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It’s supposed to be that insurance converts inherent risk into a predictable cost, but health insurance is not really doing that. The costs remain unpredictable.
The costs remain unpredictable.
I wholly disagree. I predict that the costs will be unnecessarily high.
Ahhh, but when
But they know that, which is why healthcare costs have consistently increased higher than inflation.
Healthcare is one of THE MOST demand inelastic commodities or services. People do not say “oooh that’s a lot of money - is there a worse doctor who is cheaper?”, instead they say “100% yes I will remortgage my home and sell assets to pay for the cancer treatment my child needs.” Nobody is at the free clinic by choice, they’re there because they cannot afford or borrow to pay for better care.
Capitalism is incompatible with ‘rational consumer purchasing choices’ that apply to clothes, food, TVs, etc. because when there’s death or life altering negative outcomes, the only rational decision is to pay WHATEVER the price demanded is. Healthcare has a demand wall, not a demand curve.
People do not say “oooh that’s a lot of money - is there a worse doctor who is cheaper?”, instead they say “100% yes I will remortgage my home and sell assets to pay for the cancer treatment my child needs.”
I can’t believe how many times I had to make this exact point to dipshits I worked with any time they uttered the term “free market”.
What am I going to do in an emergency in the back of an ambulance on the way to the ER? Hey, can you guys pull over for a sec? I need to check if the current ER doc is in network. Fuuuck ooooffff.
I then recount the time I needed a non-emergency procedure (MRI for my back) which affords me plenty of time to shop around. I proceeded to call around to try to get prices (LOL) and then I got my insurance and MRI place on the phone all at once and I STILL couldn’t get a solid number for how much it would cost me. Who the fuck else needs to be on the call to get a number???
For mathematics wall is a curve. But yeah, completely agree.
Indeed. They have a product. They are withholding it from us.
Insurance is, at its core, a reasonable halfway measure towards public control of a critical resource. If you need something only very rarely, but it’s something that needs to exist ALL THE TIME just in case, insurance allows you to pool your resources with other people in the same boat and afford to keep an industry around just in case. Somebody will always be using it right now, and it’ll be there when you need it, because you paid into the pool.
The problem is, as always, the insertion of capitalism into the solution. If someone has to profit from this set of relationships, the motivation to provide the resource is in competition with the motivation to extract more profit. This is what happened to healthcare.
Insurance is only a halfway measure because we already have an organization capable of managing common resources that individuals use only rarely but which the public needs all the time: that organization is the government, or the governments at various levels. We manage lots of things this way: fixing roads, stopping houses from burning down, pulling people out of floodwaters, that kind of thing. You don’t need it all the time, but it’s there when you need it because you’re paying taxes to a government that has no profit motive from it. Insurance should only ever have existed temporarily while government infrastructure was debated and organized, but the for-profit industry managed to capture enough of the government to keep itself alive indefinitely.
In short, insurance isn’t inherently bad, just not meant to be a permanent fix. Capitalism is bad.
Private insurance should only exist for things that are both a) completely optional, and b) not inevitable (so… evitable?).
Auto insurance? Well, if it’s the law to have it, why is a private company involved whose sole model is to collect money and deny payments?
Health insurance? Well, it’s optional, but you will absolutely need to pay for Healthcare at some point (or you die early). Why, again, should we put an institution in charge whose sole purpose is to make the average person pay more than they get out of it?
Famous athlete leg insurance? High value possession insurance? Have at it, private insurance.
Auto insurance being mandatory makes sense in that the wronged person shouldn’t have their life destroyed because someone can’t drive and afford to replace a car.
They didn’t say auto insurance shouldn’t be mandatory, they said that it shouldn’t be privately run
So it should be a government controlled monopoly?
You’re right. Why would I want a public entity to keep any extra money in the country when I could pay a private mego corporation to funnel it off shore?
Why would I want to fund a public entity to keep publicly available records when I could pay a private company to deny my $1200 claim and boast $104 billion profit?
Is it the choice I get to make between 3 companies that all run the same statistical algorithm for risk assessment and collectively agree to have the same pricing? That’s so much better than having a government beholden to it’s voters and public option control it, right?
