"PSA:"

It would be nice if HN did a better job of treating statements like this as testimony regarding the problem space and not an invitation for personal critique. The odds are extremely poor that some random internet stranger can fix a mess like this by making one good suggestion in a public comment.

If you are genuinely willing to give someone like this scads of money or do a fundraiser (or otherwise actually try to help them in earnest), cool. But my experience suggests you probably aren't and multiple public personal questions easily comes across as invasive and blamey, especially for someone living with a lot of duress already.

While there is a lot of truth in what you say from my experience as well, and I can be defensive from all the disappointment and ineffective advice and often outright attack and blame over the years, I try to remember people mostly DO mean well and you never know when the right thing might hit. My only real chance in all these years came from a stranger speaking up. I've gotten some lovely messages of emotional support from a handful of people before as well. I'd rather people speak up than not personally...but yeah an effective solution would be ideal. I feel I am just too far in a hole for any standard ideas to work. If I was in a strongly social nation I'd be getting assistance no question. I can't survive in the Thunderdome in my situation.

My comment explicitly allows for good faith interest in someone's situation. It's certainly not a suggestion that such comments shouldn't get engagement.

It's possible to speak up and do so more considerately and thoughtfully than is typically done in response to such comments.

I know...and thank you. I just wanted to be clear I am appreciative of empathetic and kind people. There is enough victim blaming and defensiveness from the masses in the world as it is...I don' want to alienate good people nor harm the acceptance and understanding for others in my situation by sounding ungrateful. For example I remember how grumpy and mean most older diabetics I worked with were and it wasn't because they were bad people, it's because they were worn out from suffering. But to most people they were just "jerks" who were choosing to be jerks.

Stories like these are why I feel like the medical system in America is extremist, and not a rational, pragmatic, or effective system. We are like the North Korea of healthcare.

Ironically, North Korea has a national health service and free universal health care for all its citizens. [0]

[0]: https://en.wikipedia.org/wiki/Healthcare_in_North_Korea#Heal...

Yes, but not sure to many Americans would be better off with the free heath care North Korea offers.

actually, maybe read the linked paragraphs. from what I understand "many Americans" have basically no access to healthcare whatsoever (think homeless people for example) so your statement might not hold as tightly as you'd like...

Pretty much anyone homeless is going be eligible for Medicaid. Problem for them is navigating the system to get care.

The administrational/bureaucracy seems to generally be a problem with the US healthcare system, even for more affluent people. But for homeless people it needs to be close to zero. For moral reasons (it would and does effectively prevent them from being treated like the humans they are) but also for efficiency reasons. If there's clearly no money to be had from someone, minimize your handling losses by giving them what they legally deserve without making it a lot of work for everyone.

> minimize your handling losses by giving them what they legally deserve without making it a lot of work for everyone.

The problem necessitating bureaucracy in a separate system for the poor on top of the US’s mostly-private-pay health care system is identifying who is eligible and what they legally deserve.

Other countries define "what they legally deserve" that pretty much as "what makes sense, medically"...

The part that requires bureaucracy for Medicaid is making sure the recipient is legally entitled to Medicaid at all (and, if they are, that they still don't have other insurance which should be paying ahead of Medicaid.)

That’s where having a separate system for the medically indigent in a mostly prvate-pay system becomes much more burdensome, per covered person, than a universal coverage system without private insurance.

Propaganda from the North Koreans is worse than no evidence. We don't know what is going on there as it is absurdly unlikely that the NK government are providing honest statistics or allowing anyone to check what is happening.

Cross-country comparisons are dicey at the best of times because a whole stack of basic cultural assumptions are violated. Unless there is a thriving medical tourism trade to NK it is unlikely that any American would benefit from copying North Korea.

There is a long list of about about 150 countries that they could look to before even brushing against the idea of looking to North Korea for good ideas.

I know people in HN hate to talk about politics, but this is a political problem.

People, please vote for medicare for all candidates, it might not affect your life now, but you don't know what the future holds for you.

About the "free market" approach: Medical care has what in economics is known as "zero price elasticity". That means that people have zero ability to refuse the product if the price is too high. In economics, its associated with market failure, because low price elasticity means providers make more money by raising prices than by competing with each other.

Some subsets of the health care industry have price elasticity and seem to work fine in the free market, such as Lasik and liposuction etc. But stuff that gets called medically necessary don't work in a market, there is an entire branch of economics dedicated to it: Health Care Economics. Ironically pioneered by an American, Kenneth Arrow. Won him a Nobel Prize.

Why Medicare for all vs other reforms

Because for-profit healthcare is immoral, wasteful, and inevitably results in scenarios like the above.

A Bismarck system (nonprofit govt sponsored insurance companies that all charge the same and are taken by all doctors) would be fine too, but that's not on the table in the US

> Because for-profit healthcare is immoral, wasteful, and inevitably results in scenarios like the above.

There's no such thing as a healthcare system where nobody profits in some way. Lots of people working in "non-profit" organizations are still lining their pockets.

> A Bismarck system (nonprofit govt sponsored insurance companies that all charge the same and are taken by all doctors) would be fine too, but that's not on the table in the US

You must be alluding to the German system. We actually have two-class healthcare: Private insurance for those who are self-employed or who earn well enough to afford it and public insurance for everyone else (15% of income).

Those with private insurance get preferred treatment at almost any level, because while price controls exist for both public and private treatment, the amount of money doctors get for public patients is a joke.

It doesn't stop there of course, salaries for all healthcare workers are extremely low, as is the budget for cleaning personnel. Pretty disgusting, but also dangerous. Our rates of MRSA are extremely high, for instance.

Lots of German healthcare workers are moving to Switzerland (private system, but compulsory), being replaced by Eastern-Europeans. That doesn't bother me per se, but if we didn't have that kind of cheap labor, the system would just collapse.

In effect, I can tell you how to get "affordable" healthcare, whether it is public or private: Just pay your healthcare workers dramatically less money. Instate price controls. You'll have a lot of frustrated workers in a system constantly working at the brink of collapse, but it does work.

"Bismarck" is a class of healthcare systems, referring to employer/employee financed insurance-based healthcare. It is used in Germany, the Nederlands, and Switzerland I think. Other models are Beveridge (like the UK) and National Insurance like Canada.

The difference in payment between US and European health care workers isn't large enough to make much of a dent in US healthcare expenses. The big sources of costs is the US massive bureaucracy dealing with bills, insurance and negotiation, as well as the medical inefficiency and overprovision inherent in the system. Also high drug prices.

