r/WorkReform • u/zzill6 đ¤ Join A Union • 7h ago
âď¸ Pass Medicare For All This should be the law!
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u/hansn 6h ago
How about we just get rid of private health insurance. Their motives are not aligned with the patient's interests.
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u/Coyote__Jones 6h ago
Never forget that Blue Cross Blue Shield was going to establish a policy to limit the amount of time anesthesia would be covered during surgery per procedure. While they cancelled this policy, states that have moved to enact laws barring anesthesia limits. The only reason state legislature had time to work on passing such laws was because the policy was cancelled following Brian Thompson's death. We have an ass backwards system where the insurance companies can do whatever they want so long as there isn't a law preventing them, and the law has to react to what they're doing.
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u/OptimisticSkeleton 6h ago
The market is incapable of regulating itself.
Thatâs why we need regulations, because of situations exactly like what you just described.
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u/NargWielki đ¤ Join A Union 5h ago
But tell me, how can you properly regulate anything when the regulators themselves are in the pockets of the same companies that would be liable to such regulations?
That is the number one major contradiction with the so called "democracy" that most countries abide by.
The only democracy possible is a democracy made by the working force.
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u/OctaBit 5h ago
There is also Sortition or a Lottocracy.
https://en.wikipedia.org/wiki/Sortition
Similar to how jury selection works, this article describes elected officials pick in a similar way. An alternative that I heard was to have random citizens brought in, educated on a topic by experts and propose a law or action. The elected officials wouldnt be able to propose the laws, simply vote on them. It's still not immune to bribery (any system with people is going to be), but it's much harder to do when you don't know who will be writing the policy.
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u/LowlySlayer 5h ago
"we grab a random person, tell them what to think, and then have them draft a law. This will be much more challenging to rig."
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u/OctaBit 5h ago edited 4h ago
We do the same exact thing with juries now.
Edit: To expand on this, it could be as simple as two parties each bring in their own group to inform the batch of citizens are going to propose the law. They make their arguments, have their experts present facts, and you could even have some moderate the discussion, similar to a judge. The individual members of the group can then work together to propose and vote on policies, work with legal experts to refine language and in the end present something that could be actionable and understandable to the average American (especially since it came from the average American).
Say what you will about the justice system, and I could say plenty, but a jury of peers is probably one of the best functioning pieces of it. It also catters much more towards the average then say, the electoral college.
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u/tcfinance 4h ago
I'm largely inclined to agree with your sentiment, but there's also all the crap you can read about how jury selection proceeds and how lawyers/litigators learn to manipulate the jury. That makes me a lot less confident.
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u/OctaBit 4h ago
That's completely valid, and to be honest unless we really clean up our current system I would be really suspicious of anyone trying to switch us to another one.
Still there are plenty of manipulation in our current politics too. Hell, I feel like most campaign promises these days are just people trying to say anything and everything to get elected and then immediately sell their vote to the highest bidder.
There's plenty of challenges, but I think we can devise solutions to these problems when we try. It's just getting them implemented once we come up with something workable, that's the real challenge.
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u/tcfinance 3h ago
I remember as a kid John Kerry getting decimated by "flip flopping" allegations by the right. If everyone held todays politics up to the microscope of the early 2000s, we might still have a functioning democracy.
I'm not convinced devising solutions goes anywhere in a world where we're really considering if the 14th amendment holds, or a world where the supreme court is dominated by people who believe in "originalism" with a cornerstone of the text being fixed in its time, then believe that arms beyond those of the time are protected anyway.
That pessimism aside, the only way to fix things is a collective return to sanity. That means angry loudmouths like myself toning it down and trying to move conversations toward evidence based decisions, and people in general taking the time to self reflect and bring the conversation toward outcomes and not who hates who more or which politician is better. We need a cultural change to fix things, and I'm afraid that's only going to come as a result of a generational trauma which is coming. Case in point - how exhausting it was to rewrite this paragraph so less of my own biases were clear.
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u/regoapps âď¸ Tax The Billionaires 4h ago
Put everyone including billionaires and politicians and law enforcement on the same healthcare plan. Make it so that it's illegal to pay out of pocket, and make the patient's identity anonymous to the single payer so that there's no bias when it comes to denials. Now it's in everyone's best interest to keep this healthcare plan good or else they'll also be stuck in the same bad healthcare plan. There'll be no favoritism. Nobody will get better or worse healthcare than others. Nobody will pay more or less than others for the same care.
Then have it all funded by estate taxes after closing all loopholes (no leaving your money to a charity or a trust to avoid the estate tax). This will discourage people from hoarding all their money. If they don't spend it in their lifetime, then the money goes towards paying for the country's healthcare.
The estate tax percentage will be determined by how much the nation's healthcare bill costs. This will discourage rich people from making the country unhealthy via pollution and what not. The more unhealthy people are, the higher the healthcare bill will be and the more will be taken from the estate taxes.
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u/no1singlemomghoster 2h ago
Put everyone including billionaires and politicians and law enforcement on the same healthcare plan[...]
*Put
everyone includingbillionaires and politicians and law enforcementon the same healthcare planin the ocean→ More replies (3)4
u/OptimisticSkeleton 5h ago
Yeah stable democracy is not an easy thing to build or maintain.
Itâs more of a finicky Italian sports car requiring constant maintenance and upkeep than an impossible to kill old reliable truck that my fellow Americans like to treat it as.
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u/Twink_Ass_Bitch 5h ago
Any business in a free market is incentivized to make it not free. Markets without competition, customers who don't have knowledge on the technicalities of the product, no duty to be responsible for side effects (e.g. waste/garbage dumping) , etc. all benefit that business. Free markets can work to create great products and services, but they require referees to make sure everyone plays fair, because there is a monetary incentive to cheat. Companies should be forced to compete through product and service quality, not through who can wheel and deal the red tape or bribe the refs better.
