Insurance is the only industry where they agree to pay for something (in this case, "medical care"), but then after service has been rendered can decide to pay less, or not pay at all, or stop paying that provider altogether, etc. This combined with hospitals being run by non-physicians*, and people thinking being able to Google and read WebMD qualifies them to argue with their doctor about treatment plans**, healthcare in the US is going to absolute shit***.

* I strongly believe that only physicians should be running hospitals. Certainly not administrators whose only education is an MHA and only experience is working for for-profit health companies. Medical decisions need to be made outside of cost considerations. The only factors should be medical science, quality of life, and patient wishes (in that order).

** In stark contrast to asking questions and trying to understand. But I have family members who are the "look everything up and then try to tell my doctor how they're going to treat me" ilk and it's crazy.

*** I don't think the above points are unique to US healthcare other than cost considerations, but that's all I have experience with.*

The hospitals themselves are also to blame. There are a couple court cases where the hospital threw the nurse under the bus to cover up for their own issues (short staffing, bad safety procedures, covering up for a doctor, etc), and nurses are justifiably pissed off right now.

There was a time when hospitals could have helped the nurses with the stress and workload, but the admins bungled it at every possible turn, and now it seems they missed their window.

I doubt that it's as simple as that. Nurses are also leaving in Canada and we don't have insurance breathing down their neck.

In the book The innovator's prescription: a disruptive solution for health care by Clayton Christenson, there are some good analysis of where the complexity and problems come from in the current US medical system.

A lot of it has to do with size and the complexity that goes along with it. So, as hospitals get bigger, do more, and increase in size and complexity these issues become worse.

The economics math even mirrors factories... a factory that can build 100 things compared to one that just produces one thing.

The book was enlightening, even though many of the time frames called out in the book were wrong. Disrupting medicine is a lot harder than something like technology.

It’s like that in many countries, also in EU. Average age of a nurse is rising, richer countries rescue themselves by importing workforce, because they can’t find workers for the rates they have budgeted at home.

It’s is like that in other professions too if it’s only the tech that gets compensated well. There is a shortage of skilled labour.

No one wants to hear the truth.

There’s near-infinite demand for healthcare and a constrained (mostly artificially) supply.

Insurance, people and government can’t solve the problem of the supply and demand by throwing money on it.

You either expand supply or remove demand. Given removing demand is... not desirable. The only alternative to fix the issue is remove regulation and expand supply. That’s it.

Insurance makes the issue worse by increasing demand and in a way limiting supply through requirements and procedures.

Government limits supply through regulation AND expands demand by paying for procedures.

An approach is to deregulate, such as removing government licensing, remove Medicare, etc.

Imo Prices would drop >95% within a 2-5 years (to India or Mexico levels).

I worked in medical billing for a few years and the issues are beyond obvious.

Insurance companies is a symptom of the REAL issue.

Unfortunately the American public hasn't figured out what the real issue is yet. They reason why they haven't is mostly because the Democrat party , Republican party, entertainment industry , the Main Stream Media, tech industry, and the the Commission on Presidential Debates (CPD) has them occupied with the symptoms of the REAL issue in order to keep them chasing their tails.

The REAL ISSUE why healthcare isn't getting fixed is because of Conflict of interest.The American public hasn't figured out that going to congress who is riddled with conflict of interest and who designed the existing system that we have in place and is benefiting from it, might not be the best idea to fix healthcare.

In fact the best thing to fix healthcare (and the other 99 problems)is to STFU about it and focus ONLY On reducing conflict of interest in congress. Until we reduce conflict of interest in congress nothing will be fixed.

The Democrat party ,republican party, CPD and MSM want you focused on everything but reducing conflict of interest in congress. In order to fix healthcare and any of the other issues we must FIRST try to minimize conflict of interest by implementing the following as a start:

1. Term limits

2. Closing or reducing revolving doors between private and public sector.

3. No private campaigning contributions. Use tech to overcome the need of money.

4. Reform lobbying by doing away with the money aspect of it and utilizing technology to get your voice heard.

5. Pay congress members more and better benefits, but in return demand complete transparency from financial information to limitations in investments , NCA , and make pay and benefits tied to the general overall approval of congress by the American tax payers.

6.etc

Both party and the MSM solution to fix healthcare is the equivalent of going to the MOB and asking them to fix crime in your neighborhood which the MOB is benefiting from and is promoting. It just makes no sense to talk solutions with people riddled with conflict of interest.

You want to fix healthcare stop talking about healthcare and get the individual republicans and individual democrats to put their political ideology on hold and join forces to demand that their party ONLY focuses on reducing conflict of interest in congress.

I've worked with both, and by far hospitals are much, much worse actors.

Hospitals are legally enforced local monopolies (look up Certificates of Need). Meanwhile, you might have a dozen choices of insurance companies, but they all suck because they have to take what the hospital billing departments give them and take the blame or risk being dumped by the hospital.

> You can’t do anything unless it’s exactly how insurance wants and only for what insurance will pay.

This is the part that makes the whole experience so sadly ridiculous. Nobody could ever tell patients what something might cost and let them make choices, it was (and is) "Sign here to acknowledge you'll ultimately be responsible for all charges, no matter what they turn out to be." But the insurance company doesn't operate like that, they say "Want to be part of our network? Guess what, you have to ask us for permission or we just won't pay you."

