…what? Insurance companies are not a “barrier” between doctors and patients. What, do you think some sort of insurance gremlin will manifest out of the ground and kick you in the nuts if you try to visit a doctor while uninsured? Doctors don’t care whether you’re insured or not, as long as they get paid. Insurance companies exist to soften the blow of expensive treatment. The product is not getting completely fucked over if you get very unlucky, just like with any other insurance (life insurance, car insurance, whatever). It’s kind of like bitcoin mining pools, but the other way around. Now, is mandatory health insurance justified? That’s a different discussion.
Insurance must be the only industry that actively tries not to deliver the service that its customers pay them for.
well there’s the whole telecom industry too
And car insurance. And wall street. And Google with Pixel Pass. Actually I think capitalism just fails to deliver in general.
No no, you’re confusing the product and the customer. The customer is the stockholder and investor who owns equity in the insurance company, or in its bank. The product is quite literally denying care.
I think every industry strives to be able to not deliver something after being paid, they usually just can’t get away with it.
Want to hear something crazier? They don’t even have doctors. Non doctors are telling your doctor what is medically necessary.
I had an issue with my foot and the doctor requested an MRI as an ultrasound wouldn’t show them anything they needed to see. The fucking insurance company says no, do the ultrasound… So I paid for a fucking useless ultrasound and then they refused to move forward with anything else… The issue kinda went away thankfully but there’s still something odd with my foot that I guess I just won’t fix until I can pay completely out of pocket.
I’m so fucking happy that at least $1,200 monthly is taken out of my potential pay to cover a fucking useless insurance scam, because remember even if your employer “pays” it’s factored into your total compensation so you’re still the one paying.
it’s factored into your total compensation so you’re still the one paying.
I never understand why so many people assume insurance is “free” from the employer or that they pay 0-1000 per week/month. What we see is the tip of the iceberg. Insurance companies are perfectly lucrative and they pay tons and TONS of money to workers that make sure they make as much as possible.
80% of premium revenues must be spent on treatment, the other 20% is what they have to profit off of. If they don’t spend 80% of the premiums on treatment they MUST refund excess earnings. See: https://www.healthcare.gov/health-care-law-protections/rate-review/
This means if they took in 100 billion in premiums in a year, they MUST spend 80 billion dollars on treatments. The 20 billion left over is where they can make money. So they will make sure 4/5ths of everything they make goes into treatment so they never give refunds and they maximize potential profits. If they can convince companies to raise premiums 10% next year, costs will rise 10%, profits will rise 10%. It’s so obviously designed to raise the cost of premiums and treatments at the expense of all else it’s insane.
They also don’t spend a dime over 80% of what they make if they can help it. There’s where claim rejections come in. They have mathematicians figuring out the ideal numbers and those guys make stupid amounts of money.
And these cunts get to say ‘doctor is wrong you don’t actually need that’
I just thought of a funny concept which is that when you’re born in the country you’re automatically given life insurance. Then when a doctor says “you need this operation” and the health insurance company is like “your doctor is wrong” your life insurance company can come in and be like “you can’t kill my guy, because he’d be owed a gigantic payout!” and then go to war with each other.
It would never work in reality, but I find the idea funny.
What would predictably happen is that the health insurance company would still withhold care, and the life insurance company would deny the payout based on the care being withheld. Then they both would be like “sue me”.
And eventually they would merge and be just one company.
This is a genuine concern with over regulation of any industry. If they can just say they were following the regulation, which inevitably will lack in some areas, then that is a strong defense for them.
concern with over regulation of any industry
Usually mergers happen and monopolies form because there is no regulation of industry
Intellectual property law is a form of regulation
I don’t think thought property laws help Nestle at all. Or reional monopolies.
I don’t think thought property laws help Nestle at all.
How is Nestle a monopoly?
what about just taking that money and just having healthcare instead?
I know I’ll be hated for this, but my wife works for an insurance company, as a doctor, doing chart review. She was always very responsible as a doctor, but the shit she talks about that doctors prescribe is ridiculous.
One case that sticks with me (not even the most egregious, but because of the berating she got from the doctor and the patient), the patient needed a special car seat, which they approved. The doctor also prescribed a 200 dollar car seat cover. Now the seat already comes with a removable and washable cover, this additional one would just make it easier to remove and wash. It was denied as not medically necessary, which it clearly is not. The doctor demanded a consult and then yelled at her the whole time. The patient also called her and yelled at her.
