1. https://theonion.com/health-insurance-ceo-reveals-key-to-com...
A big part of my job was to re-route people who needed wheelchairs into getting cheaper things. Our clients were United Healthcare, unions, large health insurers.
It sucked working there it was a total hellhole. I quit when they actually defrauded medicare. Their glassdoor reviews were wild. The owners daughter bragged about dating a glassdoor exec and that he would take down all the honest bad reviews for her.
The threatened “death panels” we heard about when ACA was being debated are actually employees of insurers who decide what they’re not going to pay for.
I was raised a die-hard capitalist and in many ways still am. When it comes to healthcare these days, I’m somewhere to the left of Marx. What we have now is a failed system. It simply does not work. The turnip has been squeezed and there’s no blood left to wring from it.
The key insight, though, is that this is fundamentally unavoidable. Someone, somewhere has to decide how a limited healthcare budget will be allocated among all the various healthcare it could go towards.
You and I agree that it would be best to have a system where this is never the patient's problem. Someone determines a standard of care that will achieve the best patient results with the resources available, and then any patient can get whatever treatment's best for them within that framework. That's why I have and recommend Kaiser, they do a good job of presenting that abstraction.
Other people are terrified of the idea of having the standard of care determined by some centralized committee, because what if they decide a treatment that my doctor and I like isn't appropriate? I think the fear is wrong, to be clear, but it's genuine and does deserve to be addressed. Thus all the promises about "if you like your plan you can keep your plan".
(A third group of people believe that healthcare is only limited because of shenanigans, and with the appropriate reforms we could build a system where anyone is entitled to any treatment that might reasonably help them. I'm never quite sure what to tell them, since I don't think that's true but I don't know how to prove it beyond the lack of examples.)
The system is broken. It’s useless to extrapolate how things might work based on their current functionality. It doesn’t have to be like this. Everywhere else in the world manages it better than we do, and we’re not special snowflakes who require some hellish mashup out of Cyberpunk 2077 to take our kids to the doctor.
I would like to see #1 tried but at this point I’ll gladly accept #2
Naturally, hospitals also wants prices to be higher so they can earn more money.
I would expect this dynamic to play out whenever all the buyers in the marketplace are insurance companies.
There’s no reason why this system has to exist. We can make it better any time we want.
There is no emphasis on long term planning or prevention.
Everyone is grabbing with both hands.
The employees of the managed care organization are often just using the criteria of the payer (often times the federal or state government for Medicaid/Medicare/federal employee or other large self funded plans).
The US government leaders are in a good spot. They get the managed care organizations (MCOs) to take the heat for denying coverage, while setting the rules to deny the coverage. MCOs even get audited and fined for approvals that don’t meet criteria.
In any case, all systems with limited resources will have to have someone approving or denying payments, whether it be a government employee or someone contracted out by the government.
But the most salient metric here is all the MCOs earn only 2% to 3% profit margins. And their market caps are tiny, and returns abysmal. (Except UNH, but that is due to its significant provider and software business).
Blame MCO employees all you want, but you will be doing exactly what government leaders want you to do.
It is not at all surprising that capitalism fails miserably here, IMO.
As a Canadian I had the pleasure of my insurer (Canadian government) denying my treatment. Multiple appeals, still a no. My doctor said it was the only thing that would treat my disease. So my only choice is paying for it in cash at $10,000+ per month, which I can't afford.
I’ve found numerous instances where providers have billed over $5,000 for procedures that I could get for $250 if I paid cash. They do things like seperating a test panel into 100 different separate procedures, etc.
I think they need some context in the article of the interplay between providers billing practices to maximize their fees and insurer denials instead of just demonizing the insurance companies.
Every denial doesn’t result in a patient not receiving care, but is sometimes pushback against overly aggressive providers/negotiation and some of that can and probably should be automated.
Obviously them denying necessary treatment is really bad, but I find that propublica articles are often highly opinionated against certain interests and leave out a lot of context to create an extreme headline.
Sometimes certain things are covered before you hit your deductible other times not.
You're out of pocket $180 more than you should be, and paying the $20 cash price out of pocket means your deductible doesn't budge.
https://www.yahoo.com/news/no-one-knows-often-health-2020566...
> At the same time, posts on social media have been claiming that UnitedHealthcare’s claim denial rate is the highest in the industry at 32%. This figure comes from the personal finance website Value Penguin, which said it calculated that rate from available in-network data from plans sold on the marketplace.