You are assuming that the government will run the insurance process competently. The government already is beholden to the voters and public opinion and they are just so efficient and devoid of red tape right? You’re also assuming the government will run the insurance industry as some sort of benevolent not for profit as opposed to a new form of tax. Not to mention what happens when the republicans get in and decide to raise insurance on electric vehicles or manipulate the price of insurance on cars from certain countries as a form of ersatz import tariff, or install political appointment figureheads who can take kickbacks to make certain manufacturers cheaper to insure. Not to mention the formation of a government department of adjusters and estimators to run the whole deal.
The existing system sucks buy I dont see the government having total control and no alternatives being some sort of magical panacea.
A pedestrian can be involved in a car crash too.
Tonight, on Saying That Last Little Bit that John Oliver Can’t Say…
And these cunts get to say ‘doctor is wrong you don’t actually need that’
I just thought of a funny concept which is that when you’re born in the country you’re automatically given life insurance. Then when a doctor says “you need this operation” and the health insurance company is like “your doctor is wrong” your life insurance company can come in and be like “you can’t kill my guy, because he’d be owed a gigantic payout!” and then go to war with each other.
It would never work in reality, but I find the idea funny.
What would predictably happen is that the health insurance company would still withhold care, and the life insurance company would deny the payout based on the care being withheld. Then they both would be like “sue me”.
And eventually they would merge and be just one company.
This is a genuine concern with over regulation of any industry. If they can just say they were following the regulation, which inevitably will lack in some areas, then that is a strong defense for them.
concern with over regulation of any industry
Usually mergers happen and monopolies form because there is no regulation of industry
Intellectual property law is a form of regulation
I don’t think thought property laws help Nestle at all. Or reional monopolies.
I don’t think thought property laws help Nestle at all.
How is Nestle a monopoly?
what about just taking that money and just having healthcare instead?
Insurance must be the only industry that actively tries not to deliver the service that its customers pay them for.
well there’s the whole telecom industry too
And car insurance. And wall street. And Google with Pixel Pass. Actually I think capitalism just fails to deliver in general.
I think every industry strives to be able to not deliver something after being paid, they usually just can’t get away with it.
Want to hear something crazier? They don’t even have doctors. Non doctors are telling your doctor what is medically necessary.
I had an issue with my foot and the doctor requested an MRI as an ultrasound wouldn’t show them anything they needed to see. The fucking insurance company says no, do the ultrasound… So I paid for a fucking useless ultrasound and then they refused to move forward with anything else… The issue kinda went away thankfully but there’s still something odd with my foot that I guess I just won’t fix until I can pay completely out of pocket.
I’m so fucking happy that at least $1,200 monthly is taken out of my potential pay to cover a fucking useless insurance scam, because remember even if your employer “pays” it’s factored into your total compensation so you’re still the one paying.
it’s factored into your total compensation so you’re still the one paying.
I never understand why so many people assume insurance is “free” from the employer or that they pay 0-1000 per week/month. What we see is the tip of the iceberg. Insurance companies are perfectly lucrative and they pay tons and TONS of money to workers that make sure they make as much as possible.
80% of premium revenues must be spent on treatment, the other 20% is what they have to profit off of. If they don’t spend 80% of the premiums on treatment they MUST refund excess earnings. See: https://www.healthcare.gov/health-care-law-protections/rate-review/
This means if they took in 100 billion in premiums in a year, they MUST spend 80 billion dollars on treatments. The 20 billion left over is where they can make money. So they will make sure 4/5ths of everything they make goes into treatment so they never give refunds and they maximize potential profits. If they can convince companies to raise premiums 10% next year, costs will rise 10%, profits will rise 10%. It’s so obviously designed to raise the cost of premiums and treatments at the expense of all else it’s insane.
They also don’t spend a dime over 80% of what they make if they can help it. There’s where claim rejections come in. They have mathematicians figuring out the ideal numbers and those guys make stupid amounts of money.
I’ll do you one worse. Sometimes, they do have doctors. In cases where people are trying to get coverage, especially for a severe workplace injury with lifetime effects, the insurance company will send you to a doctor who barely passed med school. They’ll have you do a “physical” that’s basically turn your head and cough. Then they write up a report that says you don’t need coverage.
Since they are technically a licensed doctor, this is still considered “expert” opinion in court (if it comes to that). The doctors involved can make way more money at this then they can working their mediocre asses in any real capacity.
their profits only exist when human beings are denied care. humans have to suffer for that stock price.
