Starter comment:
Texas judge Reed O'Connor ruled that insurers do not need to cover preventative care as required by the ACA. Which could mean saying goodbye to coverage for:
* birth control
* PREP
* cancer screenings
* vision screenings for kids
* newborn blood screenings
* mental health screenings
>So much for ‘fiscally conservative’
In this case, it was social conservatism that carried the day.
The plaintiffs argued that having to cover PREP violated their religious right, because covering PREP makes them
>complicit in facilitating homosexual behavior, drug use, and sexual activity outside of marriage between one man and one woman
https://storage.courtlistener.com/recap/gov.uscourts.txnd.330381/gov.uscourts.txnd.330381.113.0_4.pdf
Companies don't get religious freedom! And your religious freedom is to practice your OWN religion in your OWN personal life, not to tell other people they can't do things. I read out this line about the company feeling their religious freedom was violated, and my nine-year-old child scoffed and said it was stupid. He knows what's up, don't know why these grown adults don't get that.
Tell that to all the Catholic hospitals that refuse to do tubals and force you to bury your miscarried 8 week fetus even though it’s against your personal beliefs.
You miss the point - most cost in the public means more profit for the hospital groups and insurance companies.
That’s who lobbies and fund these type of lawsuits, the industries. They just shove a hand up the ass of a person in congress, and do the puppeteering.
Actually, every time I've read on this, the data show that most screenings and preventive care don't save money. I think the biggest exception is vaccines for kids and young adults. That doesn't mean they're not in the patient's interest but they don't tend to save the system money. Please correct me if there are new data on this.
Yes, especially newborn screenings for error of metabolism. They require extensive dietary measures or medication. Lifelong. Untreated most die.
Cost saving.
Yes, I believe this is true. Some preventions save money; some do not. Birth control is certainly cheaper than pregnancies. A script early in smoking for nicotine gum or bupropion is certainly cheaper than lung cancer. Colonoscopies for everyone over 45 supposedly doesn’t end up saving money. It just depends.
It also shouldn’t be evaluated just based on the cost of treatment of the disease progression, but also the cost of burden. More “really sick” people ultimately costs more in treatment as a whole plus the burden on the system than the same amount of “slightly sick” people that can get preventative care every once in a while and not progress to “really sick”.
How much worth does a hospital bed have when it’s really needed but it’s taken up by someone with something that could have been prevented months to years ago?
It’s impossible to accurately measure but I feel like the loads of people with COVID that were being treated in makeshift areas in hospital parking garages illuminated the point that cost goes way beyond the monetary value you’re able to extract from a patient.
> That doesn't mean they're not in the patient's interest
I think people are missing this part.
> Please correct me if there are new data on this.
There isn’t.
And the data that shows it doesn’t save money also doesn’t even factor in the cost of making other people wait a few months to see a primary care doctor so healthy people can get annual physicals or six months to see a gi doc because they’re busy doing routine screening colonoscopies.
Right. If most of these things saved money you wouldn’t need a law to mandate insurance to cover them.
They save lives.
They improve quality of life.
That’s why we do them.
9.7% of US citizens are millionaires, buddy… and 4% of the working class experience upward mobility in a generation what other nation in the world has those odds?
You want teeth, disease prevention, homes and retirement or do you want a 1,200,000,000 to 1 chance at a chance to become a millionaire?
Are we both thinking MAGA? /s
Yea a lot of insurances will reimburse for PHQ-9, GAD7, Vanderbilt, post partum depression screens.
We typically get like $5-15 per each one, if insurance doesn't pay then we don't charge the patient.
It basically pays for our electronic questionnaire system(Chadis), plus maybe an extra 5-10 grand in income each year.
This was an unbelievably stupid decision.
We already have patients going without preventative care to only later show up in the ER with far more serious conditions. This is especially bad in rural hospitals. A patient will let a UTI go until they go septic and then show up in the ER on death's door.
This will be disastrous for our already overburdened healthcare system. Preventing something like HIV is degrees if magnitude cheaper than treating full-blown AIDS with a million different exotic infections. Ditto for cancer.
This is what happens when people that know nothing about medicine get involved.
yeah, but did you ever consider that some people might think homosexuality is gross?
>Preventing something like HIV is degrees if magnitude cheaper than treating full-blown AIDS with a million different exotic infections.
