seriously. paying almost 5000 a year for health insurance through my job. decent plan. covers most medical stuff. but dental is completely separate. i have to pay another 50 a month for a dental plan that covers basically nothing.

i went to the dentist last week. cleaning and xrays. my insurance covered the xrays. but i still owed 150 for the cleaning. they said well your plan only covers 80%. so i'm paying 600 a year for insurance and still paying out of pocket for basic stuff.

then the dentist said i need a filling. 350 after insurance. i asked how much without insurance. she said 400. so my insurance is saving me $50 on a filling what's the poin

anyone else feel like dental insurance is a scam? like why is medical and dental separate. it's all the same body.

I've been at a medical administration job for about a year now. New field, so I've been eager to learn and try my best at the job navigating the complex labyrinth of medical billing and claims, and entering theatre lists from surgeons rooms into our system.

Recently, there has a huge push for the usage of OCR technology. It's supposedly meant to streamline our jobs and make us more efficient etc.

However, in practice all it does is take forever to load, 80% of the time it can't even read patient data from lists, and when it does read patient data it garbles it and gets it all wrong, requiring us to go in and manually correct it all.

In this time, we could have just entered the theatre list correctly the first time around. More accuracy, more efficient, which helps because we're understaffed.

We're instead being forced to use the OCR so that eventually it will learn the quirks of different lists and hopefully provide a good result. However, it's not a learning AI, it's simple Optical Character Recognition which means that any adjustments need to be manually made on the backend by an also understaffed tech team.

Additionally, now the finance manager is asking us how much we use AI in our jobs and is pushing for more AI usage in the workplace. She was disappointed when I said I didn't use any, because she's obsessed with ChatGPT. I just think it's monumentally foolish to introduce AI elements when it comes to communicating with doctors and patients.

She says "you need to get with the times!" - bearing in mind that this woman is older than me, and the last time she said "get with the times" we got a useless OCR that we have yo use, and she tried to phase out physical letters in favour of a strict email only policy, despite the fact that a large portion of patients we deal with are elderly and require physically posted letters rather than an email/sms with a link to the buggy patient portal designed by the same guys who created the OCR software.

The second the OCR was implemented, I pointed out all the pitfalls, all of which came true within a week.

Is there any point bringing up the same pitfalls we'll get with AI usage? Or do I just roll along with the bullshit and keep getting paid?

I just think it's going to be a giant negative impact on the medical field as a whole. If people are relying on AI to even write an email or summarize something for a doctor, then surely that's just going to result in dumber people with zero accountability, none of what you want in the medical field.

What do I do?

https://www.rcn.org.uk/news-and-events/Press-Releases/nurses-stacking-shelves-as-graduates-blocked-from-third-of-entry-level-nhs-jobs

I (28M) had deep vein thrombosis in my left shoulder/clavicle area. Turns out I have Thoracic Outlet Syndrome, which is ratio'd 3 out of every 100,000 people. My form of TOS is veinous, rather than the common neurogenic that makes up 90% of cases. Safe to say it's pretty rare.

I was forced to stay in the hospital for 5 days because they were too busy to do a non-emergency procedure. I was visited by doctors daily, had my blood drawn every 6 hours for 5 days straight, had two ultrasounds, and had a thrombectomy to remove the giant clot that had accumulated in my subclavian vein.

Feel free to ama.

Drugmakers put the huge number on the bottle. PBMs come in later and try to beat it down. That’s the whole point of them.

The rebate thing is a black box and patients don’t always see it. That’s a real complaint. What I don’t buy is the idea that gutting the negotiator makes the original price nicer. If nobody is steering volume or trading for a better net cost, what’s left? Just paying more of the sticker?

Curious what people think the replacement actually is. Not “transparency” as a slogan. The ACTUAL mechanism that lowers the number.

Cross-posting here because I’d really like the perspective from outside the ED.
The discussion among emergency physicians has been fascinating, but this is ultimately a healthcare-system question: Why do we ask patients to choose the right level of care before anyone has evaluated them?
If we could redesign the front door to acute care from scratch—not constrained by how we currently bill or organize healthcare—what would you build?

Giving patients more ways to find cheaper drugs is good. Pretending PBMs invented high drug prices is not. Manufacturers set the list. Plans hire PBMs to fight it. Don’t confuse the two.

You guys alright with this?

I’m in Canada, where increasingly integrated electronic health records mean information from one part of the healthcare system are likely accessible to providers elsewhere.

There are obvious benefits. Access to medications, diagnoses, and investigations can prevent dangerous interactions, duplicate testing, and missed diagnoses. But could extensive information-sharing also have the opposite effect by making patients less willing to seek care or disclose sensitive information?

For example, Alberta’s telephone nurse service now documents calls within the broader electronic health-record environment, and I was recently told I could not receive advice without identifying myself.

Consider someone who has misused a prescribed controlled medication and develops concerning symptoms. They may avoid seeking advice because they fear their prescriber will see the disclosure and permanently discontinue the medication. Someone experiencing a concerning side effect from an otherwise beneficial medication might similarly want confidential advice before involving their prescriber.

This seems especially relevant to addiction, psychiatric treatment, sexual or reproductive healthcare, and domestic violence. People may be less willing to seek help if they know sensitive information will become part of a widely accessible longitudinal record.

