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.
It limits everything, including how every profession can be compensated simply because you can’t easily hire somebody for more than what insurance will pay for their services. You can, but the funds have to come from somewhere.
* 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.*
- an attitude of "most patients are just trying to wring medications out of you" - an ego-hit of "if I didn't make the diagnosis, I don't want to help" (this applies to both patients coming in with a suspicion of what they have, or getting a diagnosis from another doctor) - burn-out/overworking, where doctors have a hard time managing all the different cases coming at them without dropping the ball here and there
It's not a simple, single-cause problem at all, but just want to provide an alternative point of view about patients who look things up or come in asking about a specific condition or diagnosis.
When I got my ADHD diagnosis after a quarter-century, I went in specifically asking about ADHD because I had seen some flags that made me think I might have ADHD. Contrast that with the people doctors screen out who are trying to get a stimulant prescription despite not needing it, and you have a situation where it's hard for doctors to tell who does or doesn't need meds, and where patients with actual conditions have to fight hard for those to be diagnosed.
Even in cases like POTS, which has no medication involved in treatment, just lifestyle changes, and yet people close to me who have POTS all had an uphill battle getting it recognized by anyone, especially doctors who could diagnose (disclaimer: sample size = 3).
I told my doctor I had already been diagnosed with ADHD because I had a strong suspicion I had it and wanted to see for myself if the medication helped (it helped massively). I think medicine should be accessible for patients who need it but I don't know how to avoid large amounts of patients then taking medications for the wrong thing, which would probably happen if it was a free-for-all. It kinda comes down to the question of having the personal freedom to hurt yourself doing something stupid, which is a balance (a little of that freedom is good, too much probably bad). All-in-all I lean toward the current system of using on experts to make the final decision. Still, I would be really pissed if a doctor prevented me from getting stimulants for something I believe I need, so I am not 100% satisfied with the current system either.
Thanks for mentioning POTS, btw. Despite how many people have it, it's still fairly poorly known about even within the medical community.
I have found it helpful to approach it in more of a teamwork-like mentality. Don't just read WebMD and try to diagnose yourself - journal your symptoms, observe the trends, record data. If it seems like it points to a specific condition hop on Google Scholar and look for some legitimate new research the average doctor may not have heard about. Print that out and then when you go in show them and ask questions without attempting to specifically diagnose yourself.
You could be totally wrong but with some background info your doctor is much more likely to accurately diagnose and take you seriously.
In my experience, I have had:
1. Doctors that know nothing about a really basic ailment and not have any meaningful guidance or treatment to suggest
2. Doctors that Google something literally in front of me, things that I have already Googled myself, and draw the wrong conclusion because they're looking at results at a glance - when I had searched myself earlier and dug deeper though, it was clear to me the result he was looking at was just plain wrong
3. Doctors that provide very little to no guidance about a wide selection of medications available to treat a problem, leaving me to essentially guess which option of a dozen or more I should go with
4. Doctors that force me to advocate for myself and my condition before they agree to help treat it - so much so that I had to visit 4 different doctors to find one that would, wasting nearly a thousand dollars of office visits with nothing to show for it.
It's no wonder people do their own research and dare to advocate for themselves. Most doctors are fucking worthless.
Keep in mind they also have to do a stupid amount of paperwork these days for every patient and the place they work for may be overscheduling the crap out of them - generally (unfortunately) I always consider my first appointment to be sort of a wash due to this and assume I am not going to really get anywhere until the second time I see them.
Doctors are not like other proffeshions, they cannot put things right if the opportunity for treatment is missed
Doctors that blatantly lie to your face because they want to push some procedure.
I still think it’s better than the other extreme of just showing up and trusting the professionals. That should work in theory, but my experience for myself and those around me is it’s incredibly ineffective. If what you’re dealing with requires the least bit of thought, odds are you’re getting brushed off to the extent you allow.
The real model of US healthcare is essentially apprentice/master, with the patient as apprentice. Apprentice does a lot of the work, not all, some needs to be approved by the master and the apprentice better know how to learn from the master, when to push back, and how to make it seem like it was their idea all along. You can imagine how this falls apart for mental health.