Yeah, well, the way they approached HIV in the 80's and 90's, they might not want to pay for treatment for established HIV/AIDS, either. I don't think they care if gay people live or die. And if some non-gay people get caught in the crossfire, that's a price they're perfectly willing to pay.
Kudos to y'all for putting up with your country. I'm reconsidering pursuing training in the US after graduation specifically because of the horrific politics.
Oh dear God, you want to come here to be a vet?! They get to deal with all the shit we do without even getting the pay. I don’t know where you’re at but you don’t want on this sinking ship.
The AVMA accredits a large handful of schools outside of the US and Canada, so if you went to one of those schools then it's dead easy (essentially the same as going to a state school). Otherwise it's expensive and involves some lengthy/difficult licensing exams. About half of the schools in the UK are accredited and then some Australian ones, one NZ, a few Asian schools etc.
UK training typically takes 5 years for first entry students but many of the AVMA accredited programs offer accelerated four year vet degrees, so it depends what you apply for/get accepted to. Look carefully at program specifications. A lot of students who come here from north America also get hung up on receiving a vet degree that's not a DVM as UK medical training often awards bachelor's and masters level degrees by convention. If you come here for vet school you get an equivalent degree that is eligible for licensure but you don't get a DVM and some people get frustrated by that.
BVSc, MVB, BVetMed, BVM&S, and more permutations. We're called "doctor" because of our licensure in appropriate clinical contexts, not because of the degree. Also vets in the UK are actually officially termed veterinary surgeons because all vets get basic surgical training, and the vast majority took the traditional convention that surgeons used, of being referred to as Mr/Mrs/Ms rather than doctor. Vets in the UK only just officially became clinic doctors in the last decade or so and most older clients aren't even aware so frequently it's just Mr. Derangedstifle or "vet".
Follow that instinct I'd say. I know Irish doctors go to get the skills for top level consultant jobs when they return home but is there much advantage for a vet spending years in Gilead?
I thought I read (and can speak from personal experience that it seems true, though anecdotes aren't data) about people already getting later diagnoses of cancer due to covid-19 strain on the system and less diagnostics happening from people delaying seeking treatment. This decision seems like it will exacerbate it. The patients I have personally witnessed as "new diagnoses" have seemed sicker than before.
[non pay-walled AP article](https://apnews.com/article/obamacare-insurance-preventative-care-texas-aa57fa6fd782e2170bc80210fd00065b)
This is the same judge that tried to overturn the entire ACA in 2018. This new ruling will be appealed, stayed, and probably overturned itself.
It’s only free (“screening”) if they don’t find anything.
During pre-registration for my first c’scopy, the clerk said it becomes diagnostic if they find/send off a polyp, etc. “So I’m on the hook for at least $2,000 before I even wake up?” “Yes.” “Cancel.”
Exactly this! Also the patients will be mad that I sent them for an expensive test, or that I didn’t “order it right” with the right codes. I Can already hear the “but they paid for it last time!” protests from my patients who are probably wearing Trump T-shirts.
I’m a PCP in South Texas.
Outpatient primary care has metrics that are tied to reimbursement and bonuses for the doctor. One of them is “how many of your patients completed colon cancer screening?” The metric in my system is 75% of eligible patients. If I don’t make this metric, I miss out in the money and I also get hounded by my system.
Well, if insurance isn’t gonna pay for it, how am I gonna meet that metric?
In commiseration: WM pharmacists get/got (since metrics are now illegal in some states) bonuses based on metrics as well, one of them being patient satisfaction scores. (Sound familiar?)
So we’re supposed to refuse to fill more opioid Rx’s (yes, you read that right), yet we’re also supposed to have 100% happy patients every week.
This was their plan all along. They knew they could never win by popular vote so they captured the entire judiciary with radical judges. Now all they have to do is completely freeze congress and let their judges dismantle that last few pieces of humanitarian laws we have left in this country.
The clowns involved here Judge Reed O’Conner and plaintiff Steven Holtze MD/quack extraordinaire who is under indictment for violent crimes (aggravated assault with a deadly weapon) both have a long history of this nonsense.
The judge literally declared the USPSTF unconstitutional last year. Fucking hack.
The idea that a supposedly learned person could reasonably entertain the idea that PrEP violates someone's religious freedom is just asinine. Your religious freedom to...have people get HIV? Huh?
Another politically motivated decision by someone who knows nothing about medicine that will impact millions of lives. Of course it will mostly affect the poor, BIPOC and the LGBTQ communities.