For example, a US medical doctor makes about 100 000 $ more than the European average, although a few countries pays doctors more. There are about 1 million doctors working in the US. So thats 100 billion. US overspending is about 1 500 - 1 800 billion.

> It is used in Germany, the Nederlands, and Switzerland I think.

Germany today has a public/private mixture, Switzerland and Netherlands is fully private. I'm making this distinction because private profits do exist in these system, while the original comment I replied to lamented them.

> The difference in payment between US and European health care workers isn't large enough to make much of a dent in US healthcare expenses. The big sources of costs is the US massive bureaucracy dealing with bills, insurance and negotiation, as well as the medical inefficiency and overprovision inherent in the system. Also high drug prices.

Are you sure about this? Last time I looked it up, I came to a different conclusion: Administrative overhead (~8%) is neither a huge part of costs, nor is it massively different than in Europe. Drugs prices also only account for 10%.

Salaries for workers on the other hand are a significant chunk, and those are easily double than those in Germany in most cases. Note that I'm talking about all salaries, doctors, nurses, clerks, cleaners...

I agree with the overprovisioning being much costlier, but those are due to legal liabilities being more expensive in the US in general. In Germany, even if you win a malpractice suit, you get a pittance.

> There are about 1 million doctors working in the US. So thats 100 billion. US overspending is about 1 500 - 1 800 billion.

Again, this disregards the vast majority of worker salaries involved.

> "Switzerland and Netherlands is fully private."

Private insurance in those countries works because those markets are highly regulated, and they don't have a corporate culture of trying to rip off people as much as they can.

I guess the point is: No matter whether you are privately or publicly insured in Germany, a transport in an ambulance, an emergency helicopter ride, a long-winded illness like cancer, or any other medical treatment won't ruin you financially. The same goes for most (all?) of Europe.

Doesn't insurance in the US cover these cases? I think it ultimately comes down to whether people can afford healthcare or not. For instance, healthcare costs are covered with unemployment benefits in Germany.

If you don't have insurance in Germany you'll have to pay for that yourself as well. That's rare, but it happens especially with the precariously self-employed.

The issue with the US system is that you can't have it be both non-compulsory but also that coverage must be offered to everyone, no matter their state of health. Then you'll have a few healthy people pay huge premiums to finance treatment for those who never bought insurance until they're sick.

It is my understanding that a compulsory purchase (as in Switzerland) would be unconstitutional, so I guess "Medicare for all" in the form of a tax would actually be the next best thing. Just keep in mind that with US levels of healthcare salaries, that wouldn't come cheap.

> If you don't have insurance in Germany you'll have to pay for that yourself as well. That's rare, but it happens especially with the precariously self-employed.

The difference is GKV being the default, and opting out of that kind of hard. You have to earn €5,062+ per month, for a start [0]. And the step is intentionally hard to reverse. I consider that a decent compromise. At that point people have to actively shoot them self in the foot, and I've little pity for those.

If you didn't opt out, thus are still under the GKV, the system will cover emergency services. Even if you haven't payed (yet).

[0] https://www.bundesaerztekammer.de/weitere-sprachen/english/h...

> The difference is GKV being the default, and opting out of that kind of hard.

It's not hard at all, just go self-employed and you have the option.

> And the step is intentionally hard to reverse.

Yes, so that people towards the end of their lives don't profit from a system they never paid into. You're stuck with expensive private insurance for the rest of your life. In the US however, you would qualify for Medicaid.

> At that point people have to actively shoot them self in the foot, and I've little pity for those.

It's actually not that uncommon for people to fall into the trap of working self-employed for most of their lives, then retiring poor because they never paid into the pension system and their private insurance costs them over 500€/month.

Compulsory purchases are constitutional, as long as Congress can reasonably invoke its taxation power in application of the penalty. Americans are already compelled to buy health insurance, but as of the 2017 Republican tax bill, the penalty for not doing so is $0.

Then it's not a compulsory purchase, it's a tax. The money doesn't go to the insurer. Even before the penalty was $0, it was too low to be effective.

In Switzerland, it is compulsory to purchase insurance, there's a basic plan that all insurers must offer, and if cost exceeds a certain fraction of the income, the state chips in.

I mostly agree with what you're saying. however I am concerned that sudden and large changes to critical components of America will 1) be hard to do right and 2) create a lot of dissent from people who think differently.

remember healthcare.gov? we were pretty glad we had other redundancies from day 1! it takes time to build a system and in my (granted unrelated) experience, big changes are best done in small steps

healthcare.gov had difficulty because it was so complicated, with layers of byzantine qualifications, exceptions, and requirements.

There is no healthcare system less complicated than "medicare pays for everything"

There are arguments to be made for medicare-for-all, but that it is the absolute minimally complicated solution is observably incorrect. One counterexample suffices to dispel a claim of being the least member of a set.

For example, the healthcare system the USA had for well past the first half of the 20th century was "pay workers a middle class wage and control costs so the average family can afford housing and pay for medical care for their 5 kids. And then send them to college after." Nothing is simpler than to be told the price of the service ahead of time and then pay for it. I know this because my father lived through it. He was the child of dirt poor immigrants, only got a high school diploma thanks to being drafted out of college, and still managed to pay for medical care for a wife and six children. He told me about how insurance started as just catastrophe coverage, and then just grew and grew until the entire system became the morass of red tape, inefficiency, and rent-seeking it is today. Just like with student loans, having the monetary sovereign spend money into existence (directly or through high interest loan guarantees) will inevitably wildly inflate prices in the affected sector. To an extent it already has.

This isn't a simple static system. If it were, then sure "government pays for everything, good to go" would be correct. Unfortunately the reality is that it's a dynamic system, and providing a payment guarantee with politically determined pricing is "government pays for everything, so now every middle-man, lobbyist, special interest, rent-seeker, and every other assorted grifter is going to wet his beak". And that's just the beginning of the higher order consequences. Maybe medicare-for-all is a good choice, I just don't know. And I won't know until I see a cogent, rigorous, and complete analysis of the second order and higher effects of the policy change. I'm not aware of anyone offering that analysis.

Careful, "for-profit" healthcare has a lot of government controls on it. Single payer is only obvious after you add a lot of controls to the market.

See https://www.youtube.com/watch?v=8q71hrwUcu0 and the more complete https://www.youtube.com/watch?v=rWlk9HreE7U.

He explains how regulation eventually results in a centrally planned setup that is less efficient than what used to happen.

