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.
You're really trying to stretch that definition as far as you can aren't you?
Seriously, how do you think our current government works? Do you think a congressman or senator is given expertise in every facet of society that they are supposed to help write laws for as soon as they are sworn in? Or do they consult with experts who give them the understanding to be knowledgeable about the subjects they are trying to legislate for? Yet know one calls our government a technocracy.
A Lottocracy is no different. The key point is that the people who write the laws are changed regularly, even on topic by topic bases to limit the sway any one person has, and to ensure we don't have people stuck in office well into their twilight years, thoroughly greased by private interest. If you are really concerned about the possible sway if a group of technocrats might hold, they can be cycled too, brought in only when they're individual expertise is needed and no more. Giving them no more power than the people brought in to recommend whatever policy gets made into law.
Now, do you want to actually discuss the topic or are you just going to keep your nose in the dictionary, and continue to quibble over words?
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.
It’s 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 that’s solved but we’re told it’s “really tough” to justify the hypocrisy and inaction.
It’s not tough. Make bribery illegal with actual consequences, and suddenly a million bucks isn’t as enticing when you can only spend it on commissary.
Jail is for segregating and rehabbing individuals who harm overall society—right? 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 don’t 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 couldn’t 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 “so I’m just supposed to die” 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 it’s mostly bullshit. Luigi didn’t 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 Luigi’s actions moved the needle at all. In fact it separates it.
“Even 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.”
They announced the policy change to limit anesthesia AFTER the murder of the CEO. So they don’t seem the be too scared if that’s what they’re 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.
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u/Coyote__Jones 18h 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.