There’s also the problem of diagnostic persistence. Someone might have a period of problematic drinking and receive an “alcohol use disorder” diagnosis that later influences unrelated healthcare encounters after their circumstances have changed. Highly stigmatized psychiatric diagnoses could have similar effects.

There may also be diagnostic path dependence. If someone believes an earlier psychiatric diagnosis resulted from a misunderstanding and seeks an independent reassessment, a highly integrated record makes a genuinely fresh evaluation difficult. An earlier formulation may influence how subsequent clinicians interpret ambiguous symptoms, potentially allowing a provisional or incorrect diagnosis to become increasingly entrenched.

If the diagnosis is heavily stigmatized, this anchoring effect could come with additional problems that genuinely impact future care.

Obviously, completely siloed records create serious safety risks too. But is there evidence that highly integrated records create a “chilling effect” on healthcare-seeking or honest disclosure, or contribute to diagnostic anchoring?

If so, how should this be balanced against interoperability? Have healthcare systems experimented with granular access controls, segmentation of sensitive records, anonymous advice services, patient-controlled disclosure, “break glass” emergency access, or access based on clinical relevance?

Where should the line be between continuity of care and patients’ ability to compartmentalize sensitive healthcare?

I read this 29 year old’s story and the part that really bothered me is that she doesn’t even know how her next treatment will be paid for. When someone needs a medication for life, the price isn’t just a number. It can find out whether they can actually get the treatment they need.

This is why I think we need to put more pressure on drug manufacturers to cut the cost of essential treatments. No one should have to worry about losing access to a life saving treatment because they can't afford the price.

I work at a fast food restaurant near a hospital so we get a good amount of healthcare workers who stop by in our drive thru. As I was working in the drive thru I had charged a nurse (or healthcare worker in scrubs) for her order and noticed that she was looking behind me and with a straight face said to me “oh sorry I just want to know who’s making the order so I know who to shoot, I’m not very kind”…an incident report had to be made. But would her work place fire her? Or is it something that should be brought up to the nearby hospital? Since she’s able to comfortably say that to a fast food restaurant full of teenagers, would that not raise concerns for how she may treat patients?

‘Murica

Good evening everyone, at this point I don’t know what else to do but ask for help. I recently got a job doing 10-99 work and had to get insurance through a broker. I did my due diligence before and made sure I went with a company and agent that had all the correct documents so I wasn’t getting scammed but here I am. Going through the process he gave me 20 different plans to choice from. We narrowed it down to a plan that works for me and my pregnant wife and 2 other kids. We got the Summary of benefits and coverage and absolutely loved the plan so we paid for it. The insurance started today and the card we got is completely different than what we signed up for. I went back through to see if I missed anything and I didn’t. Is there anything I can do? My wife is due in December and the plan we chose had $0 OOP, deductible and specialist visit, hospital cost but higher premiums $2,500. Now it is $100 per specialty visit, $500 copay for hospital visit with the same premiums. My wife is going every week to her obgyn for the rest of the year. I messaged the broker and his response was “yes, unfortunately, last minute they did decide to add co pays to the doctors but everything else is still the same “. I was never notified of any of these changes and not what I signed. If anyone has any advice at all on what i can do i would appreciate it. Thank you all in advance if you read this and have any advice🙂

In August, Yale researchers led by Alison Galvani published an analysis (https://www.medrxiv.org/content/10.64898/2026.07.22.26358689v1) estimating that a Medicare-for-All-style system would cut national health spending by $1.04 trillion a year — about 20% — while covering everyone. It's a preprint, not peer-reviewed, and the savings lean on three big assumptions stacked together (drug pricing, provider rates, one billing system). Stress-test those down to something more conservative and the number shrinks a lot. It doesn't disappear, though — some real savings survive almost any reasonable version of the model, which ended up mattering more to me than the headline figure.

That's basically what the Congressional Budget Office found (https://www.cbo.gov/publication/57637) too, back in 2022, modeling five illustrative single-payer designs: results ranged from a $700B decrease to a $300B increase in national spending, depending almost entirely on how providers get paid. The financing label doesn't determine the outcome. The rules inside it do.

So which rules actually work? Maryland's been testing one answer since 2014 — every hospital paid under the same regulated rates, on a global budget instead of fee-for-service. Hospital expenditure growth has run 8.74 points below the national average, saving Medicare an estimated [$1.6B](https://www.mathematica.org/publications/evaluation-of-the-maryland-total-cost-of-care-model-progress-report), and a 2025 Health Affairs study, (https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2025.01324) found utilization dropped 11 points more than in comparable states. Nobody had to abolish private insurance. CMS liked it enough to build its new AHEAD model (https://www.cms.gov/priorities/innovation/innovation-models/ahead) directly on Maryland's template.

Put those together and I don't think the honest answer is "pass 'Medicare for All' in one vote and hope." I believe it's a sequence: fix provider prices and hospital incentives first (the biggest, best-tested levers), negotiate drug prices without betting the whole plan on it, standardize the paperwork, then build a public option that covers the people the current system already fails — and only let it expand as far as the results justify. Nobody's employer coverage gets ripped up overnight, and nobody has to win an argument about the size of government first.

I laid the whole thing out step by step, with sources: [A Step-by-Step Path to Medicare for All (https://brokenpromiseshealthcare.org/step-by-step-path-to-medicare-for-all)

A phased in approach seems better to me than betting everything on Day One. I am sure a lot of you disagree with me. I would like to hear your ideas.