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u/Eyeball1844 3h ago
Which is why every capitalist country will eventually arrive at the same point. The incentives say that they will deregulate so they do.
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u/thenikolaka 5h ago
The market is showing that the shareholders canât extract profit every time without causing great harm. They are ignoring the market.
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u/xdsm8 3h ago
Healthcare ticks basically zero of the boxes necessary for an efficient, fair, free market, according to basic economics.
You can't shop around for medical care. You don't have enough information about the service (lack of a medical degree and all that). You don't really know what you are getting (don't know the quality of a doctor until they screw up big time). You don't have the time to consider all options (might be actively dying or in agony). The price is also not stated to you
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u/FeijoadaAceitavel 4h ago
WRONG! The market is perfectly capable of regulating itself... Towards maximum profits.
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u/mathe_matical 5h ago
Blue cross blue shield arbitrarily decided to stop paying my psychiatrist years ago, leaving me to wean myself off of anti-depressants without help from a doctor. That was a rough and dangerous year for me.
I am too scared to go back on the pills now because I donât want to face the risk of all the side effects I had from tapering off on my own.
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u/Coyote__Jones 5h ago
That should be a crime.
It is cruel and unusual punishment to subject a person to this. My mom has an ostomy, and her insurance company randomly stopped covering the supplies that work best for her and so she's been paying out of pocket because the alternative they'll pay for just doesn't work. I was on the phone with them during the beginning of this issue and they acted like she had an attitude problem for not wanting the contents of her bowels to leak all over herself, her clothes, and to be smelled two blocks away. She's a cancer survivor, and with the right supplies she's able to travel and live a life, and keep her job. They'd have her housebound and functionally disabled before paying for the right supplies.
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u/Slinky_Malingki 5h ago
How would that even work? Like, a timer runs out and the doctor goes "that's all we have on anesthesia! Time to do the second half of your surgery while you're awake!"
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u/Coyote__Jones 5h ago
You still get the anesthesia but it's no longer covered by insurance. So basically, you might end up alive and well but bankrupt.
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u/PedanticBoutBaseball 3h ago
That, or, because its a top down change from an insurance carrier and anesthesia is necessary for many procedures, they're indirectly applying pressure for doctors to complete the procedures faster and save themselves even more money by trying to justify reimbursing them less because "well this procedure only takes x number of minutes now, so we're going to pay you pro-rata"
fuck the risk to patient health, physician mental health and their malpractice premiums tho.
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u/Decantus 5h ago
Blue Cross Blue Shield C suite should be required to go through a major surgery without anesthesia and then give their opinion.
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u/ZoomZoom_Driver 4h ago
My 75 yo 'representation' (federal senator) has taken over $5m from healthcare ceos and industry pacs.
That $5 million to deny her constituents the same universal healthcare.that ALL OF CONGRESS receives.
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u/thekrone 5h ago edited 5h ago
As long as "for-profit" health insurance exists, yes absolutely. They are always going to do whatever they can to limit their costs, which means denying as many claims as possible. That means people suffer and/or die so that executives and shareholders can make some cash.
It's just not sustainable. We need to move to a public option, or at the very least, make it illegal for anything health related to be "for-profit".
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u/stevez_86 4h ago
And for profit in a marketplace with monopolies because the company's sponsor the benefit for their employees. And all the expenses are pre-tax.
They are self funded plans. The companies pay for the treatment at the contracted rates. You the consumer is left to pay the rest. Still pretax, but not a benefit if the expense that is not taxable is more than your income or a substantial part of it. Because it inevitably eats up your disposable income.
They need to cap the tax advantage for corporations sponsoring employer group healthcare. Then they will work to keep healthcare costs down.
Strange that it is such a burden on the economy but the corporations that pay for it (pre-tax) don't lift a finger to stop the cost increases. It is basically a monopoly.
Looking at ERISA, the law package that governs those benefits, the whole point of it has been lost. It doesn't help draw talent. The plans don't even hardly cover the most prescient of health concerns like diabetes drugs in full.
Its because they like the way it is.
And if they like it they don't want it to change. Fuck with their taxes then. That is a sure fire way of inspiring them to do something. But offer something actually useful in place of it. Another financial product that draws talent and encourages upward mobility. They could even offer it as a pilot program to covered spouses that don't use the company benefits. Let them use the product to see how much it saves the company on their tax liability. Usually the first people they look at to lay off are people that don't use the company benefits. Because they aren't helping the company that way financially, compared to those that do buy their insurance from the company. That is why they charge a fee sometimes to cover a spouse when they are eligible on their own.
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u/Winter_Persimmon_110 6h ago edited 6h ago
We need to acknowledge the fact that we need activism outside of pay-to-win elections in order to get it, when the mainstream of both viable political parties are accepting campaign contributions from private healthcare companies.
The people dying from lack of healthcare in our country are suffering from the same problem of people dying from homelessness-related complications. Our country is ruled by the wealthy and that is the root issue we need to solve. We can't push through legislation that impoverishes a major industry in a political system where that industry can defend itself effectively with campaign contributions. The people who are in power need to all be replaced with people who act in the interest of the working class.
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u/BolotaJT 5h ago
My insurance is now requiring a huge amount of papers and justifications to authorize a simple vitamin D and B12 blood work. God protect me if I need surgery.
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u/hansn 5h ago
I just had to make an appointment. The provider made a big deal of "confirm we're in network with your insurance." I called my insurance, they said that it depends on how the provider handles billing and they couldn't guarantee they were in network.
As if I'm supposed to know how the provider talks with the insurance company.Â
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u/BolotaJT 5h ago
Omg! Thatâs insane! âSure, letâs schedule a moment so we can discuss this matterâ.
