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Old 2009-06-04, 00:43   Link #1
Solace
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The Future of US Healthcare

This thread is for the discussion of the future of health care in the United States and the world in general. As many are aware there is a great debate raging about the health care system, from costs to the pros and cons of nationalization. So, some questions to get this going:



What do you think of the US health care system? What can be done to improve it?



As always, please try to be civil and thoughtful in your responses.
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Old 2009-06-04, 01:13   Link #2
yezhanquan
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The fact remains that in many countries (especially Singapore), it's better to die than to be sick, with or without nationalised medicine. Illnesses cost plenty of bombs to treat. The only way to go, IMO, is preventive care and awareness to bring down the number of cases.
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Old 2009-06-04, 01:42   Link #3
Reckoner
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Originally Posted by SaintessHeart View Post
Heavily subsidised healthcare is more dangerous. Like what before Aunt Marge did to UK back in 1980s, old men would just sit in clinics to waste their time and take up spaces because healthcare could be said as almost free.

But I see what you mean by exchanging wealth for health. It brings capitalism to the extreme end and damages the societal structure that is partially built on idealism and "morals".

Hippocrates probably rolled over in his grave the moment this becomes ridiculously lopsided, but personally, I view life rather than healthcare as a fundamental right, it is important to take care of oneself rather than sustain illnesses and injuries that require a higher level of medical attention due to neglect.
Replying from the News Stories thread...

Well, look, sometimes you suffer health problems not because of lifestyle choices. Say one day you find out that you have "XYZ" condition, disease, or problem while you are a freshmen in college. All of a sudden, in order to save your own life, you must go into a lot of debt (If you do not have health insurance, which many people in the U.S. don't because it's just not affordable) to get health care. And you can just imagine how these stories end...

Basically, all I am saying is that if people need care, they shouldn't have to fear the extensive costs. We often talk in society that we cannot put a price tag on lives, but that is what we are doing in the health care sector... It's such a hypocrisy.

Now I'm no expert on the medical industry, though I do have a mother who works in a doctor's office and sees first hand how patients and doctors abuse medicaid and medicare. There are issues with both sides of the public vs the private structure argument and I'm not the one educated enough to make a decision on what exact plan is the proper course of action. It is obvious though that the current system is broke and has succumbed to corporate greed.
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Old 2009-06-04, 01:43   Link #4
Vexx
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(reblurb from other thread)
The most practical system being proposed is the "single payer health plan" as a non-profit process. It takes the insurance profit leeching out of the picture and its the one that almost all the medical professionals in the United States are on board supporting. Many of my friends and acquaintences are doctors, pharmacists, and other medical types... not a single one doesn't support a single-payer non-profit system at the least.

You can blame Senator Baucus of Montana for trying to keep that option off the table (owned by the insurance lobby one might guess) despite the fact his constituents in "conservative Montana" are literally going apeshit on his aides. He doesn't seem to want to actually meet with his voters at his town hall meetings it seems. (one of many example news reports: http://missoulian.com/articles/2009/...cal/news02.txt) So if this is important to you, you might want to write him whether he is your Senator or not, because he's affecting every citizen in the US on this matter.

Importantly, a single-payer non-profit plan means that small business and all the other business can get out of the crushing burden of having to provide benefits to their employees. They can even pay them more (as much as 40% more based on total employee package cost of salary+benefits). Business shouldn't have to be involved in healthcare processes of their employees. Healthcare professionals no longer have to deal with 200 different insurance companies each with their own processes, automatic denials, formulary-of-the-week resulting in more savings.

On preventative healthcare, the HMO I use is one of the FEW in the country that actually believes in preventative care and it shows in their statistics (both in patient health and the health of the HMO). Its a matter of being non-profit rather than a MAXIMUM-forget-the-patient-who-cares-the-quarter-is-coming-up profit. Apparently the stakeholders are fine with that because, guess what, it is a non-profit organization - if that were the rule instead of the exception, we might not be having this discussion.

The current system for most people is broken. We have nearly 50 million people whose only option for healthcare is the Emergency Room (now *there's* a brilliant costsaver-not). We have almost twice that many that THINK they're covered -- til their world collapses financially after the 'fine print' and 'restrictions' are revealed in many policies. (Note: check what your lifetime maximum benefit is... also check to see what treatments they won't cover)

The question is how do we address healthcare as a people in a way that shares the load amongst everyone. Some of that may include expecting as a society for people to move more and eat less .....