The skills need to run a hospital are quite different than those required to be a doctor. I'm not saying hospitals aren't unique - I believe they are and their adminstration is highly specialized. Doctors should inform the administration at every level but it would be a waste of their training and a bad idea for doctors to run everything.
> 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).
Would you be as quick to say "Doctors should work without pay." ?
We’re “fixing” this by flooding the market with less trained nurse practitioners and PE. Doctors are being gobbled up by regional medical cartels and put where they can maximize billing.
And still, in many countries, including highly industrialized ones, hospitals are run by doctors. So either US administrators are making their hospitals run a lot better (which does not seem to be the case), or the core incentives each group optimizes for are different.
Why do you think law firms and accountancies are partnerships? Because the best proffesional for managing lawyers/accountants/develipers is such a proffeshional with loads of experience. Thats why we have progression, you gain management skill as you bevome more senior but you still know how the industry works and the people you manage
This is how it is for other professional industries. As an attorney, you can lose your license for sharing any profits with someone who isn't a lawyer. I believe states typically require accounting and engineering firms to either be wholly or two-thirds owned by such professionals as well.
There are plenty of things that could be done better now by non-lawyers with the help of lawyers (look at Rocket law).
What states are these, Canadian states?
In the US, many many many SaaS shops are wholly owned by businessmen / bean counters. It's like, weird, to be an engineer who runs a software company.
That's not always the case. The reason I stopped writing mobile applications long ago was because the mobile carriers were doing exactly this, and not even providing enough paperwork for you to argue with them about it.
People like to lambast the Apple App Store for being greedy, but the fact of the matter is that people netted 3x as much off Apple that they did from the carriers. They are asking too much money now but their rates were absolutely defensible at the time. It's not a coincidence that we had a gold rush that started almost exactly when the App Store became a viable target.
One might ask what would happen if we joined the rest of the 1st World in providing medical care and marginalized private health insurance. Would it be a similar watershed moment?
The issue is if you have someone with a scientific background doing politics, what you have at the end is still a politician. Same thing here. An MD doing hospital administration is an administrator.
Which is not to devalue specialist expertise in these roles. I definitely think you want people with these backgrounds in those roles as well. Just not necessarily exclusively. A career administrator has different skills than a physician, you want people with both, and other, roles working to run a hospital.
The real problem as I see it is probably the incentives, constraints, and pressures they work under, or towards. A physician forced to run a for-profit hospital maximizing returns is going to make a lot of the same decisions as someone with a business background in the same situation. The thing is to change the situation, not put different people into that role and expect them to do it dramatically better.
Indeed! Whereas a doctor might say yes, give that patient with cancer the treatment they need, the MBA is going to say no, it costs to much, let them die. If the goal is to maximize profit, the MBA is doing a better job. If the goal is to maximize the health of your patients, the doctor is. We must realize that these two goals are fundamentally in conflict with one another.
The question isn't whether a doctor or an MBA should be running a for profit hospital, it's whether we should even have for profit hospitals. If we care about people more than profits, then clearly we should not.
In the end, labor hours of professionals are finite. Even if you don't need to pay doctors, you only have so many, they can only work so many hours, you will need to prioritize who to help in what way, which procedures to do. Same with all the other personnel, the consumable stuff, the devices/scanners/equipment, etc. So someone is going to have to prioritize. It can be just "how much quality of life can we save using the resources we have", regardless of the patient's ability to pay/insurance/citizenship, but some prioritization will need to happen. The policy of the death panels can be changed, but their existence is inevitable.
This is why it makes no sense to have doctors and nurses waste time battling insurance companies over treatments, and hospitals over staffing. Their time is indeed too valuable.
A common attitude which may cause:
Health care is extremely costly in the United States. Although the rate of growth in spending has attenuated in recent years, per capita spending on health care is estimated to be 50 to 200 percent greater in the United States than in other economically developed countries. Despite leading the world in costs, however, the United States ranks twenty-sixth in the world for life expectancy and ranks poorly on other indicators of quality.
https://journalofethics.ama-assn.org/article/complex-relatio...
