Interlandi and Gardner
(Gardner Reading)
What are some other examples of this story that you have experienced in your own life? How has it affected you and your perception of the healthcare system?
Although I have not experienced this in my own life, I have seen many others going through similar situations. While scrolling through the internet the other day, I came across a girl online for help on how to use a medication. She explained that her insurance company suddenly stopped paying for the medication that she had been using for years, which forced her to switch to an alternative medication. She doesn’t know what to expect of this change, since the previous medication worked well for her and she’s scared of the potential side effects from this newer one. Seeing stories like this makes me realize how unpredictable the healthcare system can be. It has made me think that insurance companies sometimes prioritize cost over patients’ well-being, which can make people feel uncertain or stressed when they need medical care the most.
(Cortez Reading)
When the article says, “The patient becomes almost like an ATM machine,” what does this reveal about the power dynamics in healthcare?
This reveals that the power dynamics in healthcare are reliant on money and the market economy. Rather, power is not about who can be more in control, but instead about which patients can make these insurance and doctors the most money. This idea of power dynamics being financial can lead to a corrupt flow of care. Often patient care is pushed aside when the care they require does not have financial incentives for the providers.
Although personally I have never experienced something like this in my lifetime, people around me that I love have experienced this. My grandparents especially, have had to fight tooth and nail with insurance providers to get life saving treatments they need. This happens more commonly than one might think.
(Kliff Reading)
Are hospitals justified in charging high and inconsistent prices if they need to stay financially viable? Where should financial sustainability meet ethical responsibility?
Hospitals should be justified in charging what they need to stay afloat to insurance companies, but they should not be charging this directly to patients ever. As shared in the article, patients who were dismissed by a long waiting line and given nothing more than an ice pack end up with a steep bill. This is simply unacceptable and results in patients afraid to get the emergency care they may need, unsure of the severity and scared of the financial consequences, so can go untreated.
Financial sustainability for a hospital looks like having providers agree to be in-network, having insurance companies truly act as the supportive middlemen that they should, and allow patients and providers to serve their roles and focus on the best recovery and treatment options.
(Gardner Reading)
Who is do you believe to be at fault in this story, the doctors for not catching the spread sooner, or the insurance companies? Or is it a bigger entity at fault? Explain your answer.
I believe the problem is bigger than just the doctors or the insurance companies alone. Doctors can sometimes miss things because medicine is complicated and diseases can develop quickly. However, insurance companies also play a big role because they decide what treatments will or will not be covered. In situations like this, the overall healthcare system is part of the issue. The system often focuses on profits and costs, instead of making sure patients can easily receive the treatment they need.
(Cortez Reading)
What strategies could improve transparency and informed decisionmaking for patients facing complex treatment choices that rely heavily on physician recommendations?
There are a handful of strategies that both patients and providers can use to improve transparency and informed decisionmaking for patients facing complex treatment choices. One of these strategies could involve reaching out to other physicians at different facilities for second opinions. Although this is already a common practice, a lot of patients will often go with the first opinion they receive if the news sounds confusing and difficult to understand.
Another option that providers could rely on to have better transparency and informed decisionmaking when it comes to complex treatment choices for their patients, is creating informative pamphlets, that inform patients of treatment options in plain language. These pamphlets will explain everything, from the diagnosis to the side effects of potential treatment options.
(Kliff Reading)
Do you think stories of extreme bills help or distort public understanding of the issue?
I think stories of extreme bills can help hospitals and insurance companies take a moment to reflect and see how they can improve. However, I think it can cause negative effects for public understanding since it is not everyone that faces these extreme bills and scaring patients who are in need of emergency care away from seeking the proper medical attention.
(Gardner Reading)
Is there anything that justifies insurance companies from denying someone access to medicine that could possibly be life saving? Explain your answer.
Insurance companies often argue that they must limit coverage in order to control costs and keep insurance plans affordable for everyone. They may deny medications that they believe are experimental, extremely expensive or not proven to be effective. However, I find it difficult to find a reason to justify insurance companies from denying someone access to medicine that could possibly be life saving. When a person’s life is at risk, access to care should be the top priority, but when the insurance company is preventing that person from getting the care they need, they are the ones actively harming the person.
(Keating Reading)
How has hospice care changed as for-profit companies have become dominant?
Over the past few years, hospice care providers have become increasingly dominated by for-profit companies. Although this care has expanded hospice care access for patients , it has also raised concerns about financial incentives for providers. Recently, providers have been enrolling patients into hospice care earlier than they need to be – for financial gain. Healthier patients require less medical care, but enroll in hospice care longer than someone at the end of their life does; meaning they earn the providers more money.
(Watson Reading)
Is it fair to expect patients to bear any responsibility for navigating complex billing systems in emergencies? Where should we draw the line between personal responsibility and systemic responsibility?
