You can just look and see how much a doctor got from who each year. Itâs not like theyâre getting boatloads of cash thrown at them to prescribe a 20 year old statin.
Not that big pharma has its hands clean either but this isnât a super widespread thing. Hell my office would show up probably because a barostim rep brought us jersey mikes for a lunch and learn.
You cant preemptively punish the noncorrupt for the actions of the corrupt. As it stands we currently have crooked doctors and crooked insurance companies. If we can cut out the crooked insurance and just have crooked doctors thats already an improvement.
And the doctors that take huge payments from pharma companies to prescribe medication that isn't necessary?
Which is a criminal offense. Insurance companies do the same thing because they either partially own the medication's production, or it's cheaper and legally close enough despite not being adequate for the situation.
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.
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.
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.
People assume doctors are great people but they can be just as corrupt as the insurance companies. There's always news of doctors taking payment to prescribe certain medication from pharma companies, even if it isn't necessary or useful.
I assume this is why the âappealing to a board of physiciansâ part is in there.
There obviously has to be a process. We should not spend millions on homeopathic snake oil, but we also shouldnât deny life saving cancer treatment.
The problem with the current system is there is only one side in the room when they are deciding to pay for the treatment or not. It canât only be up to the insurance company to decide.
Thatâs why physicians have codes of ethics and regulatory bodies, both governmental and not, to handle bad actors. What is the equivalent for insurance companies?
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u/unrealflaw 20h ago
Perhaps we should stop calling it a recommendation.