Last edited by Vexx; 2009-06-04 at 02:25.
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Old 2009-06-04, 01:57   Link #5
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Now, the non-lifestyle diseases can really come from left-field, and they are expensive to treat. How do you finance stuff that can be equated to a cosmic roulette?
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Old 2009-06-04, 02:19   Link #6
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With a user pool that isn't cherry-picked by a for-profit insurance group, the costs are spread across a huge pool. If you can get a huge pool of participants, disaster-care coverage costs are spread nicely thin.

Anyone who has had to negotiate health plans for small (~100 person) business versus larger (~1000+) sized businesses know that the insurance companies give a slightly better rate to larger companies because they know statistically that a lot of money will come in and only a few will need it.

One company I worked for (small one) got dumped by the carrier because we had "too many women" (all those darn wimmen problems). When we proposed the idea of co-oping up with other small companies in the area to create a larger pool, every single insurance carrier said they'd blackball us. Bluntly and without sugar-coating...

They love the divide and conquer -- they can charge more.
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Old 2009-06-04, 02:21   Link #7
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Talk about corporate raiders, but this kind of behaviour is pushing it.
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Old 2009-06-04, 02:22   Link #8
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This whole thread reminds me of a famous tale of Aesop, Ant and the grasshopper.
Preventative healthcare means eating right and daily exercise again something lacking in the general US lifestyle.(Paying monthly fee to go to a sportsclub only to ride a car to anywhere and everywhere you go)

One of the reasons of the US auto industry bailout escapade is lack of national healthcare which the labor union demanded. This will again happen again if not changed.
The Japanese national healthcare system with all it's problems still provides minimum coverage which all stake holders pays their share. Companies pays a tax deductible amount of 1/3, the employee pays 1/3 and the government pays the remaining 1/3.

The underlying fundemental resistance to national healthcare system is because the idea is based on socialism and conservative people is led to believe that private industries can come up with a better and cheaper solution, an illusion fed by financial institutes. National healthcare does not generate profit like private health insurance since premium must be set to the lowest common denominator regulated by the State.
I think the US people in general needs to re-evaluate the entire captalism band wagon since it has a major flaw and that there are leeches that feeds on the ignorant.
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Old 2009-06-04, 03:44   Link #9
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Originally Posted by yezhanquan View Post
The fact remains that in many countries (especially Singapore), it's better to die than to be sick, with or without nationalised medicine. Illnesses cost plenty of bombs to treat. The only way to go, IMO, is preventive care and awareness to bring down the number of cases.
Compared to other countries, Singapore's healthcare is pretty good IMO (provided you are a Singaporean). I will try and make a summary of it and do a comparison case study tonight.

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Originally Posted by Reckoner View Post
Replying from the News Stories thread...

Well, look, sometimes you suffer health problems not because of lifestyle choices. Say one day you find out that you have "XYZ" condition, disease, or problem while you are a freshmen in college. All of a sudden, in order to save your own life, you must go into a lot of debt (If you do not have health insurance, which many people in the U.S. don't because it's just not affordable) to get health care. And you can just imagine how these stories end...

Basically, all I am saying is that if people need care, they shouldn't have to fear the extensive costs. We often talk in society that we cannot put a price tag on lives, but that is what we are doing in the health care sector... It's such a hypocrisy.

Now I'm no expert on the medical industry, though I do have a mother who works in a doctor's office and sees first hand how patients and doctors abuse medicaid and medicare. There are issues with both sides of the public vs the private structure argument and I'm not the one educated enough to make a decision on what exact plan is the proper course of action. It is obvious though that the current system is broke and has succumbed to corporate greed.
I get what you mean and thought about that before. Just looking at things from a different perspective in that post you quoted.

Much as many wants to put a sacrosanct label on life, pragmatism gets in the way by debating on an individual's worth in society using contribution (often material) as a gauge. In a MAD scenario, if there is enough shelters, we could have housed the entire human race, but due to limitations we only choose the "brightest" and the "most important".

Similarly, I think an utopic view would be that everyone has access to all forms of healthcare in an event of a threat on their life, but practically it is impossible due to limitations of funds and healthcare professionals.

The privatisation of healthcare is actually an attempt to boost the economy via foreign expenditure (spending money in the country profits the government), but eventually it leans too far to bring doom upon those who really needed it but had no money. Eventually, it all boils down to bad management and insufficient attention paid to crisis aversion.

