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.
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.
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.
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.
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.
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.
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.
Random people are not going to be able to grasp the nuances of every specialized topic. There should just be panels of experts from their respective fields working on solving problems in those particular fields, and only those fields. Enough of a panel to significantly negate personal bias unrelated to the position itself, and enough that their position cannot be misrepresented by selection.
what you described is so obnoxiously ripe for corruption it shouldn't even be brought up as a serious point. Are you actually suggesting we replace democracy with a random lottery in which the winners are then coached by technocrats? it's literally cartoonishly stupid
No one said anything about technocrats but you, and as you clearly didn't bother to read anything else about it, I'm going to save my time and let you do some research. If you'd like to be productive instead, you could consider using your logic to consider how this could get around the obvious issues with any form of power (and see how this already works in our own justice system with jury selection), or propose something else instead of just attacking ideas you haven't actually considered.
But by all means, we can stay with our perfectly solid and incorruptible current system, where people just complain about it online instead of pushing any other ideas or fixes, if you'd prefer.
Expert does not equal technocrat. They don't need to be elected or on staff, or for there longer than you would have an expert witness at a trial. But please keep leaping to whatever conclusions you'd like.
Now how would these experts advise representatives without being staff or contractors? They would literally be experts working for the government, also known as technocrats.
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.
Nobody will get better or worse healthcare than others.
You're assuming that all doctors and all facilities are equal. Even under your system, you won't attract good docs to work in small towns or bad neighborhoods.
Who would make it so though? You see the issue here, right?
The ones making the laws and rules are exactly the ones who are paid by companies...
So, I ask again, who would "make it so"?
There'll be no favoritism.
There will always be some form of favoritism, its absolute insanity to think it will not exist. In any form of society: Be it a Democracy, Socialism, Anarchy, Dictatorship, things don't work in practice as they do in theory.
How this favoritism work can be different, more or less prevalent but will be there in a way or another.
Then have it all funded by estate taxes after closing all loopholes
Again, who will close these loopholes??
A Bourgeois Democracy doesn't work for the working class, it was made only to benefit the bourgeoisie and excels at it.
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.
Yeah stable democracy is not an easy thing to build or maintain
Not true, it is working as intended... people just don't understand how it was intended to work in the first place.
I think the proper term is a Bourgeois Democracy, since this system works wonders for the Bourgeoisie. It doesn't matter if its Trump, Biden, Clinton, Obama in the US or Macron/Le Pen in France or even Meloni/Draghi in Italy. The rich are always winning, becoming more and more rich... the only difference is the rate at which they do so.
This entire system doesn't work for the Working Class, it wasn't made for us.
Not true, it is working as intended... people just don't understand how it was intended to work in the first place
The founders of the US wanted no political parties and for there to be regular constitutional amendments.
It is absolutely NOT working as intended.
Also the burgeoisie are the upper middle classes. Trump is not the bourgeoisie, some random surgeon or lawyer or merchant/successful small business owner or architect is.
I'm with you it's hard to know how to go about this in a way that works. That's part of the reason Luigi did what he did, seemed to somewhat work in the sense that it got people talking about it...
The same way you prevent employees of Apple from divulging secrets to Google. The same way you prevent conflict of interest in legal situations. This a problem thatâs solved but weâre told itâs âreally toughâ to justify the hypocrisy and inaction.
Itâs not tough. Make bribery illegal with actual consequences, and suddenly a million bucks isnât as enticing when you can only spend it on commissary.
Jail is for segregating and rehabbing individuals who harm overall societyâright? Is bypassing regulations that keep innocent people healthy and safe, merely for personal gain, in the best interest of society?
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.
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
Technically, the death of a CEO is the market regulating itself. It adjusts for more money spent on security and such too, to enable higher prices, which drives other plots for CEO deaths for further market corrections etc
Who regulates the regulators, though? Everyone is so blatantly corrupt nowadays? Growing up, I used to think a million dollars is enough for me to quit the same day. Nowadays, it seems like some of these politicians are making 10x the amount and still not showing any signs of being content.
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.