> Because for-profit healthcare is immoral

The [majority of hospitals in the US are non-for-profit](https://www.aha.org/statistics/fast-facts-us-hospitals). Needless to say, they are not able to provide a cheaper service than the for-profit hospitals. So there is some factor, unrelated to profit, which makes healthcare expensive.

If profit was causing healthcare expenses to rise, then non-for-profit hospitals should be be able to maintain lower prices than for-profit ones. They can't. So what's driving up the cost? The answer is pretty simple: government intervention.

The "not for profit" thing is a bit of a fiddle.

Sure, there aren't shareholders getting dividends. There are plenty of other motives that push non-profit hospital systems to want to make money. New buildings, fancy robotic surgery machines, cushy patient amenities to compete with the other system in town, expensive administrators and staff...

I think the point was that there are multiple different reforms that are important, and why health care over another. What if there is a candidate that is for health care reform, but against something else you consider important, but there's another candidate that's for the other reform, but against health care reform? Or there is a candidate that is for health care reform but also for other things your are strongly against?

Politics is all about compromises, so the answer to all of those questions is, “it depends”.

It's easy to forget the importance of compromise during a primary. Sometimes it feels like a positive feedback loop.

You speak, you debate, you argue and because of this, nothing gets done.

Even for the most urgent issues like universal healthcare that have been literaly implemented by all western countries a long time ago as well as in most developing countries, you say : "But me..."

Since you're not directly affected by the matter, you simply don't care. Even if you could be the next...

You're part of the problem and nothing will never get done in America because of people like you.

Selfishness will break America.

Before your country collapses under its own debt, America will be filled by slaves and a clique of companies and billionnaires owning them.

I was merely debating the idea that "if you believe X is important, then you must vote for the person that supports X", because it's not as black and white as that. Like it or not, there are too many other factors that come into play. The only way "vote for X is you support X" is black and white is if each topic comes up for it's own vote. Even then, it's possible that the vote could be for a horrible way to support X.

> You're part of the problem and nothing will never get done in America because of people like you.

You don't know me and you don't know what I do / do not vote for. I recommend you keep your insults to yourself.

> Selfishness will break America.

Selfishness is healthy in moderation. It's what helps people come to the conclusion that they have a shared interest on which they can collaborate.

> Before your country collapses under its own debt, America will be filled by slaves and a clique of companies and billionnaires owning them.

So the answer is to bankrupt the billionaires so everybody is living a terrible life?

Which other reforms exactly?

Both the situation before ACA and the reaction to it have shown that privatised health insurance is never going to work in the US. Medicare for All looks like the only practical way forward, and it's been gaining a lot of momentum as a result. Medicare itself also still needs some fixes; at the moment the government isn't even allowed to negotiate prices. That's a law that clearly needs to be repealed. But other than that, Medicare for All sounds pretty good, and I'm not aware of any other credible proposal that looks anywhere near as good.

Medicare for all is not a solution. The solution is make health insurance act like insurance. Health service provider needs to post their price like all services and products. They need to compete for our business.

Absolute nonsense.

What about the poor people who only have one hospital nearby that might not accept their insurance? What about people who go to a hospital that's in their network, but it turns out one of the many doctors was not? The people who have a time critical illness who can't afford to do the whole Free Market thing right after a accident?

How does anyone know that when they arrive somewhere the exact number of treatments needed to cure their illness? Are you expected to walk out of the hospital and refuse treatment because you've tabulated all of the prices for all of the services needed, then ask the ambulance to take you somewhere else?

The free market solution to health insurance simply does not work and it's insulting to see people suggest it time and time again. It ironically only works in heavily centralized areas where people actually have a choice, and not the more rural areas where hospitals are far more spaced out. There's far too many variables at play for even software engineers to manage unless you dedicate a significant amount of your free time to maintaining an excel spreadsheet of every hospital near you and their prices, formulate the exact cheapest plan on the fly according to your personal needs and can pull that out immediately when you have a medical emergency.

And that's assuming they didn't decide to go out of network the day before and delayed updating their database.

> What about the poor people who only have one hospital nearby that might not accept their insurance? What about people who go to a hospital that's in their network, but it turns out one of the many doctors was not? The people who have a time critical illness who can't afford to do the whole Free Market thing right after a accident?

All of these only apply to time-critical procedures. Otherwise you should be able to use the doctor and hospital which is covered.

Let's assume that emergency medicine should be provided by cities in the same way as other emergency services like fire companies. What's the argument for doing it that way for all medical services, including the ones that are not time sensitive and allow you plenty of time to shop around and choose the provider with the best combination of price, distance, scheduling availability, etc.?

> There's far too many variables at play for even software engineers to manage unless you dedicate a significant amount of your free time to maintaining an excel spreadsheet of every hospital near you and their prices, formulate the exact cheapest plan on the fly according to your personal needs and can pull that out immediately when you have a medical emergency.

This is hardly the only circumstance where there are many variables. Should the government buy everyone the same car because there are so many different choices between prices and safety ratings and fuel economy and performance? How does that even help, since the solution space is the same and government knows less about your priorities than you do?

> Let's assume that emergency medicine should be provided by cities in the same way as other emergency services like fire companies. What's the argument for doing it that way for all medical services, including the ones that are not time sensitive and allow you plenty of time to shop around and choose the provider with the best combination of price, distance, scheduling availability, etc.?

Because for a lot of people, there is no real choice involved. If there's one hospital around for hundreds of miles, they realistically don't have the option to go to one further out when their job expects them to be available for work every single day. Not to mention that requires every hospital to offer every service and to have every type of specialist for every type of disease.

Medical issues don't operate like a grocery store. You can't just walk into a hospital and choose between Name Brand MRI or Store Brand MRI. It requires a level of knowledge that most people don't have. It's knowledge I don't have! And something I'd prefer to never have to think about when I have other shit to deal with in real life.

> This is hardly the only circumstance where there are many variables. Should the government buy everyone the same car because there are so many different choices between prices and safety ratings and fuel economy and performance? How does that even help, since the solution space is the same and government knows less about your priorities than you do?

Your analogy falls apart because the government does make mandates for cars. Things like safety features. And you're trying to compare buying a car which is a fairly small subset of considerations for the average person versus trying to purchase medical assistance which is an incredibly wide field encompassing multiple types of examinations, surgeries, biopsies and more. When you're looking for a car, you have some properties of a car which are easily understandable. When you're searching for medical assistance, most people only vaguely know what's actually wrong.

