisors and social workers jump through all the hoops for their patients in order to get them as much coverage as they can.

Offline Jack

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The title of this graph should be, Here's some nonsensical crap someone pulled out of their butt because they really want to say the UK is the best and the US is the worst. Please don't do the math. Exhibit ES-1

I almost can't be bothered. The shit for brains OP is incapable of responding to the completely justified refutation of his nonsense. He does this time and time again. He is either stupid, a troll or I've heard he is now in politics, which explains a lot.
Adam has always been provocative. It's not often am inspired to talk this much. You should thank him. :laugh:

Offline El

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Not sure I understand your question. Haven't ever known anyone receiving regular psychotherapy, so this is more curiosity than anything. Are people on disability benefits afforded therapy every week?
Whether or not they are on disability benefits, as odeon said, it's determined by the health professionals how often they need to be seen.  Weekly or every other week is pretty standard for talk therapy.
Was asking if people who are on disability are provided by the government with more visits for psychiatric care than people with insurance limits of once per month.
Not everyone who is on disability has the same insurance.
it is well known that PMS Elle is evil.
I think you'd fit in a 12" or at least a 16" firework mortar
You win this thread because that's most unsettling to even think about.

Offline Jack

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Not everyone who is on disability has the same insurance.
Yes they do. Starting to wish Jessie or Duke were here so could ask them. This question was asked in curiosity within the context of comparing how the government provides to patients as apposed to health insurance companies, which the topic of psychiatric care was also introduced. People on disability have Medicare.
« Last Edit: June 23, 2014, 07:36:31 PM by Jack »

Offline El

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Not everyone who is on disability has the same insurance.
Yes they do. Starting to wish Jessie or Duke were here so could ask them. This question was asked in curiosity within the context of comparing how the government provides to patients as apposed to health insurance companies, which the topic of psychiatric care was also introduced. People on disability have Medicare.
No, Jack, they don't all have the same insurance.  Medicare isn't always a stand-alone insurance, and not everyone who is on disability winds up with it- whether or not that's what's "supposed" to happen.  I know- a lot of my clients are on disability.  I'm not just BS'ing.

Most who are on disability long-term (social security, not the temporary disability you get through the DTA) ultimately get what we call M&M- medicare/medicaid.  At least in the state that I live, there are different forms of medicaid (what we call "masshealth"- the state's version of medicaid).  So, for example, we have MBHP, Beacon, and Commonwealth Care, all of which are under the broad umbrella of masshealth (though MBHP is also known as "masshealth standard.")  I can think of one of my clients off the top of my head who has Beacon, rather than M&M, despite having been on disability pretty much his whole life (I remember largely because he's had issues with his insurance a few times, and I'm not sure anyone, including him, knows why the heck he has beacon in the first place- but he does have it).

At least, that's how it's been.  I've picked up on some of the changes this year- it seems like a lot of people explicitly have to get masshealth through MCOs (if not everyone)- but it's kind of convoluted and I haven't researched it extensively because I haven't had to.  Dunno how that will effect clients with disability, including the ones with M&M.
« Last Edit: June 24, 2014, 07:16:07 PM by PMS Elle »
it is well known that PMS Elle is evil.
I think you'd fit in a 12" or at least a 16" firework mortar
You win this thread because that's most unsettling to even think about.

Offline El

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Additional comment:  "Disability" is also not all one thing; even if you eliminate temporary disability, SSI and SSDI can each refer to disability.  On further research, SSDI qualifies you for medicare, but SSI likely qualifies you for medicaid.  As most of the clients who my company serves are poor, they'd end up with medicare/medicaid.

https://www.disability.gov/what-is-the-difference-between-social-security-disability-insurance-and-supplemental-security-income/
it is well known that PMS Elle is evil.
I think you'd fit in a 12" or at least a 16" firework mortar
You win this thread because that's most unsettling to even think about.