Im a firm supporter of universal healthcare, but the idea that doctors never do ridiculously unnecessary shit, regardless of the reason, requires one to be completely ignorant of how any of this actually works. And so, even with universal health care, some bureaucrat stepping in to determine if a doctor made the right decision would absolutely still be necessary.
Yeah, no, fuck off with that. The doctor is the care provider, not the insurance company, and an insurance company has no fucking business deciding what is or isn’t medically necessary.
They decide what they pay for, it is factually true that doctors will treat so they get paid more, this is especially a concern in private practice.
I notice how you didn’t actually address my point all, just reiterated the claim.
I don’t believe this happens that often, but what happens in the case that a doctor prescribes completely unnecessary procedures and visits, which makes them rich. Still the insurance company shouldn’t do anything?
If your wife has not seen or treated the patient, she has no basis to deny the claim as medically unnecessary. She has no idea what conditions the patient may have that would necessitate having a different seat cover. I get that you love your wife, but her job leads to significantly more pain than benefit.
she has no basis
You’re just wrong. I assume it because you have no medical experience and don’t have any knowledge of how any of this works, but doctors are supposed to take good notes throughout their care that go into charts. This is done so any doctor, especially if we are talking about in a hospital, can step in and read what has been done, why it was done, so they know what they should do next. There are also standards of care for certain conditions that have been established and reviewed by many other doctors.
So she can absolutely read these charts and the standards of care and have a very good basis for what is and what is not necessary. Is it 100%? Of course not, which is why doctors and patients can appeal. But if they can’t justify why it is medically necessary, which was certainly the case here and it was clearly just a case of quality of life, then it makes sense not to waste resources…this would be true with or without private medical insurance.
Yes, of course you’re right. That’s why my surgeon friend who works in oncology has to frequently waste his time calling insurance over denied claims regarding fucking treatments for cancer patients. Truly medically unnecessary, which is why they’re pretty much always reversed and when they’re not, he gets to tell the patient they are going to die because someone who has never met them denied their claim as medically unnecessary. Same goes for my friend in the PICU, except she gets the added bonus of telling a little kid’s parents.
And my guess is it would have literally been cheaper for everyone involved for insurance to just pay for the $200 seat cover. Modern American insurance companies are capitalist enterprises providing a socialist benefit. And the doctors denying claims on behalf of the insurance companies are not seeing the patients in question so are basing their decision on questionable documentation and “industry standards” that are based on heavy insurance influence. All to maximize value for the company rather than ensure patient welfare, which is the fucking point of insurance.
There is plenty of abuse of the system through over billing, but somehow fucking Medicare is the most efficient health insurance system in America. If private insurance is so great, why are they more inefficient with worse outcomes?
Medicare is the most efficient health insurance system in America.
Are you under the impression that medicare does not do chart review nor deny claims? I assure you this is incorrect because, the irony being, my wife works on the medicare side of chart review.
As I’ve been saying, this doesn’t go away, nor should it, if we move to universal health care. Something I strongly support, btw, I dislike insurance companies as much as you do. The difference between you and me is that I recognize that doctors are not infallible and omniscient and can make mistakes.
If private insurance is so great, why are they more inefficient with worse outcomes?
I started off very clearly and explicitly saying Im a strong supporter of universal healthcare. Why do you think you came to the conclusion that I think private insurance is so great?
Insurance companies shouldn’t exist. Healthcare should not be a for-profit institution.
Agreed. But as I pointed out, even without insurance companies, there would still be standards of care and there would still be people reviewing charts to make sure doctors aren’t overdoing things and wasting resources.
The thing that’s missing here is context. It’s hard to care about a random doctor prescribing an extra $200 for a patient that is taken out of the tens of billions of dollars of profit a year that health insurance companies make.
Like, this car seat anecdote costs as much as an hour meeting of a few of their higher paid employees.
Does that really matter? Should it matter?
These are different questions, I was responding to the implicit claim that it’s ridiculous that someone other than a doctor could understand what is medically necessary.
Although one thing my wife has expressed shock about since taking this role is how much waste there is, and how much doctors prescribe that is just clearly not medically necessary.