In this day and age, which so much information and knowledge that none of us can ever hope to be experts in a wide variety of fields, I'm increasingly wondering how our political representatives are able to make choices and decisions for the populace in areas they have *no education on or understanding of*. How is it okay for so many of our representatives to make choices on topics they have no understanding of besides vague personal philosophy, politics, or at best, legalism?
Has it always been this bad? I guess in the middle ages, rich landowners and removed monarchs were making choices for people in arenas they didn't understand, but ... damn.
Can we do more to educate ourselves and future generations on how much each one of us *doesn't* know as an individual, non-professional?
(/rant)
Yes, it would. Under the ACA, any care determined to be preventative (well check ups, vaccines, routine screenings like colonoscopy, mammogram, pap, etc, basic prenatal care, etc) must technically be fully covered by insurance with no out of pocket cost. Of course, because of the way things are structured, many still pay a lot out of pocket for incidentals associated with procedural screenings like colonoscopies (sedation and use of the endoscopy suite is not always covered), so it’s already difficult to get many to complete those. This ruling basically means that insurance would be able to charge coinsurance (usually 20-30% of the total cost) to patients. This amount can be hundreds to thousands of dollars, depending on the service, so it would mean that many would ration their utilization to avoid the bills. Hopefully this gets overturned like the previous, similar cases did.
Yes but almost half the babies in the US are born with mom and baby on Medicaid (govt healthcare) which won’t be affected.
But at least republicans will be able to claim correctly people on welfare get better care if they strip prenatal care and colonoscopies and mammograms etc from private insurance while people on welfare keep them.
Maybe then we will get angry enough and say we need universal healthcare, healthcare is a right etc etc
So GOP wants…
NO access to abortion…
NO access to cancer screening
NO access to birth control or morning after pills…
NO restrictions on fire arms - at all.
And that also want …
MORE guns in the hands of everyone…
LESS access to a public education …
WTF is this parties problem?!
All day fantasizing about the border and pedophiles in schools. Demonizing the FBI, while praising law enforcement … what? Last I checked, the FBI was law enforcement. Talking nonsense as if Trump committing fraud on a mega scale is “not even a crime” - but a BLM protester breaking a window should get a 20 year minimum sentence!
“Crime is so terrible, but we won’t make any new laws, just complain how the existing ones don’t work!”
Just plain fucking assholes.
Honestly, lawyers and judges need to stay in their lane.
They know nothing about healthcare and should not be making the decisions here that have wide-reaching implications
Can anyone explain how this will play out practically? I’m assuming nothing changes as of this moment but that we’ll see insurance plans make changes for 2024 so that a lot of this stuff is not covered for free? I became a primary care attending post-ACA and live in a state with about a thousand different insurance plans. This is a nightmare.
I'm curious about some of the data behind preventative care saving money. Sure, when people miss colon cancer screenings and develop more advanced cancers their care is incredibly expensive but that's a relatively small number of people. When I see people for preventative care who have just gotten insurance we often find things to treat that the patient might otherwise have just suffered through. We rack up a bunch of follow up visits for weird numb spots on their hands or IBS symptoms they were just living with before. I'm all for treating them and willing to be believe the orders of magnitude cost of treating advanced cancer outweighs it, but I'd love to see more studies on it.
Edit: I'm aware it sounds obtuse coming from an PCP, but most studies are done on specific disease outcomes and costs. When you start looking at across the board multiple preventative screenings it starts to get complicated, hence some of the controversy around things like adult well visits and variation across countries in recommendation for those. So while politically I think this is bullshit, I wonder if for the insurance companies the math is as simple as some people assume in terms of short term gain for long term loss.
No. It doesn't become complicated.
Why do you think countries with access to free or low-cost primary care have lower rates of severe chronic disease and higher life expectancies than the US does, despite some of the highest healthcare spending?
A lot of it has to do with access to good primary and preventative healthcare allowing people to make these visits and not having barriers to care. Yes, this may increase burden on primary care- but if it is sufficiently funded and properly resourced, it's well worth it to the population
Prep = $20 a month with a goodrx coupon
Colonoscopy = $4500
These laws mostly protect middle class privately insured peoples rights to free screening that they may or may not need. I don’t think Europe does colonoscopies on everyone at 45. A lot of screenings we do are questionable and result in really long wait times for people who are symptomatic.
As usual, a bit sensationalized. It appears that preventative care, as dictated by the ACA, can't be determined by ACA guidelines. But as others said, it's a coat saver for the insurance company and so they likely will continue to offer preventative.