Offline Jack

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Thanks, Elle. It's easy to gripe about what insurance covers and assume the government can/will/does/or even will do any better, but think it makes sense to understand if that's even true. Medicaid isn't disability insurance; it's state funded social welfare insurance for the poor and controlled under guidelines of the federal government, though do understand some people may have both if both, and social welfare programs can vary from state to state. Though okay fair enough, it can be different, and let's include poor people on state assisted programs. Do government/state welfare assisted programs provide more financial coverage than typical health insurance limitations of once per month? Even sometimes? Even considering someone with the best government/state coverage combined? Was reading trying to find an answer myself, though was only specifically looking at federal disability Medicare and not state funded programs. Had no clue it was so bad. Current legislation has made a lot of improvements, and though it clearly stated there are limitations on federal health care for mental care; can't seem to find it stated anywhere what those limitations are. Up until this year, mental health care for the disabled was probably the most grossly underfunded area of federal assistance, covering as low as 40% of costs and no coverage of pharmaceuticals until laws were changed in 2008, requiring annual increases beginning in 2010 until reaching 80% coverage in 2014; though inpatient care is still scarce and meds are very picky. Read that the new legislation is so important because the majority of mental health professionals wont even accept patients with Medicare. So going to stick to my guns of the government needing to fix their own healthcare problems first for the elderly, poor, and disabled. Though your input into this conversation makes me want to know if people with federal coverage, or even state coverage, are provided coverage for more services than someone else with a typical health insurance policy.

Offline Jack

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Additional comment:  "Disability" is also not all one thing; even if you eliminate temporary disability, SSI and SSDI can each refer to disability.  On further research, SSDI qualifies you for medicare, but SSI likely qualifies you for medicaid.  As most of the clients who my company serves are poor, they'd end up with medicare/medicaid.

https://www.disability.gov/what-is-the-difference-between-social-security-disability-insurance-and-supplemental-security-income/

I already know what these things are, and understand the difference between federal disability insurance and state welfare health coverage. What I don't know is if they'll pay you to see your clients once per week if that's what you say they need.

Offline El

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Thanks, Elle. It's easy to gripe about what insurance covers and assume the government can/will/does/or even will do any better, but think it makes sense to understand if that's even true. Medicaid isn't disability insurance; it's state funded social welfare insurance for the poor and controlled under guidelines of the federal government, though do understand some people may have both if both, and social welfare programs can vary from state to state. Though okay fair enough, it can be different, and let's include poor people on state assisted programs. Do government/state welfare assisted programs provide more financial coverage than typical health insurance limitations of once per month? Even sometimes? Even considering someone with the best government/state coverage combined? Was reading trying to find an answer myself, though was only specifically looking at federal disability Medicare and not state funded programs. Had no clue it was so bad. Current legislation has made a lot of improvements, and though it clearly stated there are limitations on federal health care for mental care; can't seem to find it stated anywhere what those limitations are. Up until this year, mental health care for the disabled was probably the most grossly underfunded area of federal assistance, covering as low as 40% of costs and no coverage of pharmaceuticals until laws were changed in 2008, requiring annual increases beginning in 2010 until reaching 80% coverage in 2014; though inpatient care is still scarce and meds are very picky. Read that the new legislation is so important because the majority of mental health professionals wont even accept patients with Medicare. So going to stick to my guns of the government needing to fix their own healthcare problems first for the elderly, poor, and disabled. Though your input into this conversation makes me want to know if people with federal coverage, or even state coverage, are provided coverage for more services than someone else with a typical health insurance policy.
Jack, I think I'm struggling with your question because it seems either too simplistic, or too broad.

Here are some things I can say which might get at what you're trying to ask.

Different insurance companies do PAY doctors different rates for the same services.  They will also pay different amounts- copays, coinsurances, or deductibles may fall to the client.  Some medicaid plans are actually free, while some have cost, but cost less than buying private insurance on your own, rather than having it provided by a company.  I believe with medi*caid,* the lower your income, the more likely it is you'll have lower- or no- copays, in general, but I get the impression that isn't consistent and it can vary based on type of service, or type of prescription.  Medicare has several potential "parts," and, without actually doing research, I'll say anecdotally I get the impression it doesn't fully cover things it really ought to, and having medicaid supplement it can help pick up some slack.

Summary of above paragraph:  It's complicated.