On the other hand, imagine the world where Coca-Cola makes billions on healthy drinks, people are slim and fit until they die, and half of the money spent on treatment of chronic diseases of excess can be used for something else.
It's really jarring to read an otherwise reasonable comment that drops a whopper like this. Nothing exists outside of cost considerations. The NSA has cost considerations. The Space Shuttle had cost considerations (obviously, not great ones!). The design of nuclear submarines involves cost considerations, however unsettling that may seem. You're telling me that my broken hand needs to be judged outside of cost considerations? Give me a break.
The problem is that there is a lack of "trustworthy" parties to evaluate cost expectations in medicine. The patient often doesn't understand their condition or its treatments, the doctor has a clear perverse incentive to inflate costs, and the insurance company may actually be better off if the patient dies. At least that's the conventional picture. Leftist pundits often complain that the American economy is based on "greed", but a more precise criticism is that there has recently been a trend away from expecting benevolence and for-its-own-sake honesty from anyone under any circumstances, or equivalently an increasing cynicism about human motivations. It remains to be seen whether a medical system can function when nobody expects to trust anyone.
It absolutely did, and great ones too. The program was too costly and never lived up to the original expectations of fast and easy access to orbit.
Falcon 9 + Dragon is the first American human-rated launcher and ship that can be labeled as somewhat cost effective.
I think this is exacerbated by doctors a lot of the time. I'm in Canada so it's obviously a very different system, but visits to a GP often have strict time limits and "one issue only" rules. When you can only talk about one symptom, and you only have 5 minutes to explain it, it's natural to try and do homework first to see what you're going to use your limited time on.
Strong disagree. This same attitude pervades the military ("only pilots should run the air force") and really all it does is that lower representation of the interests of the other non-pilot 90% of your organization and put a pilot bias on every decision being made.
More than that - hands on healthcare should not be a for profit industry. The need to make profit is fundamentally opposed to providing the best care. As the push for profit increases, more people get sick and die. This goes for long term care as well, which is facing a similar staffing crisis for similar reasons.
Can you elaborate on your rationale? I ask because I've worked in hospitals run by a cadre of physicians and it was not run well. Anecdotal, obviously, so I'm curious on your thoughts on what they provide.
My worry is that it can lead to an unbalanced technocracy. It's like saying a politician needs to come from [industry x] to govern [industry x]. Technical competence is a necessary, but insufficient criteria when managing a multifaceted problem. The risk is that the front-line physician priorities would always become the organization's top priority. In reality, a hospital administrator has to manage competing priorities across many different domains.
This actually isn't necessarily true when you learn how billing codes work. Most insurance companies pay out at a fixed rate per billing code based on your plan. That doesn't change. What does change is that hospitals can retroactively apply new additional billing codes.
This happened to us once for an ER visit where we got 3 additional surprise bills over 6 months because the hospital retroactively applied new billing codes to our visit.
The doctors and specialists gave me every treatment under the son to no avail.
Then I did my own research and read I should try OTC psuedophredrine. It worked like a charm. Now every time I catch a cold (and when I got Covid), I pop psuedophredrine for a few days and I am good.
Yes, psuedophredrine is suggested to treat Covid if you have virus induced asthma.
Second anecdote: I have relatively mild cerebral palsy. As I’ve gotten older, my affected foot tightens up especially in the winter. My neurologist said it was physical and not neurological. I went on vacation and was drinking more alcohol than I usual do. I noticed I was walking without pain. I did my research when I got home and found a prescription muscle relaxant with the fewest side effects and ask my doctor about it. He prescribed it to me.
He didn’t bother telling me that I should get blood work done to check for liver problems. I had to bring it up to him.
I can now walk without pain and run when properly conditioned.
If you look up possible treatments /side effects and your personal history you will be in a better position to engage and weight options. If you blindly accept everything you will end up on the most profitable treatment plan plan insurance allowed.