The real thing is many regular preventative checks are a huge money maker for physicians while not actually being that effective for patient outcomes. IIRC its been argued prostate exams are an example of this. IMO, routine removal of wisdom teeth is another, and routine circumcision is an obvious one.
Tell me why the baby needed that special cover and I’ll form my opinion…
Better yet, let the doctor tell me, rather than someone one step removed from insurance company payroll. Which brings us full circle.
Doctors can, and often do, request consults where they make their case. My wife will occasionally change her mind after hearing from the doctor on why they think it is necessary. She will often even reach out to the doctor if she is unsure about the outcome.
In this case the doctor just yelled at her and didn’t make a case at all.
I had an ear infection, the doctor thought I was lying for pain killers(she said people my age shouldn’t get ear infections, and I could’ve just used a hairdryer), I told her no the pain is fine I just want antibiotics so it doesn’t get worse. She then decided to prescribe codeine and oral antiobiotics but not ear drops.
When I went to the pharmacist they filled the codeine prescription even though I didn’t want it.
the doctor thought I was lying for pain killers
What the fuck? I see it often in english-speaking places, but I want to know why doctors say “oh, you just want pain killers”. Them being concerned about painkillers more than about biological nukes infections can become resistant to greatly concerns me.
I think because I was a young male basically was her basis
…but why?
Well it is true, many drug addicts are dependent on prescription pain killers. Which other people will intentionally get prescribed so they can sell. Y’know, the whole opioid crisis thing.
My ex suffers seizures. After years of bad doctors, he managed to see a neurological specialist who helped him manage his issues. His doctor informed his insurance that treatment was working and his symptoms had regressed - he even managed to earn his driver license back. His insurance took that as “he’s better now” and kicked him off. They sent him a bill for thousands of dollars that he had to pay before he could try to get back on his plan. He wasn’t able to afford his medication, nor his therapy, and his symptoms came back swinging. I still have a photo of his rejection letter somewhere that I keep as a reminder of how backwards and awful the insurance system is.
Good god when I hear stories like this one I think if I were in their place I’d try my best to get hired abroad so I can have proper coverage. I know it’s not possible for everybody but it is what comes to mind
I’ve been fighting with my insurance company since May. My wife had a medical emergency and I had to take her to the ER at 3AM on a Sunday. The team of doctors treating her all agreed she needed to be hospitalized and have emergency surgery. She was admitted and underwent surgery and was out in three days.
A week after she was discharged we received a letter from the insurance company letting us know they had decided not to cover the $67k hospitalization bill because they had decided it wasn’t medically necessary.
So yeah, that’s great. Not to mention we had finally hit our $6,000 deductible (after I had cardiac issues and ended up in the ER the previous month) so insurance would finally have had to actually pay something.
So glad we pay them $1500 a month for them to make decisions on what is medically necessary and what constitutes an emergency after the fact.
First. I hope your family is OK.
Second its total bullshit the medical insurance companies can just declare something isn’t needed (usually by a doctor on thier payroll). Then use that as a justification to decline coverage.
This is supposedly a standard tactic for them too. Decline all big claims and see who fights it.
That’s insanely immoral especially because anyone with a huge medical bill clearly has some shit going on and the last thing they need is the massive stress of a massive medical bill.
We have movies and TV shows that poke at how bad our medical coverage is and we Americans just accept that the plot is acceptable.
The ones that come to mind are:
The Rainmaker kid dies of lung cancer because insurance declined treatment due to it being “experimental”.
Breaking Bad yeah. Cooking meth to pay for cancer treatmentThey should be held legally to prove why the procedure is not necessary only then they can refuse the claim. Otherwise they have to provide the claim. This should be the law.
Is this a US thing that I’m to Europe to understand?
Yeah in the United States of Billionaires healthcare is a product to extract profit from in every way possible.
Pharma companies get public funding for research and then turn around and charge insane prices for the final product infuriatingly referring to research costs to justify their pricing.
Hospitals are bought and run by investment companies.
“Insurance”
scammerscorporations have their own fiefdoms that they control so there’s very little competition and their sole reason for existing is to take your money and deny coverage for absolutely anything they can possibly deny you for so they keep the most money possible.We have The Best System In The World™ (for the ultra wealthy)
Apparently, yeah.
You probably haven’t even shot up a school or anything have you.