The US has the brains to solve it and even advert it, but they are just too lazy and spent valuable time and money on places that do not benefit them. It needs to have an immediate and serious reassessment of financial priorities (yeah, just scrap the F22 program already and do something about the Stryker's).
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Old 2009-06-04, 04:04   Link #10
solomon
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Originally Posted by Tri-ring View Post
This whole thread reminds me of a famous tale of Aesop, Ant and the grasshopper.
Preventative healthcare means eating right and daily exercise again something lacking in the general US lifestyle.(Paying monthly fee to go to a sportsclub only to ride a car to anywhere and everywhere you go)

One of the reasons of the US auto industry bailout escapade is lack of national healthcare which the labor union demanded. This will again happen again if not changed.
The Japanese national healthcare system with all it's problems still provides minimum coverage which all stake holders pays their share. Companies pays a tax deductible amount of 1/3, the employee pays 1/3 and the government pays the remaining 1/3.

The underlying fundemental resistance to national healthcare system is because the idea is based on socialism and conservative people is led to believe that private industries can come up with a better and cheaper solution, an illusion fed by financial institutes. National healthcare does not generate profit like private health insurance since premium must be set to the lowest common denominator regulated by the State.
I think the US people in general needs to re-evaluate the entire captalism band wagon since it has a major flaw and that there are leeches that feeds on the ignorant.
Could you explain what that flaw is? Cause as much as I hate to admit it, it is hard to name a government overseen organization that does things better than the private sector.
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Old 2009-06-04, 04:48   Link #11
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In many cases, the reason for that is fear of competing with the private sector... Amtrak (or a collection of train operators like Japan or Europe has) could be fantastic but for one thing - the for-profit freight trains have right-of-way (on railroads built with massive government subsidies and breaks). An unreliable train system is doomed no matter what money you throw at it.

In some cases, its because the private sector would have never done it on its own because of the startup costs (NASA which gets tremendous value per dollar by any accounting).

Social Security would be quite in-the-black if the politicians wouldn't steal from it. Once a month it delivers an astounding number of checks properly.

Medicare has been quite successful - medical professionals love its smoothness BUT they grimace because it is underfunded --- why? Because there's a cap the number of dollars of a person's income that are taxed. A couple making $250K a year only pays Medicare taxes on the first $90Kish. Someone making a million a year only pays Medicare taxes on the first $90Kish. Hmmmmmm, that's not even a flat tax - its just stupid. (and yes, our family makes well over the cap).

I'd like to slap anyone that claims "private sector always does it better". They literally don't know what they're talking about. I've worked in private, non-profit, and government. Any corporation can be not only just as inefficient as any government but often more inefficient because of the politics within the corporation and the authoritarian hierarchy -- Dilbert is a corporate manual, not a satire.... I can give specific examples of both brilliance and godforsaken-waste in each sector.

Any organization, corporate or government, can be a piece of crap or relatively trouble-free.
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Old 2009-06-04, 05:08   Link #12
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About that single payer health plan, both countries I mentioned in the other post, UK and Canada both use single payer health plan and they both have similar problems with it. Too many people vs too little resources which results in increasingly ridiculous wait times for people to get the treatments they need. I'd agree that something needs to be done to address health care costs, but handing everything over to the government to royally screw it up is probably the absolute worst possible thing to do. I honestly don't get where peoples faith in the government comes from.
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Old 2009-06-04, 05:21   Link #13
Vexx
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"single payer health plan" seems to mean very different things to many people. The proposal here is that everyone signs onto a single non-profit insurance entity (the actual execution of the processing will probably be outsourced) that has the entire citizenry as its user pool rather than many tiny splinters and chunks of the population.

Rather like my non-profit HMO, you call the appointment person, make an appointment, go see the doctor.... if you're using a popular doctor it might be tougher to get in when you want. That doctor only has to deal with *one* insurance/billing entity now -- not hundreds of entities spread across his patient load.

In the case of single payer though, the doctor doesn't work for the government - but he does have to follow "best practices" (as he should anyway) as determined by groups of doctors and the payment would be made based on the cost of "best practice". No one pretends this won't have bumps and goofs - the point is to stop the enormous siphoning of $$$ out of the system at all levels and to stabilize expectations for what kind of healthcare every citizen can expect.