(Disclaimer: I have been on the design team for several hospitals, including El Camino and San Francisco General, in the bay area - and I have a family of doctors and nurses in my family - my brother was head of the Veteran Administration for the state of Alaska, and is currently CMO for a large health provider (he is a doctor)
---
That said, the "running" of a hospital isa hell of a lot more than medicine (when we are specifically talking to the running of -- but this comment was made in relation to costs/efficiencies as far as outcomes, patient treatment, insurance etc...)
Hospitals are really complex ecosystems and should be thought of more like an aircraft carrier than an other form of business.
The costs within the realm of a hospital are ridiculous - as are the methods and manner in which hospitals raise money.
Insurance is cancer to be sure, but there are so many other factors that go into the operational costs of a hospital - and I don't just mean ngoing care and operations - systems and technology and medicine evolve. People are people and regardless have the same hierachy of needs in any environment.
You have every single actor as an enemy of the hospital bottom line:
New tech, $$
Older nursing pop $$
Current nursing/doctor market salaries $$
Maintenance for existing systems $$
Insurance billing code lock-in $$
Competing hospitals for doctors and nursing staff $$
California $$
Corruption $$
Utilities and related redundant infra to ensure life systems
The ridiculous cost to upgrade
The list goes on and on...
(The cheapest hospital project I worked on was hundreds of millions of dollars)
etc...
Hospitals are really expensive to run, and it requires a hell of a lot more skills than simply being a "doctor" to run one.
This is precisely why I think we will never be able to effectively treat healthcare as a "free market" with tools like HSAs, posted price sheet, etc. The end user can never know the true cost of their procedure until it's long over (sometimes years later) and often don't get to choose at all.
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.
It's already happened with low-wage fast food jobs. Health care is next. Nurses and doctors will be replaced by poorly-trained third-world counterparts.
Yes that's basically what Quebec (and probably other provinces) is doing.
> Do twice as much work for half as much money
I might get tomatoes thrown at me for this, but anecdotally "third-world" nurses are usually not as good due to having experience on different equipment, drugs and often languages. It's better than having no one to cover the shift, but it can be seriously dangerous due to lack of training on specific protocols.
They get paid the exact same amount of money and are in the same union, so they absolutely don't do "twice as much work for half as much money".
For every story of 'X leaves to do Y', there are a thousand people claiming they'll leave, that never do.
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.
https://www.businessinsider.com/inside-indias-no-frills-hosp...
So like a 2000 bed hospital just for heart surgeries. Like you're saying, the more a heart surgeon specializes, the better they are at it and the cheaper they can do it. Better Outcomes for less money.
> Like you're saying, the more a heart surgeon specializes, the better they are at it and the cheaper they can do it. Better Outcomes for less money.
Not necessarily.
1. A heart surgeon is going to be doing heart surgery at more or less the same frequency regardless of whether the hospital they're at handles only heart patients or not. Wouldn't they?
2. I doubt if anybody here considers them cheap. Yes it's probably cheaper than in the US, but still it's rather expensive. But then again, since life is priceless, ...
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.
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.
In my opinion, healthcare has reached the state where the people who receive the benefit are too far removed from the people who pay for it and given there is no "victim" of price gauging, the prices will just keep going up up and way.
I defer to those wiser than me for the solution. I don't like complaining without being constructive so here is my ignorant pass at it. This will require a few key steps: 1) Yes, we need more supply (by deregulating the profession) 2) I personally think a more effective solution would be to gradually eliminate insurance except for catastrophic risk (like emergency medical care from a car accident). #2 will shift responsibility to the individual and the system will be capped at what they can charge based on the average person's ability to pay for it (which is how it works in many parts of the world).
I agree with you and the quote above is because of insurance. Medicare will pay 10% of that total and your father would be charged 2-5%. If he has private insurance you’ll see something different, maybe 15% and your father would be charged 3-6%. If he’s going out of network could be 100%. Hospitals / practices charge insane bills because people pay just a small fraction typically. It really impacts those without insurance or private insurance the worst. It is insane.
This is why I have suggested deregulation, particularly around licensing. It drives down the cost. Insurance may cover doctor X, but if nurse Y can do it for 5% the price... well use the nurse. All doctors would have to reduce prices and insurance would have to raise the coverage amount to compete. It’s what is done elsewhere in the world.