> Because for a lot of people, there is no real choice involved. If there's one hospital around for hundreds of miles, they realistically don't have the option to go to one further out when their job expects them to be available for work every single day.

Federal law requires employers to provide at least unpaid sick leave. That caps the premium a local hospital can charge over competitors at the loss of the day's wages and the travel costs, which are both dwarfed by the amount of money in medical expenses we're comparing them to for these bankruptcy-inducing procedures.

> Not to mention that requires every hospital to offer every service and to have every type of specialist for every type of disease.

Why would it require that? There are thousands of hospitals in the US. You don't need every hospital to do everything as long as there is some competition for any given thing.

And far away hospitals can provide competition even if people don't actually use them in practice. If it costs $1000 in travel and inconvenience to fly to another city for a procedure then people won't use a local hospital that tries to charge $10,000 more, so they charge only $900 more because it's all they can get away with. But that's only if there's price transparency -- if you can't find out ahead of time that it costs $10,000 more for the local hospital then people choose it anyway and there is no incentive for them to lower their prices, which is where we are now.

> You can't just walk into a hospital and choose between Name Brand MRI or Store Brand MRI. It requires a level of knowledge that most people don't have. It's knowledge I don't have! And something I'd prefer to never have to think about when I have other shit to deal with in real life.

And that option exists -- you buy an expansive low deductible insurance plan that covers everything. That necessarily comes at the cost of very high premiums, because it has to cover the cost of making you price-insensitive.

You can also buy a less expensive insurance plan that doesn't cover everything and then consider anything it doesn't cover as unavailable. That's what socialized systems generally do, because they do make people price-insensitive but still have budgetary requirements to meet. But there's no reason you can't get a private plan that does that either; just don't object when it doesn't cover everything. You pay for what you get, one way or another.

> Your analogy falls apart because the government does make mandates for cars. Things like safety features.

They also have mandates for medicine. There is a whole medical licensing system. That's independent from who pays for it.

> When you're looking for a car, you have some properties of a car which are easily understandable. When you're searching for medical assistance, most people only vaguely know what's actually wrong.

I don't see how it's different. There are plenty of subtleties when buying anything expensive that aren't readily apparent, like that car insurance can be more than the car payment, or that some models depreciate faster than others so you have to account for future resale value, or that some models have more frequent repairs, or more expensive repairs. Some people buy based on style and only later find out through experience the total cost of ownership is $40,000 higher than they expected.

It's the same thing with healthcare, but it's the same thing with healthcare either way. Regardless of who is paying, which doctor has the best patient outcomes? Which medication is more effective? What clinical trials are there for your condition? You can ask your doctor, but first you have to choose your doctor. And then, in the end, they only advise you what to do. It's still your decision and your life.

> Federal law requires employers to provide at least unpaid sick leave. That caps the premium a local hospital...

Not really. The law you're referring to is the Family and Medical Leave Act (FMLA), which only applies for childbirth and "serious health conditions". Most things you can shop around for also aren't serious enough to qualify, so you're not entitled to such unpaid sick leave.

But also, it's kinda a moot point because laws like that only apply to people that know them or can afford an attourney. Just like the person in the linked article didn't know she couldn't be harassed quarterly by the court system (rather, just yearly) due to being disabled, those who are most in need of that law are unlikely to know about it nor to have an attourney.

> If it costs $1000 in travel and inconvenience to fly to another city for a procedure then people won't use a local hospital that tries to charge $10,000 more

This assumes that people have both perfect knowledge of their procedure and the prices of all hospitals, and that people value money over convenience.

I know for a fact that I can fly to another country with free healthcare and get a procedure for cheaper than I can get it in the US, but hardly anyone does that regardless. It's just too inconvenient.

I also know for a fact that people rarely have even decent knowledge. Plenty of people buy incredibly overpriced cell-phone plans or internet. The free market hasn't been able to get those prices anywhere close what they should be even though people can switch providers, compare prices, and aren't stressed about their health.

FMLA has an even bigger gaping loophole - it only applies to employers with 50+ employees. That excludes an enormous number of people.

> Most things you can shop around for also aren't serious enough to qualify, so you're not entitled to such unpaid sick leave.

But now you're not making an argument for socialized medicine, you're just making an argument for requiring unpaid sick leave for a scheduled medical procedure.

> But also, it's kinda a moot point because laws like that only apply to people that know them or can afford an attourney.

Are there many laws that don't work this way? Would the same people be any better off if the government would pay for their medical procedure but they didn't get it because they didn't know that?

> This assumes that people have both perfect knowledge of their procedure and the prices of all hospitals

Which is the point of requiring price transparency. Your doctor should provide you with a list of all the places that can do the procedure along with their locations and prices and any other information useful to choose between them.

> and that people value money over convenience.

But that is the mechanism by which it operates -- there is a point where the money is worth more than the convenience, and once people actually know the amount of money required, that limits how much providers can overcharge because past that the inconvenience is less than paying the money.

There is nothing wrong with choosing convenience. It's the thing that allows trade offs between price and convenience to exist. Maybe the clinic near the big city will always have the best price because it has the most patients to amortize fixed costs over, so the rural clinic can only stay in business by charging more per patient. If the higher price is worth not having to travel to the city -- and people know that -- then people will choose to patronize it, which is how we know its value exceeds its costs. If everybody chooses to travel to the city for the lower price then we know the rural clinic costs more than it's worth, which is the same mechanism that causes it to fold.

> I know for a fact that I can fly to another country with free healthcare and get a procedure for cheaper than I can get it in the US, but hardly anyone does that regardless. It's just too inconvenient.

Because flying to another country is very inconvenient, and not at all inexpensive on its own. So the limit it places on overcharging is not very strict. Especially when you don't actually know how much you'll be charged, so you don't even realize that it would have been worth it to do that until after it's already done.

The inconvenience is much less to go to another town than another country, so that would provide a much lower limit on how much anyone can overcharge before people would do that. If they were actually provided with the price differences -- so why aren't we doing that?

Case and point, I have three reasonably sized hospitals within an hour of my house by car. All three of those hospitals made this list of top 50 most overpriced hospitals.

https://www.menshealth.com/health/a19543406/50-most-overpric...

My state has the highest rate of uninsured residents in the country and also one of the states that did not expand medicaid and take in federal funds to cover 90% of that. I paid for the best health insurance plan I could find on healthcare.gov and went with a doctor that was listed as a preferred provider with my insurance explicitly because my insurance provider claimed that any lab work, referrals, etc from that preferred provider would be covered and that they partnered with them to ensure that there wouldn't be any surprise out of network bills that weren't covered. The best health insurance plan I could buy left me out to dry for ~$600 in bills that were supposed to be covered 100% by my plan.