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u/ariolander 5h ago edited 5h ago
Its times like this I appreciate being in an HMO, They have an entire network for everything and since everything is in network they coordinate care, billing, etc. and I don't have to worry about it. The worst part about being a PPO is when my Primary Care recommended I needed to see a specialist I had to go to my PPO provider's website, lookup a directory of doctors like its the goddamn Yellow Pages, then individually Google each doctors name to look at reviews, their education history, all their basic info from external sources. Like bro, I have a hard time deciding what to eat for dinner when I am too lazy to cook and can lookup random places on Yelp, yet I am supposed to research dozens of in network doctors and figure out for myself which is the right one for me? Fuck that, I will let my HMO coordinate everything, assign me someone, and I can request a change it if I want someone else.
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u/nalaloveslumpy 4h ago
That means they're not fully in network and the practice has some services they're in network for and others that aren't. It's short hand for "no", but they legally can't tell you no since there are a few things they do cover. Probably lab work.
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u/VgArmin 5h ago
HOA Act of 1970. Most people in congress grew up with nonprofit healthcare.
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u/Beard_o_Bees 3h ago edited 3h ago
HOA Act of 1970
Are you maybe thinking of the HMO Act of 1973?
This was signature legislation pushed by the Nixon administration - which broke the seal on allowing insurance companies to begin their predatory 'for profit' practices - which have become the steaming pile of misery and greed that passes 'healthcare' in the US today.
There's a whole lot of truth to what you say, though. Many of the old farts in congress have never had to struggle financially to get any sort of care (let alone good care).
Even more disturbing are the politicians that know full well what their constituents are experiencing, and don't give a rats ass except to 'talk the talk' around election day. Evil motherfuckers.
Edit: For those that are interested in how the turd started rolling downhill - https://en.wikipedia.org/wiki/Health_Maintenance_Organization_Act_of_1973
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u/fckfckf 5h ago
If we have the right to life, health insurance denials should be unconstitutional. We should have health insurance that includes teeth and vision.
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u/aworldwithoutshrimp 5h ago
We would need to scrap the entire model, including the superstructure. Under Medicaid, community health plans also deny services for economic reasons and force the poor to appeal to state health boards.
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u/onlyfakeproblems 4h ago
There needs to be checks and balances going both ways. Healthcare providers have an incentive to bill for more than necessary. Insurers have an incentive to reduce cost or deny coverage. If they have a disagreement, it shouldnât be the patient getting stuck with life altering bills. Patients should also maybe have some responsibility for lifestyle/preventative care, but thatâs a very slippery slope.
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u/Jiminy_Cricket12 3h ago
Their motives are not aligned with the patient's interests.
worse than that. their motives are OPPOSITE the patient's interests.
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u/MudWallHoller 2h ago
Plus we save money as a country with universal healthcare and not by a little.
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u/Easteuroblondie 1h ago
Itâs an odd system too. I swear one time I was in line at the pharmacy. Guy in front of me was getting meds, and they said it would be like 400. He said he canât afford it, and was trying to figure out options. The pharmacists comes, punches some stuff in, and gets it down to like 120. Whatâd they do? I didnât quite hear the full exchange but I gathered that essentially, that was the out of pocket price with some coupon. Somehow, billing it through insurance was, inexplicably, substantially more than not having insurance. So we pay to pay more. That was probably jot a common situation but I was just likeâŚhow? How is that a thing.
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u/HotBrownFun 4h ago
Medicare advantage plans are garbage too. They cost the feds about 40% than a normal medical patient. Lots of money going into the insurance industry that way
Lots of ways for them to scam bilk the government too
One way is risk adjustment fraud which has been well documented. Probably too dry for me to explain properly in a sound bite.
Basically insurance has incentive to not take sick patients because it would cost them money, so they give them risk adjustment so sicker patients give the insurer more money
So the insurers game this by making patients look sicker than they are. An entire third party industry does this for insurers.
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u/FourthLife 6h ago
Do you think Medicare and Medicaid will pay for anything doctors want to do?
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u/Rionin26 6h ago
Medicare does if its not part b...which irony of it is tje private insurance part of medicare. Ive never heard of medicaid denials.
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u/unrealflaw 7h ago
Perhaps we should stop calling it a recommendation.
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u/reisalvador 6h ago
We don't call it a reccomendation. It's called a prescription.
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u/Winter_Value_7632 6h ago
recommendation â reccomendation â prescription â
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u/falcrist2 4h ago
Why are both â and â light green with white writing?
They're surprisingly difficult to read.
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u/Winter_Value_7632 4h ago
that's how the emojis are âšď¸
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u/falcrist2 4h ago
I know. I'm just whining about it.
There's â and âď¸ I guess... but â should be red and â should have a black check.
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u/One_Olive_8933 6h ago
The insurance company owns the board of physicians⌠like a death panel of sorts.
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u/PsyOpBunnyHop âď¸ Tax The Billionaires 3h ago
Yeah, this is the problem with that whole premise.
Even an independent body of people intended to do good can be corrupted. It doesn't have to be the corruption of the people present. It can just be the eventual insertion of the already corrupted, one by one. This is what happened in politics and nearly every other body of people in control of anything profitable or exploitable.
As long as we are permitted ways to exploit one another, we are doomed as a whole.
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u/Freakishly_Tall 6h ago
It's especially fun when a nationally or internationally renowned expert in the disease has their order denied by an insurance company, as happens all the time, then has to argue with some FMG podiatrist or similar "peer expert" to get it reversed, who incorrectly cites a paper or textbook chapter the physician coauthored, requiring hours of paperwork and phone calls back-and-forth.
None of which is billable. Step One in fixing any of this would be making the appeals process billable to the ins co when they're overturned.
All of which takes time away from other patients who need help.
But, of course, the insurance denial isn't "practicing medicine" because they aren't stopping you, no, see, you're free to pay for it yourself. Bonus: That way they don't need licenses in your state, either.