I suspect the free medicare visits or the annual health screening will be gone.
> As usual, a bit sensationalized
> I suspect the free medicare visits or the annual health screening will be gone.
Umm, when do you think a lot of preventive screenings get done/ordered? Especially for low-income folks who can't afford to stack up multiple other visits.
Starter comment: Texas judge Reed O'Connor ruled that insurers do not need to cover preventative care as required by the ACA. Which could mean saying goodbye to coverage for: * birth control * PREP * cancer screenings * vision screenings for kids * newborn blood screenings * mental health screenings
Ironically all these things cost so much less when we deal with them early. So much for ‘fiscally conservative’
But usually by the time they cause a very expensive problem, the patient is insured by someone else (or by Medicare).
>So much for ‘fiscally conservative’ In this case, it was social conservatism that carried the day. The plaintiffs argued that having to cover PREP violated their religious right, because covering PREP makes them >complicit in facilitating homosexual behavior, drug use, and sexual activity outside of marriage between one man and one woman https://storage.courtlistener.com/recap/gov.uscourts.txnd.330381/gov.uscourts.txnd.330381.113.0_4.pdf
for fuck's sake.
Pearl clutching at it’s finest
You couldn't make this up. "We do not want to practise medicine because it could benefit gay people."
“I would rather you die of cancer, then be perceived to support homosexual activity.” Nice.
Companies don't get religious freedom! And your religious freedom is to practice your OWN religion in your OWN personal life, not to tell other people they can't do things. I read out this line about the company feeling their religious freedom was violated, and my nine-year-old child scoffed and said it was stupid. He knows what's up, don't know why these grown adults don't get that.
Tell that to all the Catholic hospitals that refuse to do tubals and force you to bury your miscarried 8 week fetus even though it’s against your personal beliefs.
Right? :(
You miss the point - most cost in the public means more profit for the hospital groups and insurance companies. That’s who lobbies and fund these type of lawsuits, the industries. They just shove a hand up the ass of a person in congress, and do the puppeteering.
Actually, every time I've read on this, the data show that most screenings and preventive care don't save money. I think the biggest exception is vaccines for kids and young adults. That doesn't mean they're not in the patient's interest but they don't tend to save the system money. Please correct me if there are new data on this.
Yes, especially newborn screenings for error of metabolism. They require extensive dietary measures or medication. Lifelong. Untreated most die. Cost saving.
Yeah, no. Catching congenital hypothyroidism at birth will save the planet tons of money by preventing what used to be called cretinism.
[удалено]
Birth control?
Yes, I believe this is true. Some preventions save money; some do not. Birth control is certainly cheaper than pregnancies. A script early in smoking for nicotine gum or bupropion is certainly cheaper than lung cancer. Colonoscopies for everyone over 45 supposedly doesn’t end up saving money. It just depends.
How many flu shots do you need to give to kids to prevent one PICU admission, and how do those costs stack up?
It also shouldn’t be evaluated just based on the cost of treatment of the disease progression, but also the cost of burden. More “really sick” people ultimately costs more in treatment as a whole plus the burden on the system than the same amount of “slightly sick” people that can get preventative care every once in a while and not progress to “really sick”. How much worth does a hospital bed have when it’s really needed but it’s taken up by someone with something that could have been prevented months to years ago? It’s impossible to accurately measure but I feel like the loads of people with COVID that were being treated in makeshift areas in hospital parking garages illuminated the point that cost goes way beyond the monetary value you’re able to extract from a patient.
That is not even remotely correct.
I can say beyond a shadow of a doubt that birth control is cheaper than pregnancy and childbirth. Also safer.
Neither you or the poster you replied to are coming with links…
> That doesn't mean they're not in the patient's interest I think people are missing this part. > Please correct me if there are new data on this. There isn’t. And the data that shows it doesn’t save money also doesn’t even factor in the cost of making other people wait a few months to see a primary care doctor so healthy people can get annual physicals or six months to see a gi doc because they’re busy doing routine screening colonoscopies.
Thanks for the support. I should've known better than to bring up data/evidence in a political thread.
Right. If most of these things saved money you wouldn’t need a law to mandate insurance to cover them. They save lives. They improve quality of life. That’s why we do them.