The notion of the magic of the free market driving down healthcare spending is nothing more than a libertarian fantasy. By any objective measure we spend far more than any other country on the planet for a given medical service. The fact that doctors and hospitals can't even tell you how much a given service will actually cost beforehand should be enough to tell you that the free market clearly isn't working here.

The nature of medical care doesn't allow for "users" to decide rationally. This is primarily due to the lack of domain knowledge concerning medicine. If you have a lump somewhere, and a doctor wants to X-Ray/Biopsy/Open You Up, you generally don't know which one is best. So prices don't help at all. And that's if by chance you are conscious and able to consent. When you are under, you don't get to consent to the actions of the surgeons ,anesthesiologists or whomever else they decide to bring in to assist.

> The nature of medical care doesn't allow for "users" to decide rationally. This is primarily due to the lack of domain knowledge concerning medicine. If you have a lump somewhere, and a doctor wants to X-Ray/Biopsy/Open You Up, you generally don't know which one is best. So prices don't help at all.

How do prices not help? You at least know how much you'll have to pay, which is certainly relevant information. You still may not know which one is best (no guarantee that it's the one that costs more), but what solution are you proposing to that anyway? Even if the government was paying for your medicine, how would that help you choose which doctor to listen to?

> When you are under, you don't get to consent to the actions of the surgeons ,anesthesiologists or whomever else they decide to bring in to assist.

Which is why it may make sense to have an insurance plan that fully covers emergency services regardless of network. But emergency services aren't the majority of medical costs.

"How do prices not help? You at least know how much you'll have to pay, which is certainly relevant information."

First things first, you probably have little choice in where you are going to get things checked out, as there may only be one place in town or one place your insurance covers or one place that works with the hospital your doctor goes to. It isn't like you can opt out if you suspect things like breast cancer, which might kill you, or if you are getting anything done in an emergency fashion. AT best, knowing the cost might give relief or stress and at worst, it'll cause some folks to die a slow death because they can't afford the cure.

IIRC, they aren't always upfront about this stuff during surgery. You simply don't know or there might not be folks in your network available for a variety of reasons (like your anesthesiologist being sick that day).

> They need to compete for our business.

No, they don't. When you're out of breath with pain running down your left arm and are about to collapse, you're going to try to get to the nearest hospital, not first shop around to see which one has the most competitive rates like you're buying a new car or something.

Emergency is one thing. For others you could have time to shop.

Have you ever actually tried to do this? It is hard.

A family friend, a very smart guy himself, was recently diagnosed with Parkinson’s Disease. Since I’m a neuroscientist, he asked me for advice. I work on brain stimulation, one of the better treatments for Parkinson’s Disease. My institute is a Parkinson’s Centre of Excellence, and I collaborate with movement disorders specialists. I have easy access to experts and tons of relevant training and literature. Nevertheless, I found it very hard to make a recommendation, even between the options his doctor had laid out—-and I wasn’t even considering price, since he has excellent insurance. This decision was smack in the middle of my wheelhouse too; helping with, say, a decision about kidneys would have been even worse.

There’s no way people, especially people in vulnerable situations, can reasonably be expected to catch up with experts that have a decade of advanced training and then second-guess them.

i was mostly saying "it should be possible", not that it is possible/easy today.

Ok. So when you have flu complications? Gall bladder issues? When you fell and twisted your ankle but don't need emergency services even though you can't really walk? When you need a stint put in? Or how about when you've been diagnosed with an autoimmune disorder?

Sure, you technically have time to shop, but it seems to me that this is just an excuse and makes sick people suffer more.

In all of those cases you can:

1. Take 30 mins to find the most affordable option. 2. Ask for a lower price.

1. The most affordable option may be a complete waste of money, and you have no way to tell ahead of time. 2. Ditto.

You also could just live in a country with a good single payer health service, and know that you'll be treated without any bullshit.

The fact that anyone would seriously suggest shopping around for treatment, as if there is a convincing and credible reason why anyone should even have to consider this, is beyond astonishing to me.

I think this is the part where i use "could". This is simply not possible today. Doctors dont really know or care how much "you" will be charged vs how much they get paid. If there was more transparency, you could imagine doctors and patients working their way out. People would see the inefficiency, and yake counter measures, both as care giver and care taker.

I have heard multiple stories now whete independent practices now just want cash, without insurance, payments for much cheaper, and they get paid more in the end.

2 is interesting.

We are expecting a baby, and one of the tests we had to get done early in the pregnancy was NIPT. There was 2-3 companies we could go with, and when we asked for the price they responded some number between >2.7K - I don't really recall - it could even be 8K. When asked for the cash price, they said 250$.

Crazy.

Stop with this free market nonsense. This is healthcare, this is real lives. It’s not the same as choosing which burger joint to patronize, it’s life and death.

> This is healthcare, this is real lives. It’s not the same as choosing which burger joint to patronize, it’s life and death.

We're not talking about the life and death part though. There are already laws requiring emergency rooms to see anyone who shows up. The question is how to pay for it, which is a matter of economics.

Medical providers not being able to provide the total cost for a non-emergency procedure up-front but then expecting people to pay whatever price they make up after the fact is practically fraud. The fact that it leads to outrageous costs is entirely predictable.

> Medical providers not being able to provide the total cost for a non-emergency procedure up-front but then expecting people to pay whatever price they make up after the fact is practically fraud. The fact that it leads to outrageous costs is entirely predictable.

I’d like to turn the question around and ask folks who believe that the healthcare problem is one of not enough market freedom: what’s an example of a country that gets a free market in medical care right, from your perspective?

We universal healthcare advocates have a couple of dozen examples lined up to support our perspective, what about from the other side?

The Netherlands and Switzerland both have functioning private insurance systems. There are also several functioning hybrid systems, like Germany and Israel.

But the primary reason you don't see more successes is the lack of attempts. It's not as if there is a long list of countries with failed free market healthcare systems, either.

The Netherlands does not have a private health insurance scheme. Or rather, it does, but all the prices are basically fixed, and the biggest choice you have is whom you are paying money to. The services are ultimately much the same.