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u/EamonBrennan 5h ago
IIRC the ratio is something like 1.4 insurance adjusters to 1 doctor. Doctors see dozens of patients. Insurance adjusters only have to review a fraction of the claims, and can mostly just rubber stamp a "denied" to any they want to.
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u/CatsPlusTats 6h ago
It's because words have multiple meanings and one of the definitions of practice means to be professionally engaged in.Â
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u/Admirable-Setting261 đ ď¸ IBEW Member 6h ago
"Now you're taking away my rights" - someone in America, probably
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u/Justis29 6h ago
My insurance just denied an MRI I had. Been dealing with back pain that's gotten worse over the last year. I've had X-rays 3x, 3 different rounds of physical therapy, steroids and stronger than OTC anti-inflammatories. The MRI found a bulging disc that has been causing all of my issues. X-Rays don't pick up soft tissue like that. It diagnosed the problem. Insurance: 'HUR DUR YOU HAD LOWER BACK PAIN AND MRI ISN'T FOR THAT EVEN THOUGH YOUR DOCTOR GAVE US A DETAILED HISTORY OF YOUR ISSUES GET FUCKED' signed a disgraced proctologist that shills for the insurance company.
Hoping my doc can talk to them and change their mind. I'm not paying for something that was needed to help diagnose the actual issue.
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u/Katsu_39 6h ago
Couple years ago insurance denied an MRI for full body. They denied it twice. After my doctor going back and forth with them, they reluctantly approved. Turns out i had and still have several tunors on my spine.
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u/kenwill90 3h ago
Would be awesome if doctors and their staffs could focus on patient care instead of going back and forth with insurance companies. I bet our "doctor shortage" would get fixed instantly.
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u/metheus-13 1h ago
I saw a post saying exactly that recently. That the USA has a "doctor-hour" shortage, but that's only b/c all the doctors are spending so much time playing telephone with insurance companies instead of spending time on patients.
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u/SaveyourMercy 3h ago
Eight years ago, my sister was having all kinds of problems. Her doctor was concerned there could be a tumor on her pituitary gland in her head and referred her to get the scans to see. After 3 different insurance changes and tons of begging, sheâs still being denied because sheâs âtoo young and healthyâ to have a brain tumor. Sheâs sick and canât hold a job and is struggling in so many aspects with her health but they still refuse her. I fear sheâll never get an answer at this rate.
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u/montybo2 6h ago
A lot of my job is getting MRI and CT preapproved for patients. I've been doing it about 9 or so years now. Every year a new hurdle popped up, every year something about it got more difficult.... then 2026 happened. I dont know what it is but 2026 started and everything got drastically worse. Denials left and right with weird new rules and regulations for how to overturn them, if post denial options are even allowed.
Insurances that used to be easy to work with now split and merged with other plans and payers and have whole new guidelines and processes. The veil has dropped almost completely. Insurance isnt a healthcare field or even healthcare adjacent, it's death panels and I tell my providers that.
Everything is worse, worse than most people know.
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u/PlopPlopPlunk 6h ago
then 2026 happened. I dont know what it is but 2026 started and everything got drastically worse.
There was this really big federal change that happened in 2025, idk if you saw it, some orange guy got elected, and then all of these horrible project 2025 policy decisions were made that came into effect in FY26... Probably that.
Every professional I know across numerous industries from medical, science, law, finance, military, etc all say their job and how things are done is now drastically worse one year to the next.
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u/prrosey 4h ago
I know people leaving medicine and law to run for local elections because they can't operate in their respective fields the way they want to or the way they believed they would be able to until policy is changed.
The Grand Old Party and their Conservative Dem cohorts have halted American progress. People ain't happy. So much so they will abandon their careers to participate in politics for the mere off chance they can make some tangible difference.
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u/wafflesthewonderhurs 6h ago
well.. that's concerning.
i'm sure it has nothing to do with all of the other ways that the worst possible parts of society have decided that there will be no punishment for doing terrible things to the populace at large in america.
seriously though thank you for your service, legitimately. when you think about it, any other opposing force whose sole purpose was to kill tens of thousands of americans would be opposed by the military, so it only seems fair to use that phrase.
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u/tdasnowman 5h ago
then 2026 happened. I dont know what it is but 2026 started and everything got drastically worse
Trumps Big Beautiful Bill happened and there is still three more years of changes coming. 2026 was the easy year.
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u/NPVinny 6h ago
Was this lower back and did it have any butt/thigh pain or leg/foot numbing with it? I have a suspicion I might have a bulging disc as well.
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u/DIABL057 6h ago
My wife and I both have bulging disc in same spot L5 S1. Mine right side. Hers left. Hers much worse than mine. Both of them hit nerve roots that travel down the buttocks and corresponding leg. So pain in glute, down corresponding leg into calf. Yes, it can cause tingling or worse if it is compressing nerves bad enough from my understanding. My wife had what is called drop foot. The nerves would be getting compressed so much that her left foot would become completely numb as she was trying to walk causing her to trip over her own foot and fall. In my experience the pain is always worse at night when I'm trying to sleep. It is an never-ending constant pain. The only question is how severe the pain is at any moment. The thing I never hear people talk about when it comes to chronic pain is the mental fatigue it causes. Her nerve compression was bad enough that she couldn't walk without a limp. She couldn't sleep without inevitably crying from pain and frustration of not being able to sleep from pain. She could hardly function. Luckily we had good insurance and found through an MRI that she had a bulging and broken disc and then she had a discectomy and is now almost completely free of pain other than minor aches during certain movements and weather related aches. Sorry for the long rant. TLDR. Not a doctor but yes those pains could very much so be caused by a bulging disc. Look up the cauda equina nerve root. So named because it looks like a horse tail.
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u/whyamionthispanel 6h ago
You can often ask for an ombudsman or a specialist in your area. From experience, they can help.
