"And therefore, someone must decide what claims are reasonable."
Yes, that person is MY DOCTOR. There is no world in which it is reasonable that my health care team says I should have particular treatment, and insurance executives get to say no I don't. Sadly I understand this is not the case, and we value money more than human life, but I do not find that reasonable, no matter how common it might be.
I also understand that medical fraud happens, but I'm not sure the tradeoff to reducing it is worth the lives it's taking when we refuse claims.
"tradeoffs have to be made" is a great way to say that yes, you agree that instead of focusing on lowering health care costs, you think it's fine that people die because of them. I would posit that no treatment should be allowed to cost multiple millions of dollars - I am aware that's easier said than done, but I'm pretty sure society should try. Maybe if the CEOs didn't make billions of dollars and instead we put those profits back into play, we'd have a chance.
> So you think that your doctor should be able to order you any imaginable treatment that they think is medically necessary, and someone else will have to pay for it?
Yes. It's the cost of doing business. Why is it that when we talk about the justice system, we think it's better to let a hundred criminals go free to avoid punishing an innocent, but in healthcare suddenly it flips and now it's better to have a hundred people be denied life-saving treatment to avoid one person getting an unnecessary one?
Your hypothetical is frankly insane - nowhere in the world, despite the dozens of types of medical systems, is there a crisis of doctors ordering frivolous multimillion dollar treatments just for fun. There is no incentive for them to do so. Your entire argument hinges on something that doesn't actually happen, just to defend an evil that already exists in the world.
Outrageous idea, but we should trust the people who studied for over a decade to administer medication to decide what medication a person needs, and pry the hands of private business off that process entirely. If someone misuses the system or prescribes obviously wrong treatment, go after that individual. If in 30 years it turns out that doing this does actually cause doctors to order random treatments for fun, then we can talk about scaling it back. Until then, for-profit healthcare is not to be trusted.
If you think all denied claims are denied in good faith, I don't know what to do for you.
The insurers are hardly running up against hard resource limits, where there just isn't enough to go around and they have to triage. They are profit driven entities, and if they were legally allowed to deny all claims they would be required to do so by their shareholders.
No system is perfect, but patients shouldn't die to boost a stock price. And no patient should be required to fight for coverage at their most vulnerable.
Why would an insurer who denied all claims have any customers? I think you're missing the market competition aspect of the insurance business.
Most people do not get to choose their own insurance company, they just get whatever their job picks. Most big companies have directors and officers that personally benefit when a particular insurance company does well. The market is completely broken.
Insurance is an arbitrage leach at best, and extortion at worst. It provides no value to society.
Without insurance Market prices would drive down the cost of healthcare.
I was presenting an extreme hypothetical to a make a point that the insurers are motivated by selfishness.
In the real world, not a hypothetical, your market driven approach ensures they approve the minimum necessary to prevent customers from leaving. They require patients to to fight them for coverage while they're undergoing cancer treatment, because a dead patient they didn't pay out for is more profitable. Paying for insurance in a for-profit marketplace isn't paying for health coverage, it's paying for a CHANCE at health coverage, and you better be willing and able to fight for that chance while you're undergoing cancer treatment/surgery, or be willing to go bankrupt, or not get the treatment and die. That's the choice the insurance marketplace presents to you.
Not hyperbole, many such stories. My own father in law died in part because his private medicare advantage plan refused to approve in-patient rehab after a brain surgery that every MD working on him said he needed, but would have cost 6 figures out of pocket that nobody could front. The grim irony is he later tried to get out of bed to use the bathroom, couldn't support his own weight and suffered a skull fracture that resulted in a second brain surgery inside of a week, and that was fully covered.
I'll take the bureaucrats. The real world shows they're simply better at this, and Ayn Rand is simply wrong.
Isn't it also not the direct customer purchasing the insurance, but their employer, who also has to pay into the pot and so is incentivized to find cheap options? (I'm not 100% on this - I'm not American.)
Depends on your employer/occupation. You can purchase insurance directly as an individual but it's usually the most expensive way to go as you have no group bargaining power. Small businesses are also hit by this, as they're only trying to cover a small group of people.
For this reason many small businesses don't offer insurance directly, but provide a tax-free health insurance stipend to their employees who then source their own insurance, effectively subsidizing the more expensive premiums as a benefit.
Larger employers have more bargaining power due to the number of employees they bring with them and can get better rates/plans from the insurance companies, and these better rates/plans are typically passed along to employees as a benefit for working there. An employer might cheap out, but that's the same as offering a bad salary.
Very large employers (Fortune 500s and such) are often self-insured, where they contract all the bureaucracy out to a private insurer but the company is actually doing all the payouts. The quality of this coverage naturally varies from employer to employer. I once had a co-worker have a claim denied for an expensive psychiatric facility he sent his son to, but because he had the claim pre-approved he had grounds for a lawsuit. He had to sue both the insurance company and the company we worked for while working there.
The elderly have medicare, and the poor have medicaid, which are taxpayer funded but not always 100% coverage, and there's a bunch of private plans you can buy to fill in the gaps if you do desire with various pros/cons.
Our system is a complete fucking mess, although it's arguably still better than it was pre-Obamacare
> Do you think that there is some health care system in which all requests for care can be approved without limit?
I'm not going to wade into the murder tag, but is this the actual incentive? The health care execs don't have enough money to save everyone so they pick who they can help strategically, making sure to help as many as possible, or is the system incentivized to instead maximize finding who can be denied so that the company makes the most money?
Shame? Where's the shame for these orphan crushing machine administrators? Just doing my job. Just following orders. Just designing and optimizing it
All of it is doing it both. The system is cracking and the ONLY REASON why its brought up is because 1 guy did a murder to an important guy. Otherwise business as usual.
"And therefore, someone must decide what claims are reasonable."
