Posted by ceejayoz 1 day ago
Think about how you didn't really hear about movie theater shootings until someone shot up the one in Aurora. Now they're more common. There is a huge element of social contagion because shooters are very much copying each other's work.
Which would suggest that we would see a rise in CEO assassinations over time[0]. But the thing is, it's also legitimately harder to assassinate a CEO than shoot up a school. Schools are soft targets with predictable schedules for their occupancy. A CEO might be in 20 different countries over the course of a month; you'd have to engage in a LOT of cyberstalking to even have a chance of catching a CEO in your hometown. And not to mention, they usually have security detail specifically to prevent this exact thing from happening.
But who knows. There's a lot of people pissed off about corporate power, in every country, across party lines. It only takes one security fuck-up.
[0] This is what the phrase "propaganda of the deed" refers to
That's incredible.
I also learned that they have a whole bureaucracy already in place for appealing of payments. (People whose job it is to field all the rejected and then appealed claims, and write multi-page letters explaining their reasoning...) So I took my complaint to my state's consumer complaints department. Let the two bureaucrats explain things to each other.
And in the end, the insurance company paid me.
Except that the prevailing direction of the country is to destroy the ability of governments to function effectively. It seems like a well planned move to actively destroy the only entity capable of standing up to big business.
The tens or even hundreds of hours on hold with insurance providers and hospital billing departments and calling state regulatory agencies and time sorting through the fifty bills scattered over ten months from nine different entities, all for a couple days in the hospital, are a massive unaccounted-for cost of our already-record-settingly-expensive healthcare system.
When I reach those, I’d expect them to pay the remainder. As agreed. As implied by a prior authorization.
They won't. "Out of pocket maximum" means something completely different to the insurance company than it does to any normal person.
Out of every dollar you pay out of pocket, the insurance company will decide how much they feel like counting it. Might be the full dollar, or some pennies, or nothing.
You might have paid $20K out of pocket in a year, but the insurance company will say you've only paid $1000 because just because. Good luck reaching that "out of pocket maximum".
Source: I've been there.
Insurance companies are just doing what their clients, our employers, want which is reducing cost at every possible angle. Just like how companies cut every possible cost everywhere these days.
It's all the same problem: cost cutting across the board, at any price, by American businesses.
Insurance companies are not doctors and should not havd the privilege of denying any claim for any FDA approved action.
I do agree that a lot of people seem to believe that’s how it works. There’s some objectively correct treatment, the doctors uncover what it is, and I have an unconditional right to get that treatment no matter what it costs. But no healthcare system does or could work that way. You have to consider tradeoffs and control costs somewhere.
You can build a system that makes it seem that way to the patients; that’s why I like Kaiser. In my opinion it’s more user friendly that way. But the tradeoff is that cost controls are imposed directly on what doctors are willing to prescribe. There’s many stories of Kaiser doctors refusing to prescribe expensive treatments that other doctors would, because as a matter of policy they believe some lesser treatment would be sufficient.
For non emergencies, I would much prefer we go back to patients paying cash, and getting medical loans when they need. For emergencies I would prefer the government cover them directly without any intermediary. Because of the insurance system, things cost 10x more than they should, which makes it an actively harmful system. If it were to go away, competition and efficiencies would drive down prices 10x.
To be clear, a lot of people have very valid complaints about the US healthcare system. I'm not saying everything's perfect or even that every improvement would involve a tradeoff. But every medical system on the planet, including whichever ones you have in mind as better than the US, has controls on how expensive drugs can be used when cheaper ones might work.
That's because they negotiated and paid for such a plan.
My sister works for a similar large employer. They hired Cigna as the insurer/benefits administrator, and every interaction is a problem. Your two kids have an ear infection? Cool, we've determined that the second one is due to an auto accident. It's so bad that the company hired another company to argue with Cigna for you.
End of the day, the employer controls the purse, and the insurer is doing what the employer paid for. It's cheaper to hire another company to argue for the folks who have noticed problems than to pay for a level of service.
Stop having employer provided insurance / benefits; just tax and then provide services. No more billing department. Just single payer (we the people) get what a patient needs healthcare.
My doctor wanted to give me an MRI for a pain near the heart, and insurance told them they wouldn't cover it until they did various other forms of cheaper treatment, including taking antacids for one month, and 5 months of physical therapy. Which of course didn't work. The waiting time for the first appointment was 3 months.
It took over 9 months for my doctor, the only person to actually properly know the details of my case, to be able to give an MRI that he thought was necessary because someone at the insurance company, who I never met, who had less medical expertise than my doctor, wanted to save the insurance company money.
Anecdotally, all the people I know who live in countries with socialized medicine haven't ever had a wait time as long as that, and haven't ever had a simple MRI be delayed by their socialized insurance.
Australia has a combination of public and private health insurance, and they both work well together. The public health options provide the safety net, while the private health insurance is optional.
Where the private option makes sense is if you want to go to specific private hospitals, or if you have elective surgery (the classic example being a knee reconstruction for sports injury) and you don't want to be in a queue behind people waiting for public hospital beds for more serious conditions like heart surgery and so on.
My dad in Australia had open heart surgery 2 years ago, and is doing very well. His cost for the entire procedure? $0 and this was done by one of the very best heart surgeons in the country. He has private health insurance, but elects to go to public hospitals, which have excellent surgeons committed to the best care, because he's a patriotic sort and he's paid into the public health system through taxes for his entire life.
Meanwhile I pay > $3k per-month for not even top tier care in Upstate New York for myself, my wife and my 10 year old daughter, with no serious pre-existing conditions, and I have absolutely no guarantee that any surgery or anything that any of us need in the future will be even covered, even if my primary physician says it's medically necessary.
The rest of the world would do well to study how the combination of public and private health insurance is done in Australia.
Far better to instead wait for 11 months, spend a couple hundred hours bouncing around phone trees for my health insurance provider, and pay a few thousand dollars per month for having the privilege to do so. So much less stress for me and my doctors to get jerked around by barely medically competent insurance company employees, makes it much easier to sleep at night. Especially fun to have PA withdrawn because due to how long it's taken to get the MRI has allowed the issue to progress to the point where the kind of MRI needed is now different and requires a new PA.
There are already large swaths of people who can't get a MRI period because they are excluded from healthcare in this country. And if your belief is that a single payer system will be hampered by measures such as austerity, then say that. Because then your issue isn't with single payer healthcare but instead with politicians who believe institutions need to be run as a business instead of what they actually are, which are public services.
This option doesn't work because healthcare can't be a free market. Car insurance companies have to compete not only with each other but with alternatives like not owning a car at all. There is no alternative to being alive, so health insurance companies can effortlessly collude to raise prices across the industry knowing that they have the most captive customer base possible.
(b) if we had a reasonable market then some people could have an alternative like paying out of pocket
US healthcare has to compete against cheap healthcare in mexico or whatever
A good first step would be banning price discrimination for medical procedures. Right now you get three different prices for "I pay", "insurance pays", and "insurance denies and I pay". People can't tell you what those prices will be. The whole point of insurance is supposed to be to derisk these kinds of decisions, not increase uncertainty and risk. Attempting to use insurance and getting denied can 10x your cost, so what is the purpose of the insurance?
Otherwise we end up paying more anyway. Someone needs to bail out hospitals.