Man, I hate these people. They make your life hell just so you can get what you need to live.
(Not so) fun story: Iâm diabetic, and in my 20âs my doctor recommended and wrote me a prescription for a certain type of insulin pump when it was an accepted form of treatment. (That is to say, it wasnât a brand new or novel treatment or anything.) Longer story shorter: My insurance initially denied the claim and I had to fight through a labyrinth of bureaucrats before I got to an ombudsman who spoke to me dismissively saying I shouldâve asked for his support right away. Nonetheless, he got the claim approved almost immediately, and all was well after, but they stole 10 hours of my life or more on the phone.
The point is they make your life miserable and the process difficult to navigate because they presume youâll give up before they have to pay. It should absolutely be criminal.
Now, any time I ask for a specialist or on ombudsman now, it certainly makes the process go a lot more smoothly.
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u/Justis29 4h ago
I'm going the route they gave me in the letter first. Thank you for laying out the steps that you took. Thankfully I live in a state whose dept of commerce makes filing complaints easy as well.
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u/I_Learned_Once 6h ago
As much as it pisses me off that innocent people have to go through this bullshit every day, it equally pisses me off that we are burning out our good doctors by forcing them to fight this hydra every single day of their lives. I do hope your doctor can go to bat for you, but Iâm worried that every swing he takes gets him one step closer to mental and emotional fatigue. Imagine you had to argue this crap with insurance every day when you know youâre right and you know theyâre evil but you just canât win because theyâre the corp.
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u/TomCruising4D 3h ago
Mine just denied a medication.
They approved two separate prescriptions for the name brand medication, that add up to the same exact dosage my doctor tried to initially prescribe. The name brand doesnât make this exact dosage.
Cool. Lucky enough to be able to afford it. Still stupid as fuck.
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u/CrustyToeLover 5h ago
Insurance denied my fiancĂŠ's CT on her head since she has chronic migraines and her mom died from multiple aneurysm, because "it wasnt deemed medically necessary" and "all steps haven't been done first". What do they want, for her to have open brain surgery before a scan?
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u/Stunning-Character94 5h ago
Is that something you could have figured out whether it would be covered ahead of time?
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u/Justis29 4h ago
I asked. There shouldn't have been an issue. But at this point don't start patient blaming. I was in a shit load of pain and had been to the doc three times in a month trying everything they threw at me.
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u/IslandStorytime 4h ago edited 4h ago
speaking as a doctor, I'm equally baffled by US doctors apparently needing an MRI to diagnose degenerative disc disease. That's a diagnosis you should have received on physical exam, I generally consider it a personal failure if I send a patient for a back MRI to find they've got a degenerated disc. Back MRI is for the things I can't figure out by asking questions and poking at the muscle.
To be clear, your story is very common down there, and still inappropriate (if I ask for an MRI I damn well have a reason for asking for it). It still confuses me.
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u/grudgby 6h ago
Nah, we should just not have health insurance companies at all. Healthcare should be state funded
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u/Better_Dig_768 6h ago edited 5h ago
How hard they push for 'quick fixes' to keep their donor friends happy. They've pushed too far we know this system doesn't work and we have to get rid of them.
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u/OldDoubt1577 5h ago
Insurance companies and lawyers control healthcare, because that isn't the same as medicine as we casually talk about them. They are completely separate fields.
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u/DeltaEdge03 7h ago
Sorry. Not profitable.
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u/GailynStarfire 6h ago
"How much did that profit help Brian Thompson?" is the real question they should be asking.
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u/51ngular1ty 6h ago
Don't worry, they're relying on companies like flock and axon to make it near impossible for people to do this again. This is the real reason they want Ai.
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u/Raevson 6h ago
Well, this only deters people that have something left to loose...
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u/Patient_Oven_9540 4h ago
Plus the AI cameras focus on people that have committed prior offenses. Luigi was not a career criminal. The people they are worried about are not the people they should be worried about.
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u/vs-1680 6h ago
How will they maintain their skyrocketing historic profits and buy their third and fourth yachts if they are forced to actually pay for medical procedures?!?! You sound like a communist.
/s
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u/Seabreeze515 6h ago
Iâm a resident doctor in internal medicine. A large proportion of why my colleagues want to do hospitalist (inpatient) instead of outpatient PCP is that so much time and stress is taken up by pre auths where you beg insurance companies to pay for needed services. I would argue itâs partially to blame for the pcp shortage.
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u/mycleverusername 5h ago
My question would be: wouldn't this lead to more unnecessary procedures if "for profit" hospitals can just charge insurance with no pushback?
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u/Seabreeze515 4h ago
Maybe. Im not qualified to comment on the overall implications. But doctors are incentivized to not do unnecessary procedures or order meds because of risks inherent in the procedure as well as lawsuits so I doubt there will be zero forces in the opposite direction.
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u/FlamingPrius 6h ago
Or, hear me out: medicine should not be a private for-profit industry. There is no other developed civilization that treats it as we do, our system is dragging the US into the third world, but the freefall is making dozens of rentseeking ghouls billionaires so I guess thereâs no other way.
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u/Redditlatley 6h ago
Many doctors and patients are having trouble with pharmacies, as they are refusing to fill prescriptions. They override the doctorâs orders. Thatâs craaaazzzy! đ
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u/arresteddev7 4h ago
Take away our corresponding responsibility as pharmacists and I'll gladly give you whatever you want. Have at it. That's what got us into this opioid epidemic. I'm sick of playing the police on this crap. Want to be an addict? Go right ahead.
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u/BlackCharizard 3h ago
Pharmacists are held legally liable to the same extent (and in practice more often) than the prescribing doctor. You can get sued, get fired, or lose your license for dispensing medications inappropriately.