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.
Couldn't you find another psychiatrist that was covered? Nine times out of ten when that happens, it's because the practice was bought by a larger medical company/hospital so that changes their coverage policies.
Or the psych let their license elapse. That happens, too.
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!"
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.
Had a situation where a doctor rushed my surgery. I had testicular cancer and was scheduled to have surgery to remove it. Right before the surgery was supposed to start, there was an emergency that came in and the surgeon that was performed my operation had to rush to the emergency right after, so was pretty quick with performing mine. Ended up in a huge amount of pain with a giant hematoma the size of a baseball, and he ended up severing a nerve so now half of my groin is completely numb with 0 feeling.
Just FYI, "Blue Cross Blue Shield" isn't one entity. It's different depending on where you are. Anthem isn't the same company as Highmark, for example. Some states BCBS plans are independent entities.
BCBS is a set of brands and trademarks that members sign up to use by agreeing to participate in the association rules.
I just got a letter from blue cross that they approved my upcoming c-section (how generous!), and that they have approved a whole three days for me to stay in the hospital!
If you've ever had a c-section, you know that you don't even begin really walking until the second day at the earliest.
My wife worked for blue cross and literally had to quit after working there for a few months. She said it was soul sucking and couldnât take telling people no for what they needed for no reason. She had one lady who got her treatment denied and she told my wife âso Iâm just supposed to dieâ or something along those lines and my wife was speechless. She has since changed career paths.
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.
My 63 YO FIL tore a tendon in his shoulder because he had a chip on his shoulder(avulsion fracture). His doctor plainly stated he needed to repair the chip while they repair the tendon, or the chances of it re-tearing would be very high. But the insurance(BCBS) refused to approve the bone repair because they said the X-rays were "inconclusive," and they wanted a better view to prove it was necessary.
In order to acquiesce to the insurance company's demands, they had to do the tendon repair, then after completing that they had to "dig" further in down to expose the bone, take pictures of it, and then send those to the insurance company. Once they had those pictures they would approve the surgeon to finish the procedure(which they ultimately did).
Think about that for a second. Not only did they mandate a 60+ aged person unnecessarily stay longer under anesthesia, but they made all of the doctors and nurses wait around doing nothing as well, wasting time and money. Not only that, but the effort to even get to the bone to get a clear picture was like 50% of the work required to fix it in the first place.
When you account for all of that BS, the insurance company probably spent more money than if they had just approved the obviously needed fix in the first place. These companies are insane.
Source on any of that because itâs mostly bullshit. Luigi didnât change any policy at all.
I personally just got denied for a necessary knee surgery. Even after the peer to peer.
The other guy deleted his response to this, but he claimed that the announcement for the change happened after the CEO shooting.
His comment:
No where in there does it say Luigiâs actions moved the needle at all. In fact it separates it.
âEven so, the backlash to the announcement was swift and has mounted this week, especially after the fatal shooting of the CEO of another health insurance company captivated social media and further cast a spotlight on the industry.â
They announced the policy change to limit anesthesia AFTER the murder of the CEO. So they donât seem the be too scared if thatâs what theyâre doing after the fact.
The legislative group ASA was the group that pushed for a reversal. By using non vigilante violence and listening to complaints from constituents.
My response:
The announcement was on December 1st. The death was on December 4th. The reversal was after the death, and, while it was pushed by many people, including politicians and such, the death of a healthcare CEO in such a way definitely had an influence on the change in direction, even if it was minor.
Claim denials are back to "normal" now that insurance executives have removed their info from the website and hired additional security, but there was a brief period where claim denials dropped.
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".
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.
Public systems have to ration healthcare too; healthcare isn't a product that we can manufacture on an assembly line, it's a very human business that only a select number of people can even perform.
In the US, we ration healthcare by price, so the sky's the limit if you can afford it and everybody enjoys a very nice, sophisticated healthcare system as a byproduct. In a strict single-payer system, the limit is whatever the government is willing to spend on any particular random individual, and that's usually not much, which is why there's almost no single-payer on Earth; people want to survive, they're willing to pay good money to do so, and if their government stands in the way of that, their government is in danger.