Well, they also profit from healthy people who don’t use their insurance much.
nope
They literally do?
Customers that pay their premiums for years without actually needing healthcare is literally free money for them.
im not sure why you think the money coming in from premiums isnt the same money used to pay claims, but you go ahead and believe whatever you want.
the fact is we have to pass laws forcing them to spend a percentage of their profits on claims. their income is premiums their output is either claims, profit or operating costs.
their profit comes solely from them denying claims. if they paid all claims they would have no profit.
The argument the person above you is making is that they also profit off people who never file claims in the first place. In fact those people are more profitable since they do not consume labor to process claims.
The Byzantine system of rules and coverage exemptions exists to disincentive people from filing claims just as it exists to give leeway to deny them.
Of course the overall point that paid claims must be less than premiums charged (and investment income) is correct.
im not sure why you think the money coming in from premiums isnt the same money used to pay claims
And I’m not sure why you’d assume I think that.
You’re saying they make their money from denying claims, rather than from premiums paid by the healthy, which they then keep by denying claims from the sick (who also pay them premiums), is a distinction without a difference.
their profit comes solely from them denying claims. if they paid all claims they would have no profit.
Well, yeah. If someone claimed I owed them $20m because their dog died, I’d deny that too (unless it was life insurance for a show dog or something).
Insurance was originally profitable because the idea was to bring in more money than you pay out, but set the margins so it’s worth paying for as a service (covering things so the cost of a payout is high to make the service worthwhile, but the chances of actually paying out are low, to make the service profitable).
However, over time you are correct that it shifted to focusing on finding ways of putting profits over quality; which came with all kinds of legalese to avoid payouts, among other things (like rigging the healthcare system so the cost is always high, so their costs appear low in comparison).
So you’re kinda right, but you seem to be conflating the American insurance market with insurance as a concept.
No, they make a profit if your premiums are more than your care+overhead. Preventative care is sometimes offered with no co-pay — presumably because you end up costing them less over the long haul if you keep up to date with your Dr. appointments.
It’s not a great system; but it does work very well for some customers, and failing to recognize that tends to preclude having a productive discussion.
the united states is #1 in medical bankruptcy, including people with insurance.
insurance is a scam youve been taught to not see as a scam. its a terrible middleman which extracts profits from sick and hurt humans by denying them care. if they paid all the claims, they would have no profit. and why should they? how can anyone defend such a gross money grab.
giving the scam credibility keeps those costs high . pretending it has value keeps us from moving to a cheaper, more universal system.
When I had top surgery (getting the fat sucked out of my tits so I could put an “M” on my drivers license, funny how many jobs fell through right I9 verification…), I did a lot of research into what I needed to do to get it covered. I got letters from doctors and therapists, I’d been in hormone therapy for a while, and my policy said it covered it. I checked with a rep, they said yeah, you just pay for it up front and submit for reimbursement.
So I took out a $5500 loan, had surgery, and then attempted to file for reimbursement. Turns out that my specific policy, from my step-dad’s employer had a rider that exempted it. Somewhere buried in the fine print, didn’t come up until after I had taken out the loan.
It’s pretty common for trans people to end up turning to sex work to finance their medical care (and tbh, survival in general). That’s how I joined that statistic.
Fuck, I hope that’s not on mine. I had bottom surgery and they have paid upfront for everything except the OR day. $120k just sitting for a year as I ping the insurance and hospital every month.
My current plan has an exclusion, which fucking sucks. I want to get bottom surgery and move across the country so that I don’t have to deal with this shit anymore.
Is this a US thing that I’m to Europe to understand?
Yeah in the United States of Billionaires healthcare is a product to extract profit from in every way possible.
Pharma companies get public funding for research and then turn around and charge insane prices for the final product infuriatingly referring to research costs to justify their pricing.
Hospitals are bought and run by investment companies.
“Insurance”
scammerscorporations have their own fiefdoms that they control so there’s very little competition and their sole reason for existing is to take your money and deny coverage for absolutely anything they can possibly deny you for so they keep the most money possible.We have The Best System In The World™ (for the ultra wealthy)
Apparently, yeah.
You probably haven’t even shot up a school or anything have you.
Get that person a hamburger and a mountain dew stat!
TBH Hospital Boards aren’t all that innocent, either.
The largest hospital in my region owns the largest health insurer in the region.