Get that person a hamburger and a mountain dew stat!
When I had top surgery (getting the fat sucked out of my tits so I could put an “M” on my drivers license, funny how many jobs fell through right I9 verification…), I did a lot of research into what I needed to do to get it covered. I got letters from doctors and therapists, I’d been in hormone therapy for a while, and my policy said it covered it. I checked with a rep, they said yeah, you just pay for it up front and submit for reimbursement.
So I took out a $5500 loan, had surgery, and then attempted to file for reimbursement. Turns out that my specific policy, from my step-dad’s employer had a rider that exempted it. Somewhere buried in the fine print, didn’t come up until after I had taken out the loan.
It’s pretty common for trans people to end up turning to sex work to finance their medical care (and tbh, survival in general). That’s how I joined that statistic.
For a second I was like why does any drivers licenses have Ms on them for people that have had masectomy? Durrr.
The funny thing is, I probably wouldn’t have had gender surgery if it wasn’t a legal requirement. I barely had anything and could pass topless anyway. I just needed to be able to get a job, which was proving difficult with the non matching ID. It is 100% legal where I live to fire someone for being trans, and it had happened at multiple times by that point.
Disclaimer: I think the current U.S healthcare system is hilariously bad and should be heavily reformed.
Insurance is not a bad thing, and there is a clear product involved in it. To demonstrate, you can go to a doctor in the U.S and pay in cash for the treatment. As I’ve understood it, you can even negotiate lower prices than the list prices if you are paying in cash. Still, it’s probably going to be expensive to the point of potential financial ruin.
This is the product that insurance offers in any domain it operates - buying your way out of risks you cannot accept. Fundamentally, the concept is sound, albeit very poorly implemented in the case of U.S healthcare.
It’s basically just a bunch of people pooling their money together and having that pool of money pay in the case of an adverse event.
One of the primary alternatives to the mess that is U.S healthcare today is in fact another form of insurance - it’s just that enrollment would be mandatory and as such the risk spreading would be as uniform as possible, along with subsidies for people carrying higher amounts of risk. That’s fundamentally what universal healthcare is in other countries.
Health insurance companies sure seem like socialized healthcare but with some rich guys that steal money out of the pot
My favorite is when they send me and letter in the US mail for the sole purpose of telling me they decided to cover our medication the doctor prescribed. The language they use is infuriating.
As if we should call them back and praise them, be grateful for their service, and just ignore that I’m paying them.
Insurance transition from protection against highly unlikely emergencies to our default payment system is the biggest scam in world history.
This is a serious part of the problem. Home insurance, car insurance, can be bad, but at least you don’t usually have to deal with them. You can go years without needing anything from your home insurance.
You WILL need healthcare, minimum once a year. Most people need it every month or every few months. Your car insurance doesn’t pay for your oil changes or new tires because those are guaranteed maintenance costs, not unexpected emergencies.
Yeah, it’s a big misunderstanding to think that insurance is not a product. It is product. The problem is that these companies all have the most shit versions of this product. It’s like living somewhere where every sandwich shop had a slice of bolongne on white bread, and they just changed which brand of mayonnaise they used.
Pooling everybody’s money so that the ones who are unfortunate get money to help with their situation definitely is a product. Just because you don’t understand something doesn’t mean it doesn’t exist.
Where do you find Insurance like this? Because all of American Health insurance is just about pooling everybody’s money into the pockets of shareholders will denying as much coverage as possible
Where do you find Insurance like this?
Literally all the insurances are like this. If yours isn’t, why are you paying for it?
That’s what the concept of insurance is, but health insurance very much does not match the concept.
U.S. healthcare on average is around 2-3x as expensive as countries with socialized healthcare, so if we didn’t have insurance jacking up our prices but also didn’t have insurance for a safety net we can pretend it’s 1/2 to 1/3 the cost of what our procedures cost. A broken bone would still be around $10,000 and if 1/3 of Americans would have to take out a loan for $1000 I’m willing to wager a $10,000 bill would wreck the average person. Other not fun fact is the average American is expected to break 2 bones in their life. The way health insurance works in the U.S. is atrocious but it’s not like if we just got rid of it overnight everyone’s life would be better
U.S. healthcare on average is around 2-3x as expensive as countries with socialized healthcare
I seriously doubt it’s only that much, but even if it is, it’s the cost of production, not the cost to the end user.