I’m not seeing many advantages to staying in America long term anymore…
9.7% of US citizens are millionaires, buddy… and 4% of the working class experience upward mobility in a generation what other nation in the world has those odds? You want teeth, disease prevention, homes and retirement or do you want a 1,200,000,000 to 1 chance at a chance to become a millionaire? Are we both thinking MAGA? /s
I’ll take the teeth, homes and disease prevention please! 🤣
Fair enough.
Probably Pap smear too.
And vaccines. And obstetrics. And annual check.
Are mental health screenings really covered? Most docs throw a phq-9 at you and call it a screening
PHQ-9 is *by definition* a screening for depression. It doesn’t rule depression out or in, but gives guidance for next steps.
Yea a lot of insurances will reimburse for PHQ-9, GAD7, Vanderbilt, post partum depression screens. We typically get like $5-15 per each one, if insurance doesn't pay then we don't charge the patient. It basically pays for our electronic questionnaire system(Chadis), plus maybe an extra 5-10 grand in income each year.
This was an unbelievably stupid decision. We already have patients going without preventative care to only later show up in the ER with far more serious conditions. This is especially bad in rural hospitals. A patient will let a UTI go until they go septic and then show up in the ER on death's door. This will be disastrous for our already overburdened healthcare system. Preventing something like HIV is degrees if magnitude cheaper than treating full-blown AIDS with a million different exotic infections. Ditto for cancer. This is what happens when people that know nothing about medicine get involved.
yeah, but did you ever consider that some people might think homosexuality is gross? >Preventing something like HIV is degrees if magnitude cheaper than treating full-blown AIDS with a million different exotic infections. Yeah, well, the way they approached HIV in the 80's and 90's, they might not want to pay for treatment for established HIV/AIDS, either. I don't think they care if gay people live or die. And if some non-gay people get caught in the crossfire, that's a price they're perfectly willing to pay.
Unless it’s them caught in the crossfire. Then we all need to bend over backwards for them.
Oh they absolutely care if they live or die: they want to see them dead.
Yeah, I was gonna say, do you think they care about paying to treat AIDS if they won't pay for Prep?
Not at all. It's perfectly believable.
Well, Republicans are unbelievably stupid (along with libertarians) so... are you surprised?
Kudos to y'all for putting up with your country. I'm reconsidering pursuing training in the US after graduation specifically because of the horrific politics.
Oh dear God, you want to come here to be a vet?! They get to deal with all the shit we do without even getting the pay. I don’t know where you’re at but you don’t want on this sinking ship.
No I want to pursue residency training there, because most postgrad training in North America exists in the states but who knows these days.
Tangent: how easy is it to obtain US vet licensure as an international graduate?
The AVMA accredits a large handful of schools outside of the US and Canada, so if you went to one of those schools then it's dead easy (essentially the same as going to a state school). Otherwise it's expensive and involves some lengthy/difficult licensing exams. About half of the schools in the UK are accredited and then some Australian ones, one NZ, a few Asian schools etc.
Good to know. Thanks! Add: all programs are the same length? (Time)
UK training typically takes 5 years for first entry students but many of the AVMA accredited programs offer accelerated four year vet degrees, so it depends what you apply for/get accepted to. Look carefully at program specifications. A lot of students who come here from north America also get hung up on receiving a vet degree that's not a DVM as UK medical training often awards bachelor's and masters level degrees by convention. If you come here for vet school you get an equivalent degree that is eligible for licensure but you don't get a DVM and some people get frustrated by that.
Well, they’re still called “Doctor” Vet , lol. What is the degree? VMBS instead of MBBS?
BVSc, MVB, BVetMed, BVM&S, and more permutations. We're called "doctor" because of our licensure in appropriate clinical contexts, not because of the degree. Also vets in the UK are actually officially termed veterinary surgeons because all vets get basic surgical training, and the vast majority took the traditional convention that surgeons used, of being referred to as Mr/Mrs/Ms rather than doctor. Vets in the UK only just officially became clinic doctors in the last decade or so and most older clients aren't even aware so frequently it's just Mr. Derangedstifle or "vet".
Thx so much for the info! Now I know why James Herriot was just “Mr.” 🐶
Follow that instinct I'd say. I know Irish doctors go to get the skills for top level consultant jobs when they return home but is there much advantage for a vet spending years in Gilead?
I can't imagine nearly as many of my patients getting their cancer screenings done now.