Swiss here: Our health insurance providers might be privatized, but they're strongly regulated and every Swiss citizen must have healthcare. They do function, but not because of their free market incentives (my opinion), but because of strong regulations. Also, if there was a vote to go from public -> private insurers again (historically, they were public once), I think they'd stay public, because we're not really seeing the benefits of their privatization, only the downsides (tons of ads, calls, arcane coverage rules etc.)

Here in Israel the majority of large health providers are essentially contractors, are largely indistinguishable and don't compete on price at all. Everybody pays a health tax as a percentage of their income. You don't have to pay anything aside from it, but if you want additional coverage like improved dental and discounts for non-essential medication, the best available coverage through the largest providers would cost you about $25 a month on top of the health tax.

I don't know in what meaningful sense Israel is a "hybrid" system, it functions almost exactly like a 'Medicare for all' type proposal would.

The problem with avoiding market solutions to your problem is that many other areas of life could also make that argument "cell phones are needed to call the police, it's a matter of life and death, they should be free". "Houses keep people warm, they should not cost anything" etc. Reign in the cost of healthcare by allowing actual (cross state) competition and eliminate laws that give incumbents a free check. They should have to fight for your business as transparently and as hard as your tech company.

"cell phones are needed to call the police.." In the US, all cell phones with a charge can call the police (there are laws for this!) and there are programs to get free phones to those in danger. We already do this.

"Houses keep people warm, they should not cost anything" etc." I'm not sure who is arguing this, but it isn't a stretch for folks to agree that everyone should have access to shelter, even if you cannot afford it. I personally wouldn't mind standard and basic housing being free (Small kitchen/living room, bathroom, and bedroom or bedrooms)

I'd also point out that cross state competition would only help a little. Your laws need to be the same state to state, minimally, and most of the providers wouldn't change. Most insurance is provided through a job anyway, and I'd like to mention that most people's "tech company", besides social media, are ISP's with little to no competition.

It's not a free market if you're forced to participate. And if you're alive and want to stay that way, you're forced to participate.

So, no, "insurance" will never under any circumstances be the correct model to work from. (And no, I don't know what is.)

Sure it is, as has been demonstrated in many, many countries.

Completely agree. the main problem is not insurance, but healthcare cost. regulatory capture and lobbying lead to ballooning administrative costs and corruption on all levels. The Surgery Center of Oklahoma cannot be mentioned enough as a shining example how things should be done.

> please vote for medicare for all

No thank you. I've helped people with medicare and it's the worst health insurance I've ever encountered, with insane rules and brain-twisting billing practices.

I have absolutely no desire to inflict this on the entire country.

When you are promoting medicare - have you actually tried it? Are you speaking from a position of knowledge?

I have, it's terrible.

But worst of all it doesn't fix anything!!! The problems with healthcare in this country are that hospitals and doctors will need to take a pay cut, and we'll need to fire a lot of people in order to save money.

Medicare for all, at current payment rates, will just cause havoc.

I've not had Medicare, but know it is fraught with issues. So is the VA. I've also been under American health care through a job, been uninsured, and now am covered under Norway's health care system.

And I wouldn't trade my current system. I'd rather have medicare than nothing, and know that the issues it has can be fixed. Just because something has problems doesn't mean that it isn't better than nothing and doesn't mean that it isn't a good starting point.

It might not be so bad being a doctor if we fixed some supply issues: For example, making sure doctors (and everyone else) doesn't have tons of student debt. We can do things about how expensive malpractice insurance is: My dentist here in Norway would like to live in the US, but won't because of the malpractice suits. We can do things to simplify the office work, such as standardising payment scales and coding. We can make good use of nurse practitioners, especially for children who generally have run-of-the-mill infections THese things make it cheaper to be a doctor and cheaper to run an office.

You'd think we might need to fire a lot of people... but not really. Single payer health care means we can do things differently because our resources are pooled. Norway, at least where I live, will send a home nurse to your house for free up to 6 times a day. Even if you are in a cabin in the mountains or living on a little island. This is all because overall, this is cheaper than a nursing home... which costs 80% of your retirement, no matter how much you make.

There is also a private system, which mostly gives bells and whistles. You might get into a non-urgent MRI sooner and so on.

Medical school debt isn't a major factor (speaking as an MD with medical school debt who doesn't even practice). Great to get rid of it, but I don't think it will impact care either way. A better target would be letting student's start medical school earlier instead of after undergrad, and letting them pre-specialize into surgery and primary care. As is even family physician's have to go to medical school for four years and _then_ specialize in primary care. I think that's absurd. They should merge primary care into medical school and churn out primary care physicians by default, who could then optionally specialize.

Also my wife is a Dentist. She works 4 days a week and does extremely well. If malpractice and costs were an issue for Dentist's in the US, they would work more. I know a lot of dentists but not a single one that works 5 days a week. And of course no residency required. Its got to be the best career choice in the US today.

As for firing people... I agree probably not. But most Hospitals _do_ run on a tight margin (like 5% or less), and the majority of their costs are staff.

But overall, if you've experienced the system at all, you know how utterly wasteful and unorganized it is. Its difficult to fathom a system with more waste, which is especially ironic since there's so many smart people running around. I think single payer, whatever the flaws, would absolutely be a major change in the right direction.

Most people in the country disagree. And you politicians know this, which is why no politician would ever suggest removing Medicare.

No one smart uses Medicare, instead they use Medicare advantage, which is private health insurance funded by the government.

This is the part people don't understand when they promote Medicare for all - it's a really really bad plan, that people don't use unless they have no choice.

This should be the death nail in these proposals, except the people proposing it typically don't even realize the difference.

Medicare for all is a horrible idea.

Government funded private health insurance for all is a good idea.

I'm on MediCal, California's version of Medicare. Just want to say thanks for mentioning that. I had never heard of it before. I'm a young person who is also unemployed, and an orphan. Medi-Cal has been kafka-esque in how terrible it is. I relate it to therapists and doctors at the quality of school counselors and nurses, it's third rate care and it's practically made me lose all hope in getting treatment for chronic abdominal pain I've had for over a year and a half. I've been churning through doctors because they are so unprofessional to be flat out useless. One doctor straight up told me "so what do you want me to do about it?", And that's only one incident among many of the bad experiences I've had with it.

So to add on to what you've said, yes medicare is nightmarish. Hopefully this offers me a new chance to live a life.

It's late and I just realized MediCal is medicaid, not medicare. These program names are so confusing. Going to let out a large sigh and get some sleep.

Have you looked at bankruptcy options? Medical debt ruined my life. Bankruptcy got my life back.