We need to rip off the bandaid, as it were, and reboot the damn system. Pick one of any number of good examples from other modern industrialized nations that have functioning healthcare, and copy it. Yes, everything will be a zoo for a while. We'll survive, and maybe even come out the other side with a better system. And maybe some bankrupt insurance companies, let me find my handkerchief.

Prioritizing profit corrupts the commitment to providing care.

Healthcare can be either care or industry.

Applying corporate values to a healthcare system leads to maximum wealth extraction from both providers and patients.

In this context innovation focuses not on the care part but on the extraction. The care is secondary.

How can anyone who cares be a proponent or coexist with a healthcare industry?

It is definetely a (big) part of the reason, but if it was the only one, things wouldn't be in a similarly terrible situation in other countries. Take the UK as an example which has a single-payer system, and morale is overall really low, too, and nursing isn't an enticing career. (On a side-note, the BBC show "This is going to hurt" is quite good and on topic)

Apart from administrators and insurers, I think a large problem is that the job has become substantially more difficult and technology intense, while support and pay hasn't kept pace. At the same time, liability is more serious these days, which I don't think is a bad thing, but certainly sucks for the workers who have to constantly justify themselves and can get crucified for mistakes.

> Everything is controlled by insurance companies. You can’t do anything unless it’s exactly how insurance wants and only for what insurance will pay.

Framed that way, this sounds terrible. But... the truth is actual health care outcomes for insured patients in the USA are extremely good. This holds in comparison to other nations, when corrected for GDP and patient income, etc...

"Insurance companies" are, at least in the narrow sense, doing what we pay them to do really well.

They may or may not be making things easier for nurses, which is a different metric. But nurses aren't their customers, we are. And we're getting a fairly good[1] product.

[1] Albeit extremely expensive relative to other nations.

Offer to pay in cash and it is amazing how much better the customer service and general demeanour is from a medical office - it always blows me away. They must REALLY hate dealing all of the insurance BS.

I had not done an eye appointment in years and years because my vision is generally very good - I went in expecting to offer cash, negotiate, and generally play a bit of hardball. I was amazed when the front desk person IMMEDIATELY perked up, looked super happy, and started offering massive discounts before I even threw numbers out. The eye doctors as well were very enthusiastic.

This. I had a great doc until a few years back. Best doc I've ever had by a long ways. He'd spend a good amount of time with you, actually listen to your concerns and even bring up recent papers he'd seen on topics related to my health issues. A few years ago he decided to mostly get out of doctoring because he was tired of dealing with insurance companies. For a while he went to a retainer model ($2K/year up front, $250/visit) and cut the number of patients he was seeing down significantly. I can't say as I blame him.

I've heard the same thing from mental health counselors and therapists. In wealthier areas many will just stop accepting insurance entirely and make people pay out of pocket to avoid all the insurance paperwork and requirements (some insurers require specific diagnosis to continue paying for services). If an insurer decides to not pay you? good luck. Now you need to throw hours of unpaid labor at them to get money you're owed.

Unsurprisingly, this means many normal people can't afford a therapist and they're getting harder to find.

Granted, there's a niche for cash pay docs. Example being psychiatry - it's extremely hard to find a psychiatrist who takes insurance, even Medicare. The good ones are all cash pay...

I don't hear it talked about enough, but I think the biggest problem with insurance is that their profits are pinned to how much they spend on medical costs.

https://www.verywellhealth.com/health-insurance-companies-un....

In theory, this sounds like a great way to make sure insurance companies aren't just taking unreasonable profits, and that they are spending money on medical care, not administration, keeping the business lean.

In _practice_, what it means is that profits are constrained by medical costs, so the insurance companies are literally incentivized to pay _more_ for medical services. Originally, insurance companies were supposed to be an intelligent negotiator on behalf of their customers. After all, their experts should know much more than a layperson every will.

But with the poisoned incentive to raise costs, customers are basically held hostage by a bag faith negotiator. Not bad faith as in malicious, but in terms of having an enormous conflict of interest.

Previously, that wasn't entirely true.

In the very early nineties, insurance companies lured doctors in with promises of referral if they would just accept certain terms. Originally, this was to the benefit of the doctor -- more referrals. But only originally: once lock-in occurred, the insurance companies began to set their own terms. They couldn't have accomplished this without some greed on the part of many doctors early on.

Consolidation's a big part of it. The last decade has seen nearly all the small practices and offices in my city gobbled up by a couple of huge companies. With that comes the MBAs and the bureaucracy.

Have US hospitals ever had transparent pricing?

This seems like the root of the problem, and insurance seems like what "fixes" that but causes tons of downstream unwanted side-effects.

Insurance companies are awful and should not exist, sucking up a lot of doctor time, but when it comes to nursing, hospitals are particularly awful, cutting staffing levels to the bone in order to maximize profit. People die as a result, and nurses are burnt out.

This inefficiency and it's resulting poor working conditions aren't unique to countries with health insurance and private healthcare tho, see Canada.

Why doesn’t the American Medical Association start its own insurance company?