The responsibility for navigating complex billing systems in emergencies should not be the focus of patients going through many other physical and emotional stress during an emergency setting. Providers should have a system in which the copays for their patient are automatically listed next to what they would like to prescribe/perform and it should all be run through the patient or decision maker.
The line should be drawn after patients describe their symptoms to their provider. The insurance company’s role should be to support their clients, and that is what they registered for as they pay to continue as a client every month.
(Interlandi Reading)
What was the first example of the United States not having equal healthcare based on race? Explain how this is similar to the level of equity our healthcare system has now.
The first example of the United States not having equal healthcare based on race was how many early healthcare programs and hospitals excluded Black Americans or provided them with significantly worse care. Segregation in hospitals and medical programs meant that Black patients often had fewer resources, fewer doctors, and poorer facilities. This history still affects the healthcare system today. While legal segregation no longer exists, racial disparities in healthcare outcomes still remain. For example, some communities of color still experience higher rates of certain diseases and less access to quality healthcare services, showing that the system has not yet reached full equity.
What safeguards could be implemented to protect vulnerable elderly patients and emotionally overwhelmed family members from being improperly enrolled in hospice care?
I think the only true safeguard that can protect vulnerable elderly patients and emotionally overwhelmed family members from being improperly enrolled in hospice care, is to prevent the majority of hospice care facilities from being run by for-profit companies. Although their are pros to for-profit companies, these pros are outweighed by the cons. In my opinion, healthcare should never be controlled by companies that have financial incentive, because healthcare ends up being focused on money making and not patient care.
(Watson Reading)
If surprise billing is widely seen as unjust, why do you think it persisted for so long? What does this suggest about how the U.S. political system works?
Surprise billing is a result of one of two things usually: denied insurance claims or lack of education on the provider side of what the copays of/if covered at all of what they are prescribing/performing/ordering. This persists because neither system has changed.
The article asks the question of whose money speaks the loudest: healthcare industry’s or voters’ per voters’ vote on this potential policy. This shapes how the policy is implemented, it is ultimately the voters’ decision, but the overlap in those voters and the financial setup and push for innovation and expansion from big pharma and biotech results in a skewed favoring for healthcare companies to be prioritized currently. This is also a result of lack of education for those voting since they would believe voting for support for these companies would result in help for themselves, but this complex system includes many other priorities not highlighted nearly enough.
(Interlandi Reading)
What would a policy that would help eradicate ALL racial disparities mean? Explain whether this is a feasible policy.
A policy designed to eliminate all racial disparities in healthcare would likely focus on ensuring equal access to medical care, improving healthcare resources in underserved communities, and addressing social factors like income, education, and living conditions that affect health. While this goal is important, completely eliminating every disparity may be difficult because health outcomes are influenced by many complex factors. However, policies that expand access to healthcare, improve community health programs, and reduce economic inequality could significantly reduce these disparities even if they cannot eliminate them entirely.
(Keating Reading)
How could policymakers balance preventing fraud with ensuring patients still have access to the care they need?
There is a few ways that policy-makers can balance preventing healthcare fraud and still ensuring that patients have access to the care they need. One way this can happen is to align financial incentives with patient care incentives. In the article by Whoriskey and Keaton they raised the issue that daily flat rates in hospice care often leads to longer hospice stays. By creating financial incentives that align patient care incentives, you meet the priorities of both the providers and the patients. In addition, policymakers should implement stricter oversight. Policymakers should analyze data trends, and find hospice providers that have longer unnecessary stays, unusually high enrollment rates and keep an eye on these providers to ensure their focus is patient care and not financial gain.
(Watson Reading)
If you were designing a solution, would you prioritize protecting patients, limiting costs or preserving provider profits? Can all three be realistically balanced?
Healthcare systems need to have patients as the top priority. There is simply no other way to define a solution, for it would no longer be a solution. A provider’s number one responsibility should be patient wellbeing, and this only gets restricted when the provider does not have the ability to best support patients because of policy constraints. The article speaks of the lack of regulation in how much hospitals are billing insurance companies, when in reality there is much more lack of regulation in how much the insurance companies are paying. The fraction insurance pays makes the hospitals eat the costs. I believe a solution would be to have insurance companies pay the true billed amount to hospitals to allow them to function properly so they don’t have to search for other methods of income/cost cutting that may risk prioritizing patients. Where the insurance companies get this money, there still lies the challenge.
Realistically, it proves difficult currently to balance all aspects as hospitals are closing down, decreasing access yet cutting costs. In recent news, Medicare premiums were set to increase by just 0.09% this year, but after that tanked private insurers stock, the premium just posted skyrocketed as a response to the poor economic response, illustrating the corrupt lack of balance.