I worked at a Health Tech Silicon Valley company and our clients were healthcare companies. Our job was essentially to delay and put up barriers to care. So before they could see a doctor they would have to call us, go through the computer system, get routed to a phone doctor who would suggest cheaper things than what they really needed, give them a bunch of hoops to jump through before they could really get the thing they needed.
A big part of my job was to re-route people who needed wheelchairs into getting cheaper things. Our clients were United Healthcare, unions, large health insurers.
It sucked working there it was a total hellhole. I quit when they actually defrauded medicare. Their glassdoor reviews were wild. The owners daughter bragged about dating a glassdoor exec and that he would take down all the honest bad reviews for her.
If it’s not up to health insurers to limit healthcare spending, then which organizational role in the healthcare system do you think is appropriate to place this responsibility with?
All the time. I have a UnitedHealthcare “platinum” plan, and it may as well not include pharmacy benefits because it never covers anything. Generic thyroid meds went from $2/month with Aetna to $70 with UHC. ADHD meds went from $10 to $300.
The threatened “death panels” we heard about when ACA was being debated are actually employees of insurers who decide what they’re not going to pay for.
I was raised a die-hard capitalist and in many ways still am. When it comes to healthcare these days, I’m somewhere to the left of Marx. What we have now is a failed system. It simply does not work. The turnip has been squeezed and there’s no blood left to wring from it.
> The threatened “death panels” we heard about when ACA was being debated are actually employees of insurers who decide what they’re not going to pay for.
The key insight, though, is that this is fundamentally unavoidable. Someone, somewhere has to decide how a limited healthcare budget will be allocated among all the various healthcare it could go towards.
You and I agree that it would be best to have a system where this is never the patient's problem. Someone determines a standard of care that will achieve the best patient results with the resources available, and then any patient can get whatever treatment's best for them within that framework. That's why I have and recommend Kaiser, they do a good job of presenting that abstraction.
Other people are terrified of the idea of having the standard of care determined by some centralized committee, because what if they decide a treatment that my doctor and I like isn't appropriate? I think the fear is wrong, to be clear, but it's genuine and does deserve to be addressed. Thus all the promises about "if you like your plan you can keep your plan".
(A third group of people believe that healthcare is only limited because of shenanigans, and with the appropriate reforms we could build a system where anyone is entitled to any treatment that might reasonably help them. I'm never quite sure what to tell them, since I don't think that's true but I don't know how to prove it beyond the lack of examples.)
These are completely human systems that can be changed any time for any reasons. The current system is achieving exactly what it was designed for: wealth extraction.
There’s no reason why this system has to exist. We can make it better any time we want.
> The threatened “death panels” we heard about when ACA was being debated are actually employees of insurers who decide what they’re not going to pay for.
The employees of the managed care organization are often just using the criteria of the payer (often times the federal or state government for Medicaid/Medicare/federal employee or other large self funded plans).
The US government leaders are in a good spot. They get the managed care organizations (MCOs) to take the heat for denying coverage, while setting the rules to deny the coverage. MCOs even get audited and fined for approvals that don’t meet criteria.
In any case, all systems with limited resources will have to have someone approving or denying payments, whether it be a government employee or someone contracted out by the government.
But the most salient metric here is all the MCOs earn only 2% to 3% profit margins. And their market caps are tiny, and returns abysmal. (Except UNH, but that is due to its significant provider and software business).
Blame MCO employees all you want, but you will be doing exactly what government leaders want you to do.
Healthcare, when you actually need it, is an inelastic demand very often combined with an inelastic supply (or more exactly, an inelastic supply of suppliers) due to IP laws and the realities of specialization.
It is not at all surprising that capitalism fails miserably here, IMO.
Do Americans think they are special? Do they think that everything gets paid for no matter what? An endless pool of money?
As a Canadian I had the pleasure of my insurer (Canadian government) denying my treatment. Multiple appeals, still a no. My doctor said it was the only thing that would treat my disease. So my only choice is paying for it in cash at $10,000+ per month, which I can't afford.
Are they saying no to patients or are they saying no to providers?
I’ve found numerous instances where providers have billed over $5,000 for procedures that I could get for $250 if I paid cash. They do things like seperating a test panel into 100 different separate procedures, etc.