So it looks like software development? Are you comfortable for your life to be in the hands of a rando who just finished a 6-months bootcamp?
The problem is a large swath of the population that believe in all earnestly that squeezing profit is some magical tool for a functioning economy.
Too bad US is so good at PR, this mind virus is wreaking havoc all over the world.
In france your public insurance allows you to walk in a private clinic or hospital too, as a relative did and they cover her post-cancer treatment better than in the public hospital (by her account at least).
So yeah, "free market deregulation" may be an oversimplification but you have a problem in the US that's also far more than just being for-profit. We have for-profit over here and it works.
And that includes private & public institution doing medical R&D and selling their products to the national health services and private clinics, like quite a bunch of spanish companies do, for example. I say this becase it weirdly pops as an argument when it's totally unrelated, and it may be only a tiny fraction of the total cost.
Most healthcare in the west is subsidized by the US. The US market is far more lucrative, so companies do R&D and make capital from the US. The US also subsidizes in terms of both military and energy almost every western country. Even then, Europe has a higher tax rate and on average is far poorer.
I’m well educated on this subject and worked in this area in the US and spent time in other countries. You have no idea what you’re taking about.
The US is broken because we somehow believe that a highly regulated market is "free" as long as the government isn't paying for it. We literally have the worst of both worlds.
This worked so well for Rosemary Kennedy when she could be prescribed an ice pick lobotomy. And so well for Eben Byers when his doctor prescribed him radioactive water, and he drank so much his jaw rotted off. It works brilliantly for this woman[1] and her cheap Turkish dentist work leaving her in pain. And for, well all of this junk: https://en.wikipedia.org/wiki/List_of_unproven_and_disproven...
Deregulation is what we had when things were terrible. Regulation and licensing is what we use to block the most obvious junk 'treatments' and the worst con artists.
> "Given removing demand is... not desirable."
Removing demand is enormously desirable. Regulate the shit out of CocaCola, Marlboro, and all the other health destroying parasites and their advertising, tax them, rework town and city planning to remove driving as the primary transport in life and all the associated exhaust fumes, rework public schooling and rebuild trust in the government and medics so people aren't anti-health-advice on principle, rework employment so that employees have some rights and aren't stressed out all the time with no sick breaks. Rework medical access so people can see medical professionals, and sickness can be caught and treated early, which reduces demand on seeing much sicker people later.
> "Insurance makes the issue worse by increasing demand and in a way limiting supply through requirements and procedures."
Insurance makes the issue worse by driving up costs to patients and at the same time driving down pay to medical staff, by insurance taking as much as possible. Without insurance, supply and demand could remain the same, medical staff earn more, patients pay less, and services be more efficient with less time wasted fighting insurance companies and filling in insurance paperwork.
[1] https://old.reddit.com/r/northernireland/comments/ua9me9/eas...
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.
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.
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.
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?
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.
It blows my mind that super long shifts are the norm for a job that's generally more exerting/stressful than your average 9-5. But it's a viscious cycle now because of the shortages of qualified staff.
Here in BC we have a full on crisis where family doctors are retiring at an alarming rate and not being replaced.
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.
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.
Unsurprisingly, this means many normal people can't afford a therapist and they're getting harder to find.
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.
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.
This seems like the root of the problem, and insurance seems like what "fixes" that but causes tons of downstream unwanted side-effects.
Our options are either to mandate publicly available price lists that are adhered to and hope the market pushes things downwards, mandate prices, or socialize insurance (so that the sole representative of everyone can negotiate the price downwards using the leverage of the provider risking losing most if not all their clients). Or, you know, keep doing what we're doing which is working so well (/sarcasm).
They just sent me a bunch of small bills in the mail one at a time and had a text field online where I could blindly pay them without indicating whether or not I had completed my payments.
Of note, my vet insurance doesn't negotiate on my behalf; they just pay X% afterwards. The price the provider quotes for a given service is the price everyone gets (probably; some of the smaller vets might modify it if someone is low income and in need).