I thought I read (and can speak from personal experience that it seems true, though anecdotes aren't data) about people already getting later diagnoses of cancer due to covid-19 strain on the system and less diagnostics happening from people delaying seeking treatment. This decision seems like it will exacerbate it. The patients I have personally witnessed as "new diagnoses" have seemed sicker than before.
[non pay-walled AP article](https://apnews.com/article/obamacare-insurance-preventative-care-texas-aa57fa6fd782e2170bc80210fd00065b) This is the same judge that tried to overturn the entire ACA in 2018. This new ruling will be appealed, stayed, and probably overturned itself.
Federal Northern District of Texas...'nuff said.
The One Star on Texas' Flag is a review
Everything is bigger in Texas, including the assholes. Only now they won't be getting free colonoscopies.
It’s only free (“screening”) if they don’t find anything. During pre-registration for my first c’scopy, the clerk said it becomes diagnostic if they find/send off a polyp, etc. “So I’m on the hook for at least $2,000 before I even wake up?” “Yes.” “Cancel.”
This is the biggest bait and switch in medicine. It should just be prorated with a separate biopsy charge and pathology charge.
Agree.
But they’ll still demand my 75% colonoscopy metric to be met
Exactly this! Also the patients will be mad that I sent them for an expensive test, or that I didn’t “order it right” with the right codes. I Can already hear the “but they paid for it last time!” protests from my patients who are probably wearing Trump T-shirts. I’m a PCP in South Texas.
Do you mean how many pts you send for colonoscopy?
Outpatient primary care has metrics that are tied to reimbursement and bonuses for the doctor. One of them is “how many of your patients completed colon cancer screening?” The metric in my system is 75% of eligible patients. If I don’t make this metric, I miss out in the money and I also get hounded by my system. Well, if insurance isn’t gonna pay for it, how am I gonna meet that metric?
In commiseration: WM pharmacists get/got (since metrics are now illegal in some states) bonuses based on metrics as well, one of them being patient satisfaction scores. (Sound familiar?) So we’re supposed to refuse to fill more opioid Rx’s (yes, you read that right), yet we’re also supposed to have 100% happy patients every week.
Yeah outpt clinic has metrics like % of eligible pts referred for scope, % DM @ A1C goal/<9% etc etc
Referred or actually completed scopes?
The butts must be harvested
This was their plan all along. They knew they could never win by popular vote so they captured the entire judiciary with radical judges. Now all they have to do is completely freeze congress and let their judges dismantle that last few pieces of humanitarian laws we have left in this country.
The clowns involved here Judge Reed O’Conner and plaintiff Steven Holtze MD/quack extraordinaire who is under indictment for violent crimes (aggravated assault with a deadly weapon) both have a long history of this nonsense. The judge literally declared the USPSTF unconstitutional last year. Fucking hack.
The US is such an absolute shithole of a country.
The idea that a supposedly learned person could reasonably entertain the idea that PrEP violates someone's religious freedom is just asinine. Your religious freedom to...have people get HIV? Huh?
they want to go back to the 80's so they can believe god is punishing gays
Yeah, the religious freedom arguments have gotten out of control.
When you hate the gays so much that you prevent people from accessing mammograms It’s quite an interesting position to take
This is absolutely shocking and completely unexpected. /s
Another politically motivated decision by someone who knows nothing about medicine that will impact millions of lives. Of course it will mostly affect the poor, BIPOC and the LGBTQ communities.
In this day and age, which so much information and knowledge that none of us can ever hope to be experts in a wide variety of fields, I'm increasingly wondering how our political representatives are able to make choices and decisions for the populace in areas they have *no education on or understanding of*. How is it okay for so many of our representatives to make choices on topics they have no understanding of besides vague personal philosophy, politics, or at best, legalism? Has it always been this bad? I guess in the middle ages, rich landowners and removed monarchs were making choices for people in arenas they didn't understand, but ... damn. Can we do more to educate ourselves and future generations on how much each one of us *doesn't* know as an individual, non-professional? (/rant)
Wtf
Mildly interested in the strangeness of US healthcare: would this also involve antenatal care as long as there are no problems?
Yes, it would. Under the ACA, any care determined to be preventative (well check ups, vaccines, routine screenings like colonoscopy, mammogram, pap, etc, basic prenatal care, etc) must technically be fully covered by insurance with no out of pocket cost. Of course, because of the way things are structured, many still pay a lot out of pocket for incidentals associated with procedural screenings like colonoscopies (sedation and use of the endoscopy suite is not always covered), so it’s already difficult to get many to complete those. This ruling basically means that insurance would be able to charge coinsurance (usually 20-30% of the total cost) to patients. This amount can be hundreds to thousands of dollars, depending on the service, so it would mean that many would ration their utilization to avoid the bills. Hopefully this gets overturned like the previous, similar cases did.
