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.
But predictably. Give me a real fucking number, not just “high.” You can’t do, can you, fuck-face???
Ugly cries angrily and shamefully in the corner knowing that the wrong person just got yelled at
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???
That’s only in the case of some vertical integrators like CVS. Most just get between you and other products.
No, in theory, they work like a well-funded savings account: you put in a predictable amount of money every month, and they store it for you until you need to withdraw it; with an added benefit that they would allow you to withdraw more than you have (internally using other people’s money to cover the difference) under the assumption that any shortfalls that result will all come out in the wash eventually; some people overpay, some people underpay, and you invest what you have in low-risk investments in the meantime. All insurance companies work like that in theory, or at least that’s what they tell regulators. But in reality, they don’t pay out nearly enough to provide the consistency people need.
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
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.
I know I’ll be hated for this, but my wife works for an insurance company, as a doctor, doing chart review. She was always very responsible as a doctor, but the shit she talks about that doctors prescribe is ridiculous.
One case that sticks with me (not even the most egregious, but because of the berating she got from the doctor and the patient), the patient needed a special car seat, which they approved. The doctor also prescribed a 200 dollar car seat cover. Now the seat already comes with a removable and washable cover, this additional one would just make it easier to remove and wash. It was denied as not medically necessary, which it clearly is not. The doctor demanded a consult and then yelled at her the whole time. The patient also called her and yelled at her.
Im a firm supporter of universal healthcare, but the idea that doctors never do ridiculously unnecessary shit, regardless of the reason, requires one to be completely ignorant of how any of this actually works. And so, even with universal health care, some bureaucrat stepping in to determine if a doctor made the right decision would absolutely still be necessary.
Yeah, no, fuck off with that. The doctor is the care provider, not the insurance company, and an insurance company has no fucking business deciding what is or isn’t medically necessary.
I notice how you didn’t actually address my point all, just reiterated the claim.
I don’t believe this happens that often, but what happens in the case that a doctor prescribes completely unnecessary procedures and visits, which makes them rich. Still the insurance company shouldn’t do anything?
The thing that’s missing here is context. It’s hard to care about a random doctor prescribing an extra $200 for a patient that is taken out of the tens of billions of dollars of profit a year that health insurance companies make.
Like, this car seat anecdote costs as much as an hour meeting of a few of their higher paid employees.
Does that really matter? Should it matter?
These are different questions, I was responding to the implicit claim that it’s ridiculous that someone other than a doctor could understand what is medically necessary.
Although one thing my wife has expressed shock about since taking this role is how much waste there is, and how much doctors prescribe that is just clearly not medically necessary.
The real thing is many regular preventative checks are a huge money maker for physicians while not actually being that effective for patient outcomes. IIRC its been argued prostate exams are an example of this. IMO, routine removal of wisdom teeth is another, and routine circumcision is an obvious one.
Doctors can, and often do, request consults where they make their case. My wife will occasionally change her mind after hearing from the doctor on why they think it is necessary. She will often even reach out to the doctor if she is unsure about the outcome.
In this case the doctor just yelled at her and didn’t make a case at all.
I had an ear infection, the doctor thought I was lying for pain killers(she said people my age shouldn’t get ear infections, and I could’ve just used a hairdryer), I told her no the pain is fine I just want antibiotics so it doesn’t get worse. She then decided to prescribe codeine and oral antiobiotics but not ear drops.
When I went to the pharmacist they filled the codeine prescription even though I didn’t want it.
the doctor thought I was lying for pain killers
What the fuck? I see it often in english-speaking places, but I want to know why doctors say “oh, you just want pain killers”. Them being concerned about painkillers more than about biological nukes infections can become resistant to greatly concerns me.
Insurance must be the only industry that actively tries not to deliver the service that its customers pay them for.
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.