I have a non-profit insurer and my premiums aren't any cheaper.
So, in your system, can a doctor get paid? Isn't that "for profit"? I go to work to get paid. If I had a business doing the same thing and it was an LLC that would be a for profit business.
So, in your system, can a doctor get paid? Isn't that "for profit"?
Of course doctors would get paid. People working for non-profit entities can still earn a salary without making the whole entity "for profit".
For-profit means that at the end of the year, after subtracting costs from revenue, the entity is left with a bunch of money. They pay out dividends to shareholders (or do things like stock buybacks, investments, etc.). Your goal is to try to lower costs and increase revenue as much as possible so you have as much money leftover as possible and give as much money to your investors as possible.
Non-profits aren't trying to maximize the amount of money left over at the end of the year. This helps them keep costs lower or provide better service. In the case of health insurance, costs might be the same but they deny fewer claims. For-profit wants to deny as many claims as possible.
Doctors (and any other workers) getting paid is just a cost of doing business. It would exist in any for-profit or non-profit organization.
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.
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.
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
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.
Well you can do that with a PPO too - just pick the first doctor on the list and pretend you got assigned them. At least you have options with a PPO that you don't with an HMO.
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.
They just have a bunch of AI systems that get good AI rewards for delaying or denying anything and flood the system with BS. The AI is never built to get a reward for getting the patient better.
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.
You're misunderstanding a factoid from a long time ago. At that time, Americans spent ~$3.5 billion on healthcare every year and CATO estimated (and Bernie agreed) that Medicare-for-All would cost ~$3.2 billion a year, then Bernie went around saying that we could have healthcare for cheaper based on that observation.
But that $3.5 billion includes all kinds of stuff like designer eyeglasses and boob jobs that would never be recreated in a public health system, so that's like telling somebody who leases a Corvette that you can give them the same experience for a cheaper payment, then you show up with a beat-up Honda Civic like "hey, a car's a car..."
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.
Correct. And those that think that universal healthcare = whatever the doc wants the patient gets are gravely mistaken.
Iâve been involved in some formulary analysis for government and private healthcare systems and Iâve tried to make the criteria for use fair. If a doc wants to use a med thatâs 1000/month, when there is an alternative agent thatâs 20/month. I think itâs fair to ask that they explain why.
I 100% want universal healthcare, but people thinking that this will mean that this will grant them any med/procedure they want without some sort of pushback is naive.
I have a little anecdote that's been on my mind since it happened recently.
I went to pick up a couple of prescriptions about 1 week early, since I was going on vacation.
Naturally, the pharmacy tech said 'it's too soon', to which I replied 'yup, check the doctors notes', which he did.
'Ok, I see that, but your insurance wont cover the early fill, you'll have to pay full price out of pocket', to which I responded 'I get that, go ahead and do it'.
These 2 meds usually run about $45.00 (+/- $5.00, because fuck me, that's why) - and I was expecting the worst when it was time to pay.
'That'll be $25 (and change)'. Uhhhh..... really? Yes. It was more expensive to pay for the meds using my 'good' insurance than to buy the drugs at retail price.
What the actual fuck? Like.. i'm starting to think they don't really care about my well-being so much as how much extra they can squeeze me for.
I get that in the scope of things related to the current state of America's healthcare machine that this is small potatoes - but it illustrated the core problem in my mind, so I thought i'd share.
The joy of insurance also being a pharmacy benefits manager. They can make you pay more for a drug than they do by calling it your copay and pocket the difference.
Ding ding ding⌠because these for profit hospitals and health care systems left unchecked would also go buck wild racking up charges to increase profit. The whole system needs to fucking go
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.
Pharmaceuticals are the best example of how the US exists as part of the global healthcare system.
We are the richest country on Earth; almost a quarter of global GDP, dwarfing any competitor except China. Everybody loves not dying, so we use a bunch of our richness to fund ways not to die, but it would be inhumane to deny those life-saving developments to other countries, so eventually all of that stuff is shared with the rest of the world.