I do invite anyone to research many of the for-profit HMOs around the country and check out their resources and wait times --- they've become ridiculously inaccessible as well. The HMOs maximize profit by constricting access to the service and reducing the assets that provide the service. They also deny or eliminate services that are less profitable. They are barely accountable to the patient, marginally accountable to the employer, and mostly accountable to their executives who feign accountability to the stockholders...
The same problem *could* happen no matter what constructs one devises --- but it is already the case now. And the existing system still doesn't address the 40 million plus who don't have insurance.

Oh and many people can *afford* insurance... but no one will insure them because they have pre-existing conditions. Friend of mine was force-retired/laid off a couple of years ago at age 45... he has diabetes. So far he's been unable to find anyone to insure him. He also has been unable to get hired because of his medical condition --- since businesses are forced into the healthcare providing, they don't want their rates to go up. He lives in a state with no state government "safety net" insurance plan.

Last edited by Vexx; 2009-06-04 at 05:36.
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Old 2009-06-04, 05:29   Link #14
Tri-ring
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Originally Posted by solomon View Post
Could you explain what that flaw is? Cause as much as I hate to admit it, it is hard to name a government overseen organization that does things better than the private sector.
Vexx elaborated the reason eloquently.

If I were to add as Vexx also posted, projects with massive startup costs like social infrastructure will not be possible by the private sector.
There are also business like trash collection, waste water treatment that needs to be heavily regulated because private sectors may cut corners to obtain maximum profit with little safegaurd to health and/or enviorment.

Capitalism's main objective is to pursue profit which may go against the required need of public service. In these cases capitalism fails because it is interlocked into a self-contradicting position.
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Old 2009-06-04, 05:44   Link #15
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In these cases capitalism fails because it is interlocked into a self-contradicting position.
That's a core element of my problem with our existing healthcare system. The customer of the health insurance package is not you, it is only marginally your employer (the one who has to negotiate and buy a package); the customers are the health insurance executives looking for those bonuses and profits for not spending the money they bring in.You are not in their interest except as a cash source. When an employer is negotiating for an employee package, there isn't a customer-vendor relationship... its "we don't know if we want to risk having your company in our system, its going to cost you".

Employers who opt out of insurance for their employees -- end up with uninsured employees who get sicker because they can't get insurance on their own (ever price individual policies??? They're priced to say "f you, we really don't want your business because you're just one person and we only want to deal in large volume"

Their goal is to extract the maximum amount of money out of the system for their own pockets while spending as little as possible to achieve patient or medical care goals. It is the innate nature and definition of a for-profit corporation and directly at odds with the health of the citizens of society.
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Old 2009-06-04, 05:46   Link #16
SaintessHeart
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Originally Posted by Tri-ring View Post
Capitalism's main objective is to pursue profit which may go against the required need of public service. In these cases capitalism fails because it is interlocked into a self-contradicting position.
I would fix that line as "Capitalism's main objective is to pursue profit at all costs." There are a few of which points as abovementioned where captalism has succeeded with a little tweaking.

Take for example Hyflux and Blackwater/Xe (examples are not chosen for a pun, just coincidence). Both of them sell ideas for huge amounts of money with little loss. Water Treatment can be done by just contracting any company, but Hyflux did it by providing a quality service and investing in water infrastructure assets, which are aplenty since earth is made of 80% water.

Blackwater, on the other hand, provides a proxy fighting unit to conduct deniable operations at a manageable cost (e.g go in, blow up the building, but let the soldiers get back on their own with little help on extraction). The field staff provided may be paid higher, but when they are dead, there is no need to pay them long term so the company saves money on that.

So basically, things like trash collection and water treatment CAN be profitable if run alongside other things. It would be a "form of investment in public relations" so to speak.

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Originally Posted by Vexx View Post
That's a core element of my problem with our existing healthcare system. The customer of the health insurance package is not you, it is only marginally your employer (the one who has to negotiate and buy a package); the customers are the health insurance executives looking for those bonuses and profits for not spending the money they bring in.You are not in their interest except as a cash source. When an employer is negotiating for an employee package, there isn't a customer-vendor relationship... its "we don't know if we want to risk having your company in our system, its going to cost you".