Firstly, Luigi Mangione is presumed innocent until proven guilty.
Secondly, there's a fair amount of real evidence that Luigi is being set up as a scapegoat by the NYPD—a police department with a known history of planted evidence.
"Arbeitsbeschaffungsmassnahmen" ( German for "employment creation scheme" ) in an industry where there is not enough actual work for--and or to justify the--number of employees. One of the more useful Ponzi schemes; if you are not a real capitalist, that is. Because if you are, then this shit is just fugly drag.
Blanket rejections are an extremly efficient measure from the perspective of an entity when the consumer has nowhere else to go and you don't care about ethics. Just tell them no and many people will just give up. If they appeal, you can invest the work to fob them off properly or just pay and not deal with the hassle. I can barely tell the difference with the many public healthcare insurers in germany - if my insurer were to try this nonsense, I would be gone the next month. Universities, some agencies and especially the god-damned GEZ on the other hand...
What frustrates me more, is that it often turns into a class indicator: Do you know how to word your letters or to handle yourself in a way that indicates, that it will be more annoying to not-deal-with-you than to deal-with-you? And if you don't: Do you have a access (network/money) to someone who does?
Oh, man. One could rant for hours about this. You are absolutely right. But in the end it's not really a class indicator because info about this particular and similar schemes could theoretically be packed into a weekend long workshop. In any small company or big factory, and definitely in schools as early as grade 10.
But it's a matter of character and you have to be damn lucky if you get a teacher who cares that much. Even neighbors will more often than not, NOT enlighten "the less fortunate" about stuff like this. It's pathetic.
But that's why this cascade works so well to keep almost all of the "more fortunate" under perfect societal control by which I don't mean some mythological conspiracy but "Steuerungsmechanismen" (some dude who got out of some cult beautifully explained this but I forgot both his name and the title of the book), keeping almost all of them in line, mostly silent, and alienated from the inter-generational usefulness of critical thinking.
And there is no irony in all this. Too many peoples mindsets never left the modern dark ages. One can only raise a brow and chuckle at all this.
It's a class indicator for sure, but, in my opinion, not class in the sense of hierarchies but of intellectual style, niveau. These tactics are low, like punching drugs.
- Through extensive lobbying, the US passed the HMO act of 1973 which requires that all employers offer an HMO plan to employees. HMOs were created to keep costs down, but United really took this to the extreme, making it as hard to use your health insurance as possible, and creating vertical monopolies like OptumRX. United takes so long to pay providers for the work they do that they now offer payday loans to doctors offices, which is crazy.
- The US uses a fee-per-service model that priorities procedures over preventative treatment or patient education. Some other countries have moved towards reimbursement based on health outcomes.
- The Affordable Care Act banned physician owned hospitals, which were growing in popularity and had better outcomes for less fees to patients.
- Private Equity is swallowing up hospital systems, emergency departments, etc. The most common seller is another PE firm, so they try to make a quick return through heavy cuts and then flip it 5 years later.
This should be illegal. I have read that UNH also owns around 10% of providers so they own the whole chain.
Aetna "forces" you into using its pharmacy by refusing to authorize any prescription with more than a 30-day supply unless through its wholly-owned pharmacy-by-mail subsidiary.
it's worth noting that the healthcare system has a couple of antagonistic components and right now probably insurers are the only group actually fully happy with the situation. medical providers, pharmacists, and patients are all getting shafted.
There also isn't much interest in improving healthcare from either side right now. The right has nothing. Their current platform is ignorant views about vaccines. The left has a stronger interest in Palestine and housing abundance right now, though all of that is dwarfed by trying to keep the rule of law going, and preventing us from falling out of a democracy. Healthcare is way way down the list for everyone sadly--even Bernie doesn't talk about it much anymore. The electorate has spoken, and they are not interested.
No insurance, none, of any kind.
I've got a Free h D in hillbilly medicine though. I've accomplished some amazing shit, but it's unraveling a bit now, and I'll be super surprised if I last much longer.
One can certainly say such a hit to morale is just collateral damage in the beautiful face of our wondrous mutant hive, but what are you guys gonna do when we start stinking up your streets en masse? One way or another, you'll be smelling the smoke.
Soylent Green is here. Read your labels carefully.
Proudly Made in the USA with Harshly Sourced Ingredients. I was free roaming though, if that matters.
Edit: returned to clarify that I was pulling myself up by me bootstraps. It's just that it's getting tough to hold on to em tightly enough. No shoes no service though, I guess.