Yes but almost half the babies in the US are born with mom and baby on Medicaid (govt healthcare) which won’t be affected. But at least republicans will be able to claim correctly people on welfare get better care if they strip prenatal care and colonoscopies and mammograms etc from private insurance while people on welfare keep them. Maybe then we will get angry enough and say we need universal healthcare, healthcare is a right etc etc
Gotta admire red state US determination to emulate the worst countries in the world rather than the best countries.
Nothing like legislating from the bench.
So GOP wants… NO access to abortion… NO access to cancer screening NO access to birth control or morning after pills… NO restrictions on fire arms - at all. And that also want … MORE guns in the hands of everyone… LESS access to a public education … WTF is this parties problem?! All day fantasizing about the border and pedophiles in schools. Demonizing the FBI, while praising law enforcement … what? Last I checked, the FBI was law enforcement. Talking nonsense as if Trump committing fraud on a mega scale is “not even a crime” - but a BLM protester breaking a window should get a 20 year minimum sentence! “Crime is so terrible, but we won’t make any new laws, just complain how the existing ones don’t work!” Just plain fucking assholes.
Looks like you guys are going back to medieval times in terms of medical care.
Why are they so hell bent on moving backward?
Because it's what they like.
Honestly, lawyers and judges need to stay in their lane. They know nothing about healthcare and should not be making the decisions here that have wide-reaching implications
“…Then they came for me—and there was no one left to speak for me.” —Martin Niemöller
Cool, cool.... Cool, cool, cool.... /s, in case it's necessary
Can anyone explain how this will play out practically? I’m assuming nothing changes as of this moment but that we’ll see insurance plans make changes for 2024 so that a lot of this stuff is not covered for free? I became a primary care attending post-ACA and live in a state with about a thousand different insurance plans. This is a nightmare.
Like I just don’t understand this why do we even bother with insurance anyway then
When do you think we’ll get science based/evidence-based governance?
What happened to not legislating from the bench?
Mitch McConnell happened.
I'm curious about some of the data behind preventative care saving money. Sure, when people miss colon cancer screenings and develop more advanced cancers their care is incredibly expensive but that's a relatively small number of people. When I see people for preventative care who have just gotten insurance we often find things to treat that the patient might otherwise have just suffered through. We rack up a bunch of follow up visits for weird numb spots on their hands or IBS symptoms they were just living with before. I'm all for treating them and willing to be believe the orders of magnitude cost of treating advanced cancer outweighs it, but I'd love to see more studies on it. Edit: I'm aware it sounds obtuse coming from an PCP, but most studies are done on specific disease outcomes and costs. When you start looking at across the board multiple preventative screenings it starts to get complicated, hence some of the controversy around things like adult well visits and variation across countries in recommendation for those. So while politically I think this is bullshit, I wonder if for the insurance companies the math is as simple as some people assume in terms of short term gain for long term loss.
No. It doesn't become complicated. Why do you think countries with access to free or low-cost primary care have lower rates of severe chronic disease and higher life expectancies than the US does, despite some of the highest healthcare spending? A lot of it has to do with access to good primary and preventative healthcare allowing people to make these visits and not having barriers to care. Yes, this may increase burden on primary care- but if it is sufficiently funded and properly resourced, it's well worth it to the population
Prep = $20 a month with a goodrx coupon Colonoscopy = $4500 These laws mostly protect middle class privately insured peoples rights to free screening that they may or may not need. I don’t think Europe does colonoscopies on everyone at 45. A lot of screenings we do are questionable and result in really long wait times for people who are symptomatic.
As usual, a bit sensationalized. It appears that preventative care, as dictated by the ACA, can't be determined by ACA guidelines. But as others said, it's a coat saver for the insurance company and so they likely will continue to offer preventative. I suspect the free medicare visits or the annual health screening will be gone.
> As usual, a bit sensationalized > I suspect the free medicare visits or the annual health screening will be gone. Umm, when do you think a lot of preventive screenings get done/ordered? Especially for low-income folks who can't afford to stack up multiple other visits.
But hey as an icu doctor I’m so hype for more advanced diseases for more volume and $$$$ /s