Employers who opt out of insurance for their employees -- end up with uninsured employees who get sicker because they can't get insurance on their own (ever price individual policies??? They're priced to say "f you, we really don't want your business because you're just one person and we only want to deal in large volume"
That is pretty much a behaviour of selfishness and refusal to look in a direction which both parties benefit. Or it could be said to be lazy since selling a single insurance plan could be hectic compared to selling one to a group ; you get more from a group but you do the same amount of work for both.
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Old 2009-06-04, 06:03   Link #17
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Old 2009-06-04, 08:24   Link #18
Tri-ring
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Originally Posted by SaintessHeart View Post
I would fix that line as "Capitalism's main objective is to pursue profit at all costs." There are a few of which points as abovementioned where captalism has succeeded with a little tweaking.

Take for example Hyflux and Blackwater/Xe (examples are not chosen for a pun, just coincidence). Both of them sell ideas for huge amounts of money with little loss. Water Treatment can be done by just contracting any company, but Hyflux did it by providing a quality service and investing in water infrastructure assets, which are aplenty since earth is made of 80% water.

Blackwater, on the other hand, provides a proxy fighting unit to conduct deniable operations at a manageable cost (e.g go in, blow up the building, but let the soldiers get back on their own with little help on extraction). The field staff provided may be paid higher, but when they are dead, there is no need to pay them long term so the company saves money on that.

So basically, things like trash collection and water treatment CAN be profitable if run alongside other things. It would be a "form of investment in public relations" so to speak.
I don't know much about their systems to give an accurate assessement but waste water treatment for example is not just about treating the water but it's also required to process the waste that came out through the treatment.
You just can't dump that in a dump site or it's completely a zero sum gain to society where only the private corporation gains profit.
I am not saying Hyflux is doing it that way since I do not know the company but you really need to scrutinize thoroughly to actually know these kind of unique business model.
The second example, Blackwood can only work when there is enough staff willing to take the risk which again will become a problem to society as a whole in the long run.
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Old 2009-06-04, 08:54   Link #19
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Originally Posted by SaintessHeart View Post
And we scan that 100 times more. I went for a few BASIC (para)medic-level FA courses before, and that is the standard medical procedure across the world. In triage, it is important to know which is the part that requires IA, and there is a need to do complete treatment before going onto the next one to prevent complications.

For example, if a bomb explodes, and there are two patients : one with his leg below the knee blown off and another with fragmentation in his neck, rupturing the jugular, you treat the one with leg problem first because the there is little use of treating the other because he won't live more than 10-15 minutes. The other guy would just have 1 less leg for the rest of his life.
Imagine in front of a facility, instead of 100 people, you have 10,000 people. Oh, and most cases are not that obvious. The most important part of the process is the self-diagnosing of the patient. If he doesn't go to see you, then there is nothing you can do.

You oversimplify the problem by believing that being socializing health care the only difference it makes to the current system is that instead of paying to get diagnosed for say, heart disease, a patient will have to pay nothing. That is not true. That patient, if not restricted by the cost, will also go to see other doctors trying to scan for unforeseen diseases. At this moment, we don't have enough doctors and people are proposing adding 100 times more workload to them? Ridiculous.
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That is the hard truth of lifesaving. You can't save everyone.
And that is what advocates of universal health care are trying to do.

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There is a reason why you CONSULT a general practitioner FIRST. The human body is bloody complex, it is theoretically impossible to straightaway diagnose cancer or heart failure.
You have a perfectly healthy looking guy who also think he's healthy going to see a practitioner. What will they talk about? Football? There are diseases that without careful scanning, there is no way even a doctor could tell, like you said. So let me ask you again, in the population of 300,000,000 people, using what methods would help pinpoint who needs what?

Quote:
Of course, the cost of going to a GP is mutually exclusive from the argument. That is a financial problem, not a medical problem.
_Doctor, my stomach hurts really bad, please see me.

=>No, I can't. It's required that you see a GP first.

_But the line is too long there.

=>What a shame!

Quote:
Then the doctor shouldn't even be a doctor in the first place. It is his duty to provide medical attention to those who need it.
Huh? A students spend 10 years to become a doctor not only because he loves humanity, you know. Generally, that doctor would cater the sick first because he will get paid more.

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Old 2009-06-04, 10:20   Link #20
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I don't know what will be of this....but I hope good healthcare will be available in the US. I am only 21 and I have a large debt in the hospital and my family pays big money every month so my treatment will continue.

It only worsens when I have never worked due to Major Depression and GAD and I am unable to attent school anymore.
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