With socialised medicine, you don’t pay yourself, that’s the fucking point. You pay taxes and the system is payed from everyone’s taxes.
I broke my arm last year here in Finland. I think the whole bill for an overnight stay and surgery and all the medications was… around 50 euros. Now ofc that doesn’t cover even the cost of a single worker for a few hours, let alone anesthesiologists, surgeons, nurses, physiotherapists, etc. It’s just the part I have to pay straight up.
but even if it is, it’s the cost of production, not the cost to the end user.
You want to say shareholders give up their yachts?
Australia has a mixed system.
Theres some nuance to this but essentially the government covers most things but you might wait a long time, especially for anything that isnt actively killing you. You don’t get to pick your doctor, you get the treatments that are govt approved and you get shuffled out the door just as fast as humanly possible.
Private health insurance means you can choose your specialist, you have more of a say in your treatments and if your specialist says “If you want to go home tomorrow you can, but I’d like you to stay in for 3 days ideally” and you can if you want.
You don’t get to pick your doctor,
you get shuffled out the door just as fast as humanly possible.
Please fix. Even in Russia of all places I can choose specialist. Well, if there is specialist at all. Regional healthcare is kinda fucked.
That reminds me of an old joke. Life in Soviet Union is not different from USA. For Dollars, you get everything.
I broke my arm last year here in Finland. I think the whole bill for an overnight stay and surgery and all the medications was… around 50 euros.
Finland is famously having major problems with public healthcare currently because the costs versus clients relation is too low.
Pooling everybody’s money
It’s called taxes
Yes, exactly. Healthcare via taxation can be viewed as a some sort of public insurance. The problem there is that the level of resources needed has to be decided manually instead of letting the markets handle it “magically”.
Healthcare via taxation can be viewed as a some sort of public insurance
But, why would any sane person view it that way? Do you think of the fire department as “some sort of public insurance”? Or is it just the people who come put out fires?
Do you think of the fire department as “some sort of public insurance”?
Yes, it can be viewed as such! Things can be viewed from many angles. Another one that’re not called insurance but kinda are, are flat prices for things whose price actually varies. Like electricity prices: they’re often based on a spot price in an power exchange, so if you as a consumer choose to get a flat price, you’re essentially paying a premium.
Insurance is a pretty great industry and good fit for markets if only there’s healthy competition. If there’s no fertile ground for competition, it’s one signal that perhaps the public sector should handle that one.
Insurance is generally for contingencies that are very rare but ruinously expensive. The average cost per person is low, but the cost to the one it happens to is extreme, like a reverse lottery. So it makes sense for a large group of people to pay a little bit of money each month, to pay for the cost to the one. This is how both health and fire insurance work. (Health care is about more than that but that’s a different and less straight-forward story.) So, anyway, that’s why sane people view it that way.
Historically, the problem with private firefighters was that you had a business that made money when there were major fires. That’s a bad incentive. You get similar bad incentives in health care, too, which is one reason why coverage for some interventions may be denied. Another thing about fires is that they are contagious. They threaten the entire neighborhood. That’s why you have, for example, the CDC in the US. Controlling contagious diseases is not left to private providers.
Controlling contagious diseases is not left to private providers.
But, by the nature of the US, it still has to involve them. Because of the system, you can’t get shots into people’s arms without involving private hospitals, private insurance companies, etc. Which, during the pandemic resulted in some insurance companies still trying to charge co-pays for vaccinations, or billing people who received them. Maybe it was just paperwork mix-ups but it happened. And, since many people are used to the private system, they assumed that they would get charged or couldn’t get vaccinated because they lacked insurance, so they didn’t get vaccinated.
Imagine if a city had all kinds of private fire departments but it had a Center for Major Fires that could issue orders if a fire was declared to be “major”. Until that point, firefighters could refuse to put out a fire at a business that hadn’t subscribed to their firefighting services. So, they could sit there and watch a building burn down, only using their hoses on the stray embers that flew into houses nearby which had subscribed. Then, one day, there’s a fire at an abandoned warehouse (no fire coverage, naturally) and it starts spreading to nearby buildings, some of which are also abandoned. The Center for Major Fires examines the situation and declares that this is a Major Fire, and that all the fire companies need to help put it out, regardless of whether it affects their pre-paid customers. But, unfortunately communicating that with the various fire companies is hard because the fire has already started to spread. Some companies are willing to do what’s required, but first they want to ensure that their paid-up customers are safe, then they’ll get to the abandoned warehouses… Other fire companies are hard to contact because they’re already too busy fighting part of this Major Fire, so any hope of a coordinated response is slim.
