No one argues that the California or Texas power grids were geared to be unreliable and fail, but they were deliberately engineered over the years in specific ways for specific reasons.

Our medical system is no different. Insurers developed byzantine claims departments and custom plans as a way to make medical coding complicated and error prone for the purpose of denying claims due to error. They setup private panels and doctors to reviews claims and treatment plans with the explicit purpose of denying claims as not medically necessary.

The system is designed to intimidate, overwhelm, and confuse and it's stacked against both the customer and the medical provider.

The intent is to maintain status-quo despite evidence that it's a broken system for medical users. Profits are being made based on the system we have. It's boards & c-suite executives keeping their fiduciary responsibility to their investors by lobbying against structural change. The intent is clearly there.

You say this:

> It does not take a deliberate will behind something for it to be pulled toward this sort of inequality, and presenting it as if that's what's happened suggests that if we could only defeat the Evil People who "engineered" it this way, we could make it better.

...but then also this:

> ...to inhibit the flow of money upward from the 99% to the 1%. It's hard, it will take a long time, the people with the most wealth and power will fight us every step of the way...

So maybe there are "evil" people and deliberation at work, and it's not just emergent complexity?

Agree in part — but there has been some engineering due to the moneyed interests. Few other industries have the perverse incentive structure where you cannot “shop around” to keep costs low. Also, the tax code was most assuredly engineered: tax code, as insurance that pays for medical procedures is tax-free to workers. But if they want to pay for the same procedure out of pocket, they have to pay tax on it. This leads to more insurance coverage and less consumer control.

It does seem like it’s engineered towards making profits in extremely unethical ways?

I get they need to make money, but many times it seems like hospitals/doctors sent out bills just hoping people will pay.

Me, and my father used to have great union insurance (Cadillac plans). For years their were no problems. That started to change in the late 90’s.

1. I once got a $900 lab test from a hospital. They knew I had insurance. I called multiple times, and told don’t worry about it, but I still got the bills. Lather I saw what the the hospital charged my insurance company, and it was $90 for the test. I paid $9 for my premium. Isn’t in the hospitals interest to send out bills just hoping I might pay $900?

2. My mom is sent so many bills even though she has the same plan.

My point is there are no laws against sending out bills. Hospitals/doctors might not have it written down anywhere, but just send out a bill, and let the patient clean up the mess with their insurance company seems like a good strategy—for the heathens?

My mom had a bad tooth a few years ago. Went to her dentist, and he demanded cash upfront—conveniently on a Friday, and he knew she had great insurance. She paid because of the pain. She called up a few weeks later, and asked for a refund. She gave $2500, and insurance (Delta Dental) paid 90% of the bill. She kept calling the dr’s office, but always was told we need to contact the insurance company. I finally got on to a Delta Dental worker, and started to explain the situation. The work seemed to know exactly what I was trying to say. In thirty minutes, after Delta called the doctor, a highly apologetic money manger said we are sending off your check today. (I won’t publicly saw what the representative implied here of the doctor here.)

3. My father once went to Marin General for a routine hernia surgery. My father was beyond a hardened man. I saw him close to crying once, and it over taxes. Well he woke up after the surgery, and their was a Teddy Bear, and bouquet of flowers waiting for him. It wasn’t me, I told him. Anyways it was a mystery until he got his bill. Beyond the typical $12 Tylenol’s, there was a $330 psychological enrichment fee. Yes—that was the hospital charging my father, and insurance for the unasked for gift.

So it is it seems like it’s in their best financial interest to overcharge, do unethical things, and hope people just pay?

Is that engineered—-in my book yes.

Sure, nobody sat down 50 years ago and said this is how we want things to happen, but each individual part was created and the direct interactions are intentional.

For example insurance pays for procedures not the process of doctors filling out insurance forms. That’s by design and ends up having horrifying implications for the healthcare system as doctors often spend more time dealing with insurance than the patient actually needing treatment.

The Social Transformation of American Medicine is an illuminating read. Much of how we got here came in the form of, essentially, patches on top of patches, some of which were for good reasons, some of which were not.