I appreciate the advice. I may not have been clear in my rant but I am not in legal debt presently. If it were medical debt from a recoverable position and with support it would be a different story. I have skirted it by paying up front from savings or not seeking/getting care if it cost too much (a decision many have to make here) as I know in my condition and situation I would never recover once that happens. I will end things before that if faced with it. But conditions keep worsening making me fear that outcome. I was denied any governmental assistance even with lawyers and years of effort and my partial medical retirement pension has no medical insurance or benefits and isn't even enough for all needs itself, let alone extreme medical costs. I have been living with hyper-conservative family who have made things quite difficult for me, blaming me because my situation flies in the face of their beliefs, and that is coming to and end soon as I am blamed for their pre-existing 4th marriage issues being a convenient target.

Basically once you are removed from the ability to control and maintain independent life, to the normal degree most can, and there is no support network or safety net to rely on, you are faced with hits from every side which amplify each other and no matter how hard you try and what you do the exponential weight is crushing. There just wasn't enough help from family or systems when it would have enabled me to recover, and now I will never recover and there is even less help, meaning none, to survive when you are dependent. Likely since I have to move, I will just pack up and go abroad by end of year with whats left, rent a tiny flat for as long as I can, and hope a miracle takes place somehow before I am forced to flip the switch off. I don't have the funds, health, or support to survive anywhere legally or continuously alone...but I refuse for my last breaths to be here. Sorry for the anger...cathartic dumping as I have no real ear to bend regularly. It's been a rough few decades ;)

If you start looking at resources for digital nomads, you'll start seeing how people live abroad for cheap. Here's a recent video on living in Bankso, Bulgaria in an apartment for 150 Euro per month => https://www.youtube.com/watch?v=L_w28W1_4PY. Combine that with some online work, maybe teaching English, and you could probably do OK.

I've been there and been that digital nomad. I have lived in cheaper countries. I've taught English. Those things sound romantic and if you are healthy and have special skills you can have a good life. If you are not healthy and are competing with every other gig worker who IS and is half your age, and every other native speaker, hustling in the grind every day it's not sustainable. It was quite hard even when things weren't as bad as now. It's exhausting and doesn't (in most cases) give you any of the stability,immigration requirements, access to systems, consistency you need to live when you aren't able to sleep on floors and rough life. It sounds nice and I know the advice is well meant. It's just not like people imagine in context.

An extreme option to consider before the edge gets you:

Move to another country. One that has free healthcare even to foreigners. Yes, they exist. Brazil is one. I'm not sure but I've heard Spain might too.

Granted you wont get the best and most responsive health care in the world but at least you'll get some and for free.

Things are different out there. Worse in some aspects, better in others.

Just something to think about. Stay strong.

I've been trying to move back abroad since I returned to the USA. It's not as easy as people think in the best of times to immigrate, let alone when you are in such bad shape all around. No place takes broken and relatively broke people. Believe me I'd have been gone years ago if I could have managed it. I've thought about extreme ideas like asylum but my research shows it's never granted to people from such countries as mine and for such reasons. The system is taxed enough with war refugees and people even worse off. I'd happily trade passports with anyone who thinks this is the place to be. There is just not a clear path to a sustainable life anywhere now.

In my travels getting a long term residency visa requires a medical exam. I’m not sure how people think immigration in other countries work but it’s not as simple as showing up at the airport.

If you're moving because you're probably going to die if you don't, does it really matter whether or not you're doing so legally or not?

It's really easy to remain in EU forever as an illegal immigrant, in some places your immigration status will have no effect on your access to free healthcare.

Because as someone said below it's not going to fix things just by being in another place I like better. Being illegal is a hard life with constant risk and lack of access to many things. It's not "really easy" at all and I don't know why anyone would think that. I need MORE stability than I have...not less. I said I am going to move because I refuse to die in this miserable country after what it's done to me. The only power I have left is to choose where it ends. It's not like I think moving will solve things in itself. I am in bad shape all around and am sick of suffering and the common response being to teach myself how to swim and get a job as a swim instructor as I am drowning. The clear lesson is society here thinks if you cannot produce consistently or enough for their ledger then you don't deserve to live. That's that.

> Being illegal is a hard life with constant risk and lack of access to many things

It's a hard life in the US, often with access to even less things than illegal immigrants have here. Not sure what this "constant risk" is, unless you engage in violent crime you'll find it very difficult to get yourself deported.

By far the biggest thing you lose is the ability to fly around easily, but it remains (and will remain) easy to sneak out after overstaying your visa waiver.

> It's not "really easy" at all and I don't know why anyone would think that

Because I know multiple illegal immigrants who vastly improved their lives by moving. A good friend of mine spent 4 years going in and out of KS state prisons, after a while he decided that he needed a change of scenery and hopped on a plane to Spain.

There's little chance he could get a visa without lying, but that hasn't really affected his life. He makes a living freelancing online, gets paid to his US account and pays the IRS. Here he enjoys access to excellent healthcare without risking bankruptcy.

I've met many illegal aliens in the EU. It's not an easy life. Yes, you could move to one of the EU countries, clandestine. You would give up up a lot to do so. Access to work would be "on the black." Access to housing would be restricted to sublets with multiple roommates, who are also in the same illegal immigrants. A good friend of mine, without papers, was living 10+ people in a 2 bedroom flat. Everything he owned had to fit in a dufflebag. Not everyone from developed countries is willing to make that sacrifice for the potential access to better healthcare. If you came from a poor country, though, it's a big step up.

> Access to housing would be restricted to sublets with multiple roommates, who are also in the same illegal immigrants.

Nobody has ever checked my immigration status while renting in the EU, nobody has ever cared about the fact that I work for an US company owned by me that pays my salary to my US account.

Sure, maybe you'll have a bad time renting in France. Don't go live in France unless you want to have a hard time while renting.

> A good friend of mine, without papers, was living 10+ people in a 2 bedroom flat

A good friend of mine, is here illegally and lives in a nice central 2 bedroom flat in Barcelona all by himself. He had zero trouble finding an apartment, the landlords just don't give a shit.

Many illegal immigrants are completely broke, but that's by no means a requirement.

Have you looked into working remotely and then moving somewhere like Argentina? They are very open to immigration and you can apply for citizenship after two years.