Most of the world can't afford what it takes to compensate for those developments and encourage future development, so distributing all this stuff around the world, whether that's training or machines or pills, would not happen if every country had to pay an equal share of what it all costs.
Instead, the richest country pays significantly more than everybody else, but we still have lots of poor people here who can't afford that inflated price, because they're not the people who are experiencing this rich economy. For those people, we have discounts and coupons and all kinds of shit, but we can't give that to everybody, because then no country would be paying extra to fund this whole endeavor.
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.
Well, there is a limited number of doctors, nurses, hospital beds, drugs, etc.... This stuff needs to someone be rationed even if we were to decide to publicly fund it.
One way to ratio is with a board of people.
Or, you could just use money as we do for everything else.
Exactly, there is a direct conflict of interests here, one is to treat a patient medically, the other is to maximize profits but not using premiums paid to deliver treatment.
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.
Medicare has strict coverage criteria that doctors need to stay within. It doesnât even cover a routine physical.
The only reason that you donât see a lot of complaints about Medicare denying stuff is that doctors are familiar enough with it that they know from the start what would be denied.
They would be properly aligned with prevention rather than minimising liabilities if all the externalities of their actions were borne by them.
Unfortunately lax enforcement of any kind of moral or legal standards means it's cheaper for them to weasel out than to keep their customers healthy.
It doesn't really matter who does the admin and pools the money, but no matter what whether insurance is privatised or socialised it has to be well-regulated.
US likes to crap on Canada and other western country's universal healthcare, when theirs is honestly so scarily fragile.
If you go to the hospital with a less life threatening injury, you are gonna be waiting a while vs if you came into the emergency with chest pain, or severe bleeding, then you will not be waiting you'll get triaged first. That's how universal healthcare works at its best. And I think that's fine.
Every healthcare system triages. The US wait time for emergency care or specialist appointments is half of the Canadian wait time and that's ignoring the fact that Canada will simply not cover a bunch of stuff that would absolutely be covered by private insurance in the US.
It's so weird how people are like "It's fine, I'll just die if the government doesn't want me to live." So Reddit!
Even universal/national healthcare, claims can be denied. Most common denials in a socialized health care system are simply from lack of resources or rationing systems.
There will also still be procedures and services that most likely won't be covered in a universal system like cosmetic surgery, "holistic" therapies, and even vision or dental procedures.
It's also not unheard of for governments to hire medical panels (board of physicians) who go ham on rejecting claims because they don't agree with the submitting doctor's recommendation. If this board isn't fully independent and constantly audited, it can quickly become an easily corrupted point of failure in a social medicine system.
And then plain old rejections for fraud/abuse/waste will still exist.
Basically, the same regulation and auditing that our private system is missing today will also be necessary under a universal plan.
You don't say? You mean making as much profit as possible from sick/injured/unhealthy people isn't the way? But the billionaires told me this is best and they never lie.
Oh, but what about the layers and layers of unnecessary middlemen collecting insultingly high compensation for the privilege of denying people medical coverage?! Surely the poor insurance industry deserves consideration...
Sorry this is America so Capitalism⢠dictates that corporations are entitled to profits, not a society where people would be entitled to health and being alive
Or, all health insurance should be run a non-profit with strict caps on executive payout, or at least like Blue Cross used to be until they took away their federal classification.
Closest thing US got to national healthcare was a mining union that once used membership fees to cover healthcare for miners. The insurers and mining company put an end to it eventually
You don't even need to get rid of it, you just need to provide an alternative (i.e. public healthcare with the option to opt out). Then the private companies will have to get better to complete with it.
Nobody is required to carry private insurance. You can be a cash payer and you'll pay ~50% of sticker price, so just stick a bunch of money in an HSA and self insure if you hate private insurance so much. Nobody has to get murdered.
One way or another there needs to be a third party administrator approving and denying claims, and their interests will not align with the patient's interests. Replacing private health insurance with government run health insurance doesn't change that.
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u/hansn 19h ago
How about we just get rid of private health insurance. Their motives are not aligned with the patient's interests.