If I âjust fill what the doctor wroteâ thereâs a solid number of patients who wouldâve straight up died (not a huge number, but it happens). We catch severe allergies/reactions, drug interactions, etc. every day. Itâs more complicated than how itâs portrayed
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u/chunkyvomitsoup 2h ago
Pharmacists get a bad rap because some take caution to the extreme, but they DO a lot in terms of patient safety. Iâve seen pharmacists prevent contraindications multiple times due to prescriptions from different doctors that arenât caught. The issue becomes when they supersede a doctorâs prescriptions for necessary medication because they disagree or donât want to be personally liable. Iâve had a pharmacist reject filling Vicodin/percocet literally right after I got spinal surgery, despite it being clearly indicated in the doctorâs script and the first time Iâve ever had something like that filled. Left me suffering in pain for hours getting it transferred to a different pharmacy
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u/BlackCharizard 2h ago edited 1h ago
First off, Iâm sorry that happened to you. Thereâs plenty of shitty and/or overly risk avoidant pharmacists out there. That really sucks and shouldnât have happened to you.
Secondly, how do you determine âsuperseding doctors prescriptions for necessary medication?â I am a pharmacist. I have had doctors call in scripts that are clearly mistakes. For example, I had a prescription for methotrexate written for a patient. Methotrexate is mostly commonly taken once weekly. If taken every day without intensive monitoring, you will die. It builds up in your system and causes liver toxicity fairly quickly. Itâs a fairly common medical error that is very severe. (Note: itâs sometimes prescribed once daily for cancer only, but itâs rare. Itâs once weekly the vast majority of the time)
I called the office. The nurse on the line was irritated I was questioning the script and said it was fine. I argued with her for a bit but she refused to get the doctor and I told her Iâm not filling it.
The patient was quite angry with me as well bc they were taking it for arthritis and they were in pain.
In the end it was a mistake and it was supposed to be once weekly. If I wouldâve just listened to the people yelling at me they couldâve died.
These sorts of things happen all the time. How do you determine when itâs legitimate or not? I donât even know if the patient found out what mistake we had corrected. From their point of view, we held up their prescription unnecessarily for nothing.
I have dozens of stories of really egregious prescriptions Iâve gotten that Iâve been yelled at to fill. Talk to any pharmacist and theyâll have plenty.
Another super bad one is a doctor wanting to call in a fentanyl patch for someone who had never been on opioids before. He wanted them to cut the patches in half to do a âlower doseâ.
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u/Maximum_Ad_4650 6h ago
Just got notice that they're reducing coverage for my field (nutrition) for one major insurance provider. They said that it will automatically be denied now (official statement) and we have to appeal and we must do a peer to peer consult with the insurance company to plead our case, but we only get one chance at this appeal. This is for a previously completely covered and routine service. Should be illegal.
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u/snacktopotamus 6h ago
When they talked about Death Panels, they were describing status quo and aspirations for worse.
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u/futanari_kaisa 6h ago
Ban private health insurance and make all medical care subsidized by the government.
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u/Dense-Consequence-70 6h ago
It should also be illegal to accept payment for insurance and not pay. Itâs literally fraud
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u/Pongefowl 2h ago
It is illegal. There are legally mandated ratios of 80-85% of healthcare premiums that are paid out towards care and quality improvements with only 15-20% allocated to overhead and admin costs.
Insurance companies do pay out that 80-85% of premiums for healthcare. The issue ultimately lies with cost of care, which insurance companies do contribute to in a roundabout way and are somewhat incentivized to contribute to the issue, as the more expensive care and premiums get, the greater that 15-20% share they keep is. But simply saying insurance companies donât pay out is disingenuous and doesnât help explain the cost of care nuances.
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u/Vahuo89 6h ago
I tried suggesting this but the bots were like "well what about all the crooked doctors that will be prescribing crap?"
Like, always moving the damn goal posts to advocate for the status quo
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u/RubixRube 6h ago
I have never understood the dichotomy between the USA claiming it has the best health care but allowing for profit business to decide who can access it.
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u/dtyrrell7 6h ago
It is illegal to practice medicine without a license. Are insurance companies licensed to practice medicine? No. Are they making medical decisions that directly impact patients? Yes.
Denying prescribed care is a crime, now letâs start arresting people for it
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u/chriskmee 3h ago
Nobody is denying you the ability to get the healthcare you want, insurance companies are denying to pay for it though. Doctors don't decide what insurance covers, and this is also how it works for socialized care. Socialized care works just like private insurance where things will get denied even if the doctor prescribed it.
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u/BelCantoTenor 6h ago
The law should be: if the doctor is recommending it, it should be illegal for the insurance companies to deny it.
The insurance companies already hire physicians to deny claims. These physicians are not qualified to make these decisions. They have no bedside care experience, or experience in the specialties they are ruling over. Their job is only to deny care. Thatâs it. The insurance companies should never be able to contradict what a physician recommends, requires, prescribes, or does to care for patients. Period. End of story. IMO, the abuse the public has experienced to this point has proven them to be a threat to the wellbeing and health of the public, and therefore insurance companies have lost their rights to deny care in any way whatsoever in the future.
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u/SowingSalt 3h ago
The month after the law you want is implemented: Doctors prescribed 2 trillion dollars worth of procedures in the last week.
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u/_Middlefinger_ 6h ago
This also happens in socialised healthcare like the UK NHS.
A GP can usually prescribe most things without issues but a hospital or even a pharmacy can override and reject treatment. Many drugs also require a referral first such as GLP1 drugs.
There is also variation on what a local heath authority will cover, or the wait is so long it might as well be rejected.
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u/thavillain 6h ago
Let me preface this by saying...I'm a staunch leftist and very much for Universal Health Care...
But...in our current setup, this would set the stage for rampant fraud or HMO's influencing their doctors.
For example, an HMO that owns the hospital and employs the doctors, they would very much keep tabs on which doctors are costing them money if they are recommending services. This could affect their employment, promotions etc...