I think they need some context in the article of the interplay between providers billing practices to maximize their fees and insurer denials instead of just demonizing the insurance companies.
Every denial doesn’t result in a patient not receiving care, but is sometimes pushback against overly aggressive providers/negotiation and some of that can and probably should be automated.
Obviously them denying necessary treatment is really bad, but I find that propublica articles are often highly opinionated against certain interests and leave out a lot of context to create an extreme headline.
So far this year I'm seeing basically "We got $100 off! $0 paid by plan. You owe $xxx" I barely use it, but so far insurance isn't covering anything except basic $x refills
> At the same time, posts on social media have been claiming that UnitedHealthcare’s claim denial rate is the highest in the industry at 32%. This figure comes from the personal finance website Value Penguin, which said it calculated that rate from available in-network data from plans sold on the marketplace.
All the time is not a number but in Germany it's common that your legitimate insurance claim gets rejected at first and then you appeal once or twice and do the paperwork and
document the proof again, citing all terms & conditions that apply and you get what you are
owed or you get a lawyer to do the whole thing again and get what you are owed then.
"Arbeitsbeschaffungsmassnahmen" ( German for "employment creation scheme" ) in an industry where there is not enough actual work for--and or to justify the--number of employees. One of the more useful Ponzi schemes; if you are not a real capitalist, that is. Because if you are, then this shit is just fugly drag.
I have had this experience, but not with healthcare insurers (in Germany). I cannot remember the last time I had to contact them - the last two times they contacted me, was to explain to me, that they have expanded their preventive care offerings and they recommend I go and get them.
Blanket rejections are an extremly efficient measure from the perspective of an entity when the consumer has nowhere else to go and you don't care about ethics. Just tell them no and many people will just give up. If they appeal, you can invest the work to fob them off properly or just pay and not deal with the hassle. I can barely tell the difference with the many public healthcare insurers in germany - if my insurer were to try this nonsense, I would be gone the next month.
Universities, some agencies and especially the god-damned GEZ on the other hand...
What frustrates me more, is that it often turns into a class indicator: Do you know how to word your letters or to handle yourself in a way that indicates, that it will be more annoying to not-deal-with-you than to deal-with-you? And if you don't: Do you have a access (network/money) to someone who does?
Is there any hope to clean up the US health system in any foreseeable future? How did the health lobby get so much power and get away with all this abuse?
- Through extensive lobbying, the US passed the HMO act of 1973 which requires that all employers offer an HMO plan to employees. HMOs were created to keep costs down, but United really took this to the extreme, making it as hard to use your health insurance as possible, and creating vertical monopolies like OptumRX. United takes so long to pay providers for the work they do that they now offer payday loans to doctors offices, which is crazy.
- The US uses a fee-per-service model that priorities procedures over preventative treatment or patient education. Some other countries have moved towards reimbursement based on health outcomes.
- The Affordable Care Act banned physician owned hospitals, which were growing in popularity and had better outcomes for less fees to patients.
- Private Equity is swallowing up hospital systems, emergency departments, etc. The most common seller is another PE firm, so they try to make a quick return through heavy cuts and then flip it 5 years later.
there's a bunch of problems with the setup but a major one is that employer health plans are tax deductible. employees don't really get market choice, and employers really only care about reducing their own expense in regards to healthcare. ending this would be very expensive and disruptive for both employer and employee in the short term, and people have a strong preference for the devil they know vs. the devil they don't (either a public option or fully market-based healthcare)
it's worth noting that the healthcare system has a couple of antagonistic components and right now probably insurers are the only group actually fully happy with the situation. medical providers, pharmacists, and patients are all getting shafted.
I'm not sure if there's any hope of US healthcare improving for a long while. The ACA was the only recent improvement. It was a small change, but the electorate decided that it was bad, pushed its supporters out of office, and elected a series of people who promised to "repeal and replace" it, but weren't really serious about any improvement. And then when the "repeal and replace" crowd failed, they were not held accountable, but reelected anyways.
There also isn't much interest in improving healthcare from either side right now. The right has nothing. Their current platform is ignorant views about vaccines. The left has a stronger interest in Palestine and housing abundance right now, though all of that is dwarfed by trying to keep the rule of law going, and preventing us from falling out of a democracy. Healthcare is way way down the list for everyone sadly--even Bernie doesn't talk about it much anymore. The electorate has spoken, and they are not interested.