There are just some jobs that should be done by government. Firefighting and healthcare are both in that category.
Healthcare isn’t something that only the unfortunate need. Healthcare is something every person needs. If you live long enough, it will be costly. This is why insurance as a concept is fundamentally unable to handle healthcare. It is antithetical to the concept of insurance.
If you live long enough, it will be costly.
This is why if you start paying for a healthcare insurance at an older age, your premiums will be higher. They are pretty good with the math there, and it’s not even very advanced math.
Its a service.
If only there was some kind of entity representing you the people, pooling your money to help the unfortunate…
Except when said healthcare is gated off for the protected class by cost or being and to work a certain type of job, that pool only helps those swimming in it. Here in the US ACA has done some to narrow that gap but it’s still not enough. The proper model is everyone has a mandatory contribution % of their income above a poverty line. Then we see the pool truly helping those who cannot afford it and even those who can because care is standardized.
The proper model is everyone has a mandatory contribution % of their income above a poverty line.
State-run Mandatory Health Insurance, that provides healthcare free of additional charges. *old Russian anthem intensifies*
And nazis rolled out the highway system, but that’s not a reason to dislike it.
Not true. Though the nazis certainly built a lot of additional Autobahnen to prepare for the war, they knew they would start. Fun fact: Wehrmacht logistics largely relied on horse-drawn carriages. The soviets got Studebaker trucks.
Not true. Though the nazis certainly built a lot of additional Autobahnen to prepare for the war, they knew they would start.
I don’t follow.
Is there a nonprofit insurance company?
Healthcare provided publically can be thought of as nonprofit insurance.
Medi-caid.
Sounds like something everyone should have
No argument from me. Although Medicare/Medicaid is generally not a great insurance.
Yeah I have a partner that has it and she has MS took her 6 years to approved her for a life time injection.
Yes, but they’re fake.
This is my favorite answer so far
Kaiser Permanente to an extent, same with BCBS- though they also have a lot of for-profit affiliates. There are also a fair number of local non-profit insurers
Like Mozilla, the parent company is not-for-profit with for-profit subsidiaries
How do they make money? Honestly I don’t even know how Mozilla works with out Google paying them.
There are. They are also state-run. But they are mostly in former soviet republics.
Yes - if they weren’t one of the main causes for debt and inflated prices.
What’s this “we” bullshit? You and I never had a say in it. It’s not like we get to vote on this stuff.
TBH Hospital Boards aren’t all that innocent, either.
The largest hospital in my region owns the largest health insurer in the region.
One hand washes the other
Nor the doctors themselves (well most are innocent, but there are a few who lobby with the AMA to help keep prices high so they keep getting paid)
So the boards should be reformed and have equal parts worker/union, patient, and shareholder representation.
Nah fuck that lets just do singlepayer.
Single payer is preferable, just want to point out that healthcare coops are another option
If you squint your eyes just enough, insurance is like gambling… You are betting that something is going to happen to you, the insurance company is betting against that. The insurance company can improve their chances by adding conditions to that something.
That’s the part that makes the US system insane.
In countries with a public health care system, the goal of the patients and the doctors is the same. Everybody’s goal is to prevent diseases and sickness, and to treat it when it isn’t prevented. The administrators just estimate how much funding is needed to achieve that goal.
In the US system, the patients are trying to prevent and treat their sicknesses and diseases. The administrators are trying to find ways to avoid paying for any treatments, and the doctors make more money if they can find a way to bill more things.
And, what’s especially insane is that healthcare really isn’t a normal market like other things. If you’re buying a truck, you can shop around, haggle with salespeople, etc. If you’re hit by a truck, you’re not going to be comparison-shopping emergency rooms.
It’s way worse than gambling. When you win a jackpot there are laws that require you to get paid out.
Insurance companies can just say no and fight you in court until you die because it’s cheaper for them to pay some lawyers than for your treatment.