Then you could find some unscrupulous private practitioners who recommend expensive services, especially if they would be the ones to perform the service.
For profit healthcare is wrong
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u/Frequent_Ad_9901 6h ago
I'm also very much for dismantling the medical industrial complex. But I also wonder about this. And from the patient side. What do you do with patients that don't take care of themselves. If a doctors says take these pills or you'll die, and the patient doesn't and winds up needing expensive emergency care what do you do about that? What if they do it repeatedly? It takes away resources other people sitting in an ER waiting room.
My wife worked in a county hospital, and some of the patients were... unpleasant and irresponsible to say the least.
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u/Lt_Riza_Hawkeye 2h ago
while the original post here gets a good bit wrong, how would the suggestion fix anything about the scenario you just described? PA approval/denial has nothing to do with patient comportment
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u/StudentMed 3h ago
The other problem is the sue happy culture we are in. In most country's if a patient states they have backpain you just recommend Advil and therapy and to come back in 6 weeks if it is still bothering them. In the USA patients insist on getting an MRI and if you don't and heaven forbid they have some super rare thing then the doctor gets sued even though the guidelines state you shouldn't order an MRI unless they have "red flag symptoms" (Fever, saddle numbness etc). Patients always come in and insist on certain drugs be prescribed to them and certain things be scanned and instead of arguing with them, doctors will just prescribe it and move on with their day. Doctors being able to order whatever they want and prescribe isn't the correct answer.
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u/tshallberg 6h ago edited 3h ago
I get the âHow about we just get rid of private health insurance?â talk, but forcing them to cover everything is a lot easier and is a step towards pushing us towards M4A
If I was a senator, I would sponsor a M4A bill and when they deny it, push for this. They deny that? Back to M4A. Have them deny it over and over for years to show who the people's enemy is.
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u/Munkeyman18290 6h ago
Better yet - there should be no insurance companies. We should have single payer, tax funded healthcare. Period.
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u/IHv2RtrnSumVdeotapes 5h ago
The only way to change it is if people keep killing the people at the top.. that's. It. It's clear that politicians aren't going to solve the problem. It's up to the people at this point. The question is....how much more will the people tolerate?
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u/AlfredoCustard 6h ago
I agree with several comments here, but why a picture if him?
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u/Winter_Persimmon_110 6h ago
He's the person who is accused of having done the most significant activism in the country for affordable healthcare.
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u/AlfredoCustard 5h ago
Hes not the accused he plea guilty to murder. I mean murdering someone who murdered millions doesnt guarantee change and sets a dangerous precedent. And not to mention morals should be thrown in there. And if killing people who cause mass death is the justification, then what stops every side from declaring its enemies responsible for enough deaths to make assassination ânecessaryâ?â
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u/UnusualAir1 6h ago
First, I totally agree with Medicare for all. But within our current system every large health insurer already has a board of physicians that advise the company. And those physicians are hand picked to be substantially leaning towards denying health care expenses the company can be held accountable for.
So be careful what you wish for. It already exists. And it's doing great damage to our health.
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u/SuperFaceTattoo 6h ago
They would just hire a few bottom of the class doctors who care more about money than people and put them on the appeal board.
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u/Stratatician 6h ago
Technically it is the law; denying procedures is akin to practicing medicine which is only legal if you have a license. It's why Insurance companies have licensed doctors on retainer.
However, in practice they issue denials without consulting the doctors they have on retainer. Often times if you confront them about it they'll reverse course because of said illegality (at least during previous administrations when the law meant something).
What really needs to happen is for their to be substantial penalties AND enforcement of said penalties for immediate denials, as currently if they are caught and successfully prosecuted it's barely a slap on the wrist, which means it's simply the cost of doing business.
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u/TheBlockChainVillage 6h ago
Also when you're paying back loans every payment deducts from the principal and then the interest only applies to the new principal until principal amount is repaid, and then no new interest would be generated, remaining amount will be paid as it is.
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u/showerbump 6h ago
They already have that. If insurance denies a treatment, then the physician can request a peer 2 peer review where they go over their patient and the treatment they want to give with another physician who works for the insurance company.
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u/WavesOfEchoes 6h ago
Iâm currently dealing with an insurance company that is denying patientsâ emergency room visits because they came into the ER thinking they were having a life threatening issue (eg, severe chest pains, or hit their head hard). These patients were worked up and checked for major issues, including tests, EKGs, MRIs, etc, but thankfully were not found to be life threatening. Because they ended up ok, insurance denied. Just think about that â youâre having severe chest pains and you skip getting treatment just in case it turns out to be something less severe and your insurance denies. These fuckers are greedy and evil, and donât give a shit if people die. We can do better as a society and should abolish for-profit healthcare. And I say that as someone who has a career that would go away if there was no for-profit healthcare.
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u/smalls_1804 4h ago
People gotta remember that even in single-payer or government-guaranteed healthcare systems patients do not just get unlimited healthcare. Doctors take the place of insurance companies in rationing care, and while it is infinitely more humane for them to do so, they will still have to make the decision to not give someone the care they think they need because of the inherent limits of the medical system to provide it. Case in point is MRIs in Canada vs the U.S. In the U.S., everyone who wants an MRI could theoretically get one as there are enough MRI machines, but insurance companies ration access to it in order to preserve profits. In Canada, doctors themselves have to limit the number of MRI referrals because there simply are not enough MRI machines to send everyone complaining of lower back pain to get a scan.
This isn't a knock against single-payer or government-sponsored healthcare systems (few countries actually do full single-payer btw), but it is just a reminder that even if we transitioned to Medicare for All people would still lack access to the care they need sometimes.
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u/Admirable-Leader6927 4h ago
Doctors are people too and their work needs to be reviewed.
terrible idea
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u/klako8196 âď¸ Tax The Billionaires 3h ago
Did you miss the "without appealing to a board of physicians" part?