Different insurance companies require different things of the exact same providers of the exact same services.  Sometimes doctors don't "accept" masshealth clients not because masshealth is a lousy payor, but because private insurance companies don't have the same kinds of burdens in terms of administrative hoop-jumping to be licensed as a provider.  (I could bitch about this one for hours but that's the quick version).

re: the issue of how many visits clients will "get" with me:  It's largely at my discretion, regardless of insurance.  And regardless of disability.

Further explanation of this:  M&M allows infinite visits, and they will periodically audit the company to make sure they're getting what they're paying for (rather than ask us to prove to them that we need more units).  The various masshealth payors have their own systems of having us ask them for units (different web sites, which they periodically tweak)- they all start off with 12 units automatically auth'ed, and we ask for more as we need them, which is not a big deal and is a part of the job (albeit one of the many unpaid parts, of course).  Typically that is us providing relevant clinical information to make the case for how often we want to see certain clients, and why.  This will be granted based on level of symptomatology, not on disability status.  Private insurance companies usually seem more lax; those clients usually don't meet "medical necessity" to be seen weekly (that's clients who are more high-risk/high-need, typically), but, again, we can plead the case (fill out paper forms, usually).  And even some private insurances seem to automatically authorize what effectively end up being infinite visits.  They usually will start with 12 or 24 units before needing another auth, but the 12 units thing isn't an absolute.  The insurance company will just need to have a reason to give more units after that.
« Last Edit: June 24, 2014, 08:05:44 PM by PMS Elle »
it is well known that PMS Elle is evil.
I think you'd fit in a 12" or at least a 16" firework mortar
You win this thread because that's most unsettling to even think about.

Offline El

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Additional comment:  "Disability" is also not all one thing; even if you eliminate temporary disability, SSI and SSDI can each refer to disability.  On further research, SSDI qualifies you for medicare, but SSI likely qualifies you for medicaid.  As most of the clients who my company serves are poor, they'd end up with medicare/medicaid.

https://www.disability.gov/what-is-the-difference-between-social-security-disability-insurance-and-supplemental-security-income/

I already know what these things are, and understand the difference between federal disability insurance and state welfare health coverage. What I don't know is if they'll pay you to see your clients once per week if that's what you say they need.
Why the hell didn't you ask THAT in the first place???  :P
it is well known that PMS Elle is evil.
I think you'd fit in a 12" or at least a 16" firework mortar
You win this thread because that's most unsettling to even think about.

Offline El

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One more comment:

There's not a 1:1 correlation between which of my clients has the highest level of need, and which are on disability.  Which is an assumption I think you may be making, Jack, and which is a part of what has been confusing me, because I don't make that assumption.
it is well known that PMS Elle is evil.
I think you'd fit in a 12" or at least a 16" firework mortar
You win this thread because that's most unsettling to even think about.

Offline Jack

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Why the hell didn't you ask THAT in the first place???  :P
:laugh: Really thought that's what I was asking. So okay, then it's about the same, complicated, with lots of hoop jumping and justifications, whether it be for the government/state or insurance companies, though patients generally get the services advised regardless. Is that what you said? Thanks, Elle.

One more comment:

There's not a 1:1 correlation between which of my clients has the highest level of need, and which are on disability.  Which is an assumption I think you may be making, Jack, and which is a part of what has been confusing me, because I don't make that assumption.
Not really. My focus on disability is because disability insurance is a federal program, and nationalized care would be a federal program. It's easy to see state governments already do a better job than federal programs, so tend to prefer to look at what the federal government actually does when discussing what the federal government could potentially do.

Offline El

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My focus on disability is because disability insurance is a federal program, and nationalized care would be a federal program. It's easy to see state governments already do a better job than federal programs, so tend to prefer to look at what the federal government actually does when discussing what the federal government could potentially do.
Ergh!!!  :P  Wish you'd started off asking about medicare, explicitly, rather than about disability.
it is well known that PMS Elle is evil.
I think you'd fit in a 12" or at least a 16" firework mortar
You win this thread because that's most unsettling to even think about.

Offline Jack

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:laugh: Asked about people who have disability benefits; that's Medicare. Appreciate the conversation.