For what it's worth, I've been thrown in society's waste basket altogether on this one.
No insurance, none, of any kind.
I've got a Free h D in hillbilly medicine though. I've accomplished some amazing shit, but it's unraveling a bit now, and I'll be super surprised if I last much longer.
One can certainly say such a hit to morale is just collateral damage in the beautiful face of our wondrous mutant hive, but what are you guys gonna do when we start stinking up your streets en masse? One way or another, you'll be smelling the smoke.
Soylent Green is here. Read your labels carefully.
Proudly Made in the USA with Harshly Sourced Ingredients. I was free roaming though, if that matters.
Edit: returned to clarify that I was pulling myself up by me bootstraps. It's just that it's getting tough to hold on to em tightly enough. No shoes no service though, I guess.
spyspy|5 months ago
1. https://theonion.com/health-insurance-ceo-reveals-key-to-com...
randycupertino|5 months ago
A big part of my job was to re-route people who needed wheelchairs into getting cheaper things. Our clients were United Healthcare, unions, large health insurers.
It sucked working there it was a total hellhole. I quit when they actually defrauded medicare. Their glassdoor reviews were wild. The owners daughter bragged about dating a glassdoor exec and that he would take down all the honest bad reviews for her.
avalys|5 months ago
kstrauser|5 months ago
The threatened “death panels” we heard about when ACA was being debated are actually employees of insurers who decide what they’re not going to pay for.
I was raised a die-hard capitalist and in many ways still am. When it comes to healthcare these days, I’m somewhere to the left of Marx. What we have now is a failed system. It simply does not work. The turnip has been squeezed and there’s no blood left to wring from it.
SpicyLemonZest|5 months ago
The key insight, though, is that this is fundamentally unavoidable. Someone, somewhere has to decide how a limited healthcare budget will be allocated among all the various healthcare it could go towards.
You and I agree that it would be best to have a system where this is never the patient's problem. Someone determines a standard of care that will achieve the best patient results with the resources available, and then any patient can get whatever treatment's best for them within that framework. That's why I have and recommend Kaiser, they do a good job of presenting that abstraction.
Other people are terrified of the idea of having the standard of care determined by some centralized committee, because what if they decide a treatment that my doctor and I like isn't appropriate? I think the fear is wrong, to be clear, but it's genuine and does deserve to be addressed. Thus all the promises about "if you like your plan you can keep your plan".
(A third group of people believe that healthcare is only limited because of shenanigans, and with the appropriate reforms we could build a system where anyone is entitled to any treatment that might reasonably help them. I'm never quite sure what to tell them, since I don't think that's true but I don't know how to prove it beyond the lack of examples.)
arwhatever|5 months ago
I would like to see #1 tried but at this point I’ll gladly accept #2
azemetre|5 months ago
There’s no reason why this system has to exist. We can make it better any time we want.
lotsofpulp|5 months ago
The employees of the managed care organization are often just using the criteria of the payer (often times the federal or state government for Medicaid/Medicare/federal employee or other large self funded plans).
The US government leaders are in a good spot. They get the managed care organizations (MCOs) to take the heat for denying coverage, while setting the rules to deny the coverage. MCOs even get audited and fined for approvals that don’t meet criteria.
In any case, all systems with limited resources will have to have someone approving or denying payments, whether it be a government employee or someone contracted out by the government.
But the most salient metric here is all the MCOs earn only 2% to 3% profit margins. And their market caps are tiny, and returns abysmal. (Except UNH, but that is due to its significant provider and software business).
Blame MCO employees all you want, but you will be doing exactly what government leaders want you to do.
georgemcbay|5 months ago
It is not at all surprising that capitalism fails miserably here, IMO.
unknown|5 months ago
[deleted]
refurb|5 months ago
As a Canadian I had the pleasure of my insurer (Canadian government) denying my treatment. Multiple appeals, still a no. My doctor said it was the only thing that would treat my disease. So my only choice is paying for it in cash at $10,000+ per month, which I can't afford.
OhMeadhbh|5 months ago
daft_pink|5 months ago
I’ve found numerous instances where providers have billed over $5,000 for procedures that I could get for $250 if I paid cash. They do things like seperating a test panel into 100 different separate procedures, etc.