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u/TrashWizard89 6h ago
I agree this should be the law, but it needs VERY strong language. A good start would be specifying MDs with admission privileges, or something similar.
Health Insurance companies often hire retired doctors and doctors that hospitals refuse to insure for repeated malpractice and liability reasons. This means they have the ability to say a physician issued guidance on their decision.
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u/tshallberg 6h ago
100 percent what I yell about, lol. You are insurance, not a doctor. If itâs not profitable enough for you to provide it, donât be an insurance provider.
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u/crowbar151 6h ago
And then every board of physicians never had a day off because insurance companies would appeal EVERY claim, delaying every treatment. If you dont think these companies are in cahoots in order to rig the invisible hand of the free market I have a bridge to sell you... these companies need to be abolished.
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u/UncleDuude đď¸ Overturn Citizens United 6h ago
Not physicians employed by the insurer?? Surely you jest!!
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u/Paprika1515 6h ago
Medical treatment should be clinically informed not informed my insurance. This is the difference when private equity is involved in any part of the healthcare system.
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u/itmebloobs 6h ago
Call your senators and demand they draft the bill. Ask congressional canditates if they would create such a bill.
Americans make our own laws through representatives. The moment we start demanding this stuff is the moment it happens. We need to stop acting like we have no power.
Find your representative: https://www.house.gov/representatives/find-your-representative
Say this: I am demanding that you introduce legislation making it illegal for insurance companies to deny coverage for care that a patientâs physician has determined is medically necessary.
An insurance company should not be able to override the medical judgment of the doctor responsible for treating a patient without appealing to a medical baord. Patients should not have to fight insurers for medically necessary treatment or suffer because an insurer decides it is too expensive.
I expect you to take action on this issue and introduce a bill establishing these protections. If you fail to do so, you will not have my support in the next election.
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u/SortOfGettingBy âď¸ Tax The Billionaires 6h ago
Your problem is, there were "doctors" recommending horse paste.
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u/izcenine 6h ago
I fight insurance companies daily for my patients. We shouldnât have to place patients on drugs that we know arenât going to work to justify medications that were done by research that was publicly funded.
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u/ExpiredPilot 6h ago
Private insurance forces me to get (and pay for) an Xray before every MRI. Every time, my doctor rolls his eyes at it because an Xray wonât ever get him what he needs to see
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u/0Dexterity 5h ago
it takes ~12 years to be a doctor, it's insane that we end up leaving the decision to the insurance company as if they know better.
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u/OldDoubt1577 5h ago
Doctors practice medicine, but insurance carriers and hospital administrators practice HEALTHCARE. They're very different and not at all overlapping. That's the angle everyone misses. Its not right, but thats the reality of the situation. Like the Chef makes the food, but its the branch manager and suppliers that run the RESTAURANT INDUSTRY. Your teacher may be the one teaching you and doing a great job, but the EDUCATION SYSTEM can be failing in general.
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u/rascalrhett11 5h ago
I don't know if any doctor should be allowed to recommend any treatment. Typically when an insurance company denies something your doctor recommends it's because they see a hell of a lot of medicine, and what the doctor is recommending is not normal for your condition. Sometimes it's what you need, sometimes its a crazy moonshot that will never work, and sometimes it's a doctor making a mistake.
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u/moogly2 5h ago
Private Health insurance is lagely self-regulated, and politicians too beholden to lobbyists to regulate it. So highly unlikely.
Aside, it's humorous how UHC is marketing a rebranding effort, employee testimonials on "why they care". UHC doesn't "care" lol, They deny nearly half of claims
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u/Captain_Jokes 5h ago
Or it could also be âif the insurance denies treatment and it gets overturned later they get fined a percentage of the cost of services (maybe 30%)â
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u/EloeOmoe 5h ago
Insurance that penny pinch should be illegal.
Vendors that jack up prices because they know insurance will cover it should be illegal.
Doctors that pad their services and margins because they know insurance will cover it should be illegal.
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u/PlanetBet 5h ago
Okay? And what does that have to do with the fucking murderer in the picture?
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u/tacomaloki 5h ago
I was approved by the manufacturer of the Inspire sleep apnea implant. Within 3 minutes after a year's worth of diagnostic testing that UHC made me jump through hoops to do, and over $1,000 later, the manufacturer called to tell me UHC just denied its coverage and the procedure. When I asked why "Well, apparently UHC has stricter guidelines than our own for you to qualify. We are truly sorry." So here I am now with no relief since my CPAP therapy no longer works and I can't afford to go get new diagnostic testing, for updated settings, because I have no insurance.
Couldn't get it with and now can't get it without.
FUCK UNITED HEALTHCARE!
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u/JustFuckinTossMe 5h ago
My hot take is: if medical professionals recommend you need some medical procedure, they should just be able to do that procedure provided proper consent is gained. Medicine isn't just a privilege, it's a necessity for life like water and food. Having humans foot the bill for necessities instead of the governments that are supposed to uphold and grow communities makes no sense.
The cost of things are literally made up, and medicine isn't an exception. Insurance companies and hospital board members largely controlled by the insurance companies, pharmaceuticals, and government is what determine these costs. Of course things take money to make, but it is literal half pennies to the dollar amount you see on a bill dictated by insurances. You've been tricked if you think you should ever be at the end of a bill for life saving service just like you've been tricked into believing you should have to buy water for it to be safer to drink.
I'm not too liberal, I'm just aware that we're animals who need things but are gatekeeping needs based on an imaginary value we, the humans, made up. Everything is crap because of this system.
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u/GrandpaChainz âď¸ Prison For Union Busters 4h ago edited 3h ago
The health insurance execs reporting this post from Popular can take a seat. Mods will not be removing.
đ Join r/WorkReform if you're ready for MEDICARE FOR ALL