One hand washes the other
Nor the doctors themselves (well most are innocent, but there are a few who lobby with the AMA to help keep prices high so they keep getting paid)
So the boards should be reformed and have equal parts worker/union, patient, and shareholder representation.
Nah fuck that lets just do singlepayer.
Single payer is preferable, just want to point out that healthcare coops are another option
I’ve been fighting with my insurance company since May. My wife had a medical emergency and I had to take her to the ER at 3AM on a Sunday. The team of doctors treating her all agreed she needed to be hospitalized and have emergency surgery. She was admitted and underwent surgery and was out in three days.
A week after she was discharged we received a letter from the insurance company letting us know they had decided not to cover the $67k hospitalization bill because they had decided it wasn’t medically necessary.
So yeah, that’s great. Not to mention we had finally hit our $6,000 deductible (after I had cardiac issues and ended up in the ER the previous month) so insurance would finally have had to actually pay something.
So glad we pay them $1500 a month for them to make decisions on what is medically necessary and what constitutes an emergency after the fact.
First. I hope your family is OK.
Second its total bullshit the medical insurance companies can just declare something isn’t needed (usually by a doctor on thier payroll). Then use that as a justification to decline coverage.
This is supposedly a standard tactic for them too. Decline all big claims and see who fights it.
That’s insanely immoral especially because anyone with a huge medical bill clearly has some shit going on and the last thing they need is the massive stress of a massive medical bill.
We have movies and TV shows that poke at how bad our medical coverage is and we Americans just accept that the plot is acceptable.
The ones that come to mind are:
The Rainmaker kid dies of lung cancer because insurance declined treatment due to it being “experimental”.
Breaking Bad yeah. Cooking meth to pay for cancer treatmentThey should be held legally to prove why the procedure is not necessary only then they can refuse the claim. Otherwise they have to provide the claim. This should be the law.
Disclaimer: I think the current U.S healthcare system is hilariously bad and should be heavily reformed.
Insurance is not a bad thing, and there is a clear product involved in it. To demonstrate, you can go to a doctor in the U.S and pay in cash for the treatment. As I’ve understood it, you can even negotiate lower prices than the list prices if you are paying in cash. Still, it’s probably going to be expensive to the point of potential financial ruin.
This is the product that insurance offers in any domain it operates - buying your way out of risks you cannot accept. Fundamentally, the concept is sound, albeit very poorly implemented in the case of U.S healthcare.
It’s basically just a bunch of people pooling their money together and having that pool of money pay in the case of an adverse event.
One of the primary alternatives to the mess that is U.S healthcare today is in fact another form of insurance - it’s just that enrollment would be mandatory and as such the risk spreading would be as uniform as possible, along with subsidies for people carrying higher amounts of risk. That’s fundamentally what universal healthcare is in other countries.
Health insurance companies sure seem like socialized healthcare but with some rich guys that steal money out of the pot
If you squint your eyes just enough, insurance is like gambling… You are betting that something is going to happen to you, the insurance company is betting against that. The insurance company can improve their chances by adding conditions to that something.
That’s the part that makes the US system insane.
In countries with a public health care system, the goal of the patients and the doctors is the same. Everybody’s goal is to prevent diseases and sickness, and to treat it when it isn’t prevented. The administrators just estimate how much funding is needed to achieve that goal.
In the US system, the patients are trying to prevent and treat their sicknesses and diseases. The administrators are trying to find ways to avoid paying for any treatments, and the doctors make more money if they can find a way to bill more things.
And, what’s especially insane is that healthcare really isn’t a normal market like other things. If you’re buying a truck, you can shop around, haggle with salespeople, etc. If you’re hit by a truck, you’re not going to be comparison-shopping emergency rooms.
It’s way worse than gambling. When you win a jackpot there are laws that require you to get paid out.
Insurance companies can just say no and fight you in court until you die because it’s cheaper for them to pay some lawyers than for your treatment.
Same as student loan “servicers” collecting billions in interest to just keep track of peoples’ debts.
All health care costs then also are greatly inflated just so these a-holes can make money without affecting what the doctor gets.
My favorite is when they send me and letter in the US mail for the sole purpose of telling me they decided to cover our medication the doctor prescribed. The language they use is infuriating.
As if we should call them back and praise them, be grateful for their service, and just ignore that I’m paying them.