I have. In fact the once in a lifetime offer I got from a member here, the only real help in all these years, was to work remotely and live in Europe. My only real friends are there and my previous doctors there were wonderful so that is the goal. But a (as usual) complicated health issue made doing that job and that time impossible for me and I hate every day that it might have been the last hope. My health keeps blocking things. I don't even know what I could do to earn at this point that I would be sure of being able to sustain. I cannot depend on my body for consistency unless that consistency is pain and weakness at varying levels and that's incompatible with your ability to live being linked with your ability to use said body consistently to work in trade for cash. Every time I invest in an idea with energy and money something else happens to crush it. I'd need years of physical, financial, and mental stability to even begin to recover some life and simply cannot start entirely over with no help like one can when they are young and healthy. I have no bootstraps in any sense of the word to pull on.

I may be able to offer you a similar solution (remote job so you can live in Europe) as I have a UK company and my whole team is remote. You write beautifully and thoughtfully, which is what I need. Please shoot me an email to dbulic at my username dot eu - let's see if we can work together.

If you are a software engineer just came to brazil and you will live as a king here. There more than 400,000 jobs opening related to computer science.

And I’m sure you will have access to universal health system and private ones.

I am not a sw engineer and cannot work consistently or enough to earn like a normal person. That's the entire problem. My health was ruined and my finances decimated. Since without social aid your health is required to work and buy a life that puts me in an unsurvivable situation.

Maybe post this on Reddit in /r/legaladvice - maybe there's a better subreddit - re: all of this? I have seen some seemingly helpful advice or links to resources that can help.

> "things I did not consent to be sent away or billed externally."

This may be the thing that most baffles me about this: how can you be held responsible for costs you never agreed to?

Mysterious medical costs popping up that you were never aware of and never agreed to, sounds like a recipe for fraud and extortion.

Some medical issues spontaneously present and you end up needing an emergency procedure and there’s very little you can do in that situation to control the costs.

In the best case scenario, everything is considered in-network and you are on the hook for up to your annual maximum out of pocket expense.

But for a condition where you can predict a short/medium term future which is going to involve being inundated with medical bills, one thing you absolutely must consider is whether working (earning money) is actually costing you more than not working.

It’s going to vary dramatically depending on the state you live in (and that’s something you need to consider about where you decide to live) particularly if the state expanded Medicaid under ACA.

In cases where there are massive predictable bills, earning a dollar more than the Medicaid eligibility threshold will likely cost you at least $10-$20k per year after tax, but in a failure mode could cost you much, much more. Not to mention there are no premiums - compared to potentially paying the full out of pocket maximum on top of full-bore monthly COBRA premiums after losing a job - if you don’t realize a better option is available.

Getting income down, getting on Medicaid and SNAP, shelters you from any medical bills (you literally never see a bill on Medicaid, and can see a huge network of providers) and that peace of mind can help you focus on healing.

In some states if a medical issue forces you to stop working you can also get short-term disability payments which are entirely tax free, and do not count toward Medicaid eligibility.

It’s important to understand all the options that are possible and under what terms they are accessible, and be willing to do what’s necessary to get access to those benefits when your life depends on it.

Now you know why people use cryptocurrencies. Can't be seized for medical debts or anything like that.

Take your savings and move out of the country.

I lived abroad in the past. Had a much better life and healthcare. But now that savings is so small and my health so limited I cannot just "move". I wouldn't be able to sustain myself financially. There are immigration requirements I cannot meet. I would love nothing more to leave. But even then things are so bad with pain and health I would never have a good life, maybe just a survivable one in a more comfortable environment for me. But again, the consequences of what was done to me here has taken away the ability to immigrate as per usual. An amazing member of this site once offered to help me with his company abroad and I fought to make that happen but more and more health and financial issues kept hitting me and I couldn't make it happen. When even such an accommodative thing won't work out it robs you of all hope. Occasional rants, when energy and pain allows (the real killer), seem my only attribute at this point. The dying gasps of an angry man.

This is only one problem of many, so I definitely don't expect pointing this out to do anything to change your situation.

>There are immigration requirements I cannot meet

If you could vastly improve your life by moving, why would you let immigration laws stop you? It's really hard to get kicked out of the EU and you shouldn't have any issues with access to healthcare in places like Catalonia, Helsinki and I'm sure many others.

Answered above. I cannot work in any consistent and significant way and without enough money and legal status none of the things you have when ill are available. It's not just about a location. I can't live rough or in an unstable situation. It's also not hard at all to be deported.

Im confused as to why you don't just walk away. After 7 years it will fall off your credit report and u can start over.

I don't have a financial strain bankruptcy would fix. I cannot walk away from current needs for medical care, housing, food etc. I am getting worse not better which equals more needs and cost with less to no resources. You cannot sign up for a post paid life in America and just ignore the costs. The featured article shows how that debt snowballs into worse issues. There won't be seven years in my future at this rate and no means to start over now let lone then. It's not a hiccup to get over nor some administrative issue to be worked around. The amount of "Why don't you just...." that I have heard over the years robs me of all hope. It's usually well meant and not malicious...but its never actionable or realistic and rather based in what people think it SHOULD work like or how it will be for them if they need it.

Im sorry to hear about your situation. I asked the question because I have a family member who was in a similar situation to you and rather than make prudent choices, he made decisions based on pride and not wanting hand outs. Years later if cost him dearly. Not saying this js you, but I know there are people who pay debts because it's. "the right thing to do" without realizing it may be the worst thing to do for them in their situation.

I apologize for any defensiveness. I am exhausted and tired of being in pain, poor, and alone. I am often criticized and blamed and it conditions you to expect bad from people. I try to stay aware many people mean well but sometimes I overreact. I avoided asking for help for a long time for the pride reasons you mentioned...hoping I could find a way...but once it became clear that wasn't going to happen and I did reach out it was denial and silence at every turn. In all these years only one person, a complete stranger, offered any real path, and like some perfect game some trickster god would design that path was blocked by outside forces as I took the first step on it. Seeing every system you trusted and all the people who promised you support deny you...and worse BLAME you...is soul crushing.

Most important question... what health issues are you dealing with?

That's not something I feel would help me in any way to get into publicly. It's multiple very difficult issues with no cure and little understanding even (legitimate and diagnosed...not quackwatch sort of stuff...just not common nor cared about much overall), mostly iatrogenic, I have done all the normal stuff you are supposed to, a lot of alternative stuff, and have never once gotten any useful advice from explaining it all in detail that helped. At best it's just "wow that really sucks and isn't fair". At worst it's "if so much bad keeps happening it must be you". I don't need any more surgery, lab test, medication, diet, or yoga suggestions. I just need stability so I can cope as best as possible within my limits.