I think they need some context in the article of the interplay between providers billing practices to maximize their fees and insurer denials instead of just demonizing the insurance companies.
Every denial doesn’t result in a patient not receiving care, but is sometimes pushback against overly aggressive providers/negotiation and some of that can and probably should be automated.
Obviously them denying necessary treatment is really bad, but I find that propublica articles are often highly opinionated against certain interests and leave out a lot of context to create an extreme headline.
downrightmike|5 months ago
Guvante|5 months ago
Sometimes certain things are covered before you hit your deductible other times not.
lordnacho|5 months ago
ceejayoz|5 months ago
https://www.yahoo.com/news/no-one-knows-often-health-2020566...
> At the same time, posts on social media have been claiming that UnitedHealthcare’s claim denial rate is the highest in the industry at 32%. This figure comes from the personal finance website Value Penguin, which said it calculated that rate from available in-network data from plans sold on the marketplace.
carabiner|5 months ago
wtbdbrrr|5 months ago
"Arbeitsbeschaffungsmassnahmen" ( German for "employment creation scheme" ) in an industry where there is not enough actual work for--and or to justify the--number of employees. One of the more useful Ponzi schemes; if you are not a real capitalist, that is. Because if you are, then this shit is just fugly drag.
braabe|5 months ago
Blanket rejections are an extremly efficient measure from the perspective of an entity when the consumer has nowhere else to go and you don't care about ethics. Just tell them no and many people will just give up. If they appeal, you can invest the work to fob them off properly or just pay and not deal with the hassle. I can barely tell the difference with the many public healthcare insurers in germany - if my insurer were to try this nonsense, I would be gone the next month. Universities, some agencies and especially the god-damned GEZ on the other hand...
What frustrates me more, is that it often turns into a class indicator: Do you know how to word your letters or to handle yourself in a way that indicates, that it will be more annoying to not-deal-with-you than to deal-with-you? And if you don't: Do you have a access (network/money) to someone who does?
vjvjvjvjghv|5 months ago
jmcgough|5 months ago
- Through extensive lobbying, the US passed the HMO act of 1973 which requires that all employers offer an HMO plan to employees. HMOs were created to keep costs down, but United really took this to the extreme, making it as hard to use your health insurance as possible, and creating vertical monopolies like OptumRX. United takes so long to pay providers for the work they do that they now offer payday loans to doctors offices, which is crazy.
- The US uses a fee-per-service model that priorities procedures over preventative treatment or patient education. Some other countries have moved towards reimbursement based on health outcomes.
- The Affordable Care Act banned physician owned hospitals, which were growing in popularity and had better outcomes for less fees to patients.
- Private Equity is swallowing up hospital systems, emergency departments, etc. The most common seller is another PE firm, so they try to make a quick return through heavy cuts and then flip it 5 years later.
bobthepanda|5 months ago
it's worth noting that the healthcare system has a couple of antagonistic components and right now probably insurers are the only group actually fully happy with the situation. medical providers, pharmacists, and patients are all getting shafted.
lostdog|5 months ago
There also isn't much interest in improving healthcare from either side right now. The right has nothing. Their current platform is ignorant views about vaccines. The left has a stronger interest in Palestine and housing abundance right now, though all of that is dwarfed by trying to keep the rule of law going, and preventing us from falling out of a democracy. Healthcare is way way down the list for everyone sadly--even Bernie doesn't talk about it much anymore. The electorate has spoken, and they are not interested.
s5300|5 months ago
[deleted]
unknown|5 months ago
[deleted]
erikig|5 months ago
eth0up|5 months ago
No insurance, none, of any kind.
I've got a Free h D in hillbilly medicine though. I've accomplished some amazing shit, but it's unraveling a bit now, and I'll be super surprised if I last much longer.
One can certainly say such a hit to morale is just collateral damage in the beautiful face of our wondrous mutant hive, but what are you guys gonna do when we start stinking up your streets en masse? One way or another, you'll be smelling the smoke.
Soylent Green is here. Read your labels carefully.
Proudly Made in the USA with Harshly Sourced Ingredients. I was free roaming though, if that matters.
Edit: returned to clarify that I was pulling myself up by me bootstraps. It's just that it's getting tough to hold on to em tightly enough. No shoes no service though, I guess.