Yes, that person is MY DOCTOR. There is no world in which it is reasonable that my health care team says I should have particular treatment, and insurance executives get to say no I don't. Sadly I understand this is not the case, and we value money more than human life, but I do not find that reasonable, no matter how common it might be.
I also understand that medical fraud happens, but I'm not sure the tradeoff to reducing it is worth the lives it's taking when we refuse claims.
[flagged]
"tradeoffs have to be made" is a great way to say that yes, you agree that instead of focusing on lowering health care costs, you think it's fine that people die because of them. I would posit that no treatment should be allowed to cost multiple millions of dollars - I am aware that's easier said than done, but I'm pretty sure society should try. Maybe if the CEOs didn't make billions of dollars and instead we put those profits back into play, we'd have a chance.
> So you think that your doctor should be able to order you any imaginable treatment that they think is medically necessary, and someone else will have to pay for it?
Yes. It's the cost of doing business. Why is it that when we talk about the justice system, we think it's better to let a hundred criminals go free to avoid punishing an innocent, but in healthcare suddenly it flips and now it's better to have a hundred people be denied life-saving treatment to avoid one person getting an unnecessary one?
Your hypothetical is frankly insane - nowhere in the world, despite the dozens of types of medical systems, is there a crisis of doctors ordering frivolous multimillion dollar treatments just for fun. There is no incentive for them to do so. Your entire argument hinges on something that doesn't actually happen, just to defend an evil that already exists in the world.
Outrageous idea, but we should trust the people who studied for over a decade to administer medication to decide what medication a person needs, and pry the hands of private business off that process entirely. If someone misuses the system or prescribes obviously wrong treatment, go after that individual. If in 30 years it turns out that doing this does actually cause doctors to order random treatments for fun, then we can talk about scaling it back. Until then, for-profit healthcare is not to be trusted.
If you think all denied claims are denied in good faith, I don't know what to do for you.
The insurers are hardly running up against hard resource limits, where there just isn't enough to go around and they have to triage. They are profit driven entities, and if they were legally allowed to deny all claims they would be required to do so by their shareholders.
No system is perfect, but patients shouldn't die to boost a stock price. And no patient should be required to fight for coverage at their most vulnerable.
[flagged]
Why would an insurer who denied all claims have any customers? I think you're missing the market competition aspect of the insurance business.
Most people do not get to choose their own insurance company, they just get whatever their job picks. Most big companies have directors and officers that personally benefit when a particular insurance company does well. The market is completely broken.
Insurance is an arbitrage leach at best, and extortion at worst. It provides no value to society.
Without insurance Market prices would drive down the cost of healthcare.
I was presenting an extreme hypothetical to a make a point that the insurers are motivated by selfishness.
In the real world, not a hypothetical, your market driven approach ensures they approve the minimum necessary to prevent customers from leaving. They require patients to to fight them for coverage while they're undergoing cancer treatment, because a dead patient they didn't pay out for is more profitable. Paying for insurance in a for-profit marketplace isn't paying for health coverage, it's paying for a CHANCE at health coverage, and you better be willing and able to fight for that chance while you're undergoing cancer treatment/surgery, or be willing to go bankrupt, or not get the treatment and die. That's the choice the insurance marketplace presents to you.
Not hyperbole, many such stories. My own father in law died in part because his private medicare advantage plan refused to approve in-patient rehab after a brain surgery that every MD working on him said he needed, but would have cost 6 figures out of pocket that nobody could front. The grim irony is he later tried to get out of bed to use the bathroom, couldn't support his own weight and suffered a skull fracture that resulted in a second brain surgery inside of a week, and that was fully covered.
I'll take the bureaucrats. The real world shows they're simply better at this, and Ayn Rand is simply wrong.
Isn't it also not the direct customer purchasing the insurance, but their employer, who also has to pay into the pot and so is incentivized to find cheap options? (I'm not 100% on this - I'm not American.)
Depends on your employer/occupation. You can purchase insurance directly as an individual but it's usually the most expensive way to go as you have no group bargaining power. Small businesses are also hit by this, as they're only trying to cover a small group of people.
For this reason many small businesses don't offer insurance directly, but provide a tax-free health insurance stipend to their employees who then source their own insurance, effectively subsidizing the more expensive premiums as a benefit.
Larger employers have more bargaining power due to the number of employees they bring with them and can get better rates/plans from the insurance companies, and these better rates/plans are typically passed along to employees as a benefit for working there. An employer might cheap out, but that's the same as offering a bad salary.
Very large employers (Fortune 500s and such) are often self-insured, where they contract all the bureaucracy out to a private insurer but the company is actually doing all the payouts. The quality of this coverage naturally varies from employer to employer. I once had a co-worker have a claim denied for an expensive psychiatric facility he sent his son to, but because he had the claim pre-approved he had grounds for a lawsuit. He had to sue both the insurance company and the company we worked for while working there.
The elderly have medicare, and the poor have medicaid, which are taxpayer funded but not always 100% coverage, and there's a bunch of private plans you can buy to fill in the gaps if you do desire with various pros/cons.
Our system is a complete fucking mess, although it's arguably still better than it was pre-Obamacare
> Do you think that there is some health care system in which all requests for care can be approved without limit?
I'm not going to wade into the murder tag, but is this the actual incentive? The health care execs don't have enough money to save everyone so they pick who they can help strategically, making sure to help as many as possible, or is the system incentivized to instead maximize finding who can be denied so that the company makes the most money?
Eichmann never directly murdered anybody either.
Shame? Where's the shame for these orphan crushing machine administrators? Just doing my job. Just following orders. Just designing and optimizing it
All of it is doing it both. The system is cracking and the ONLY REASON why its brought up is because 1 guy did a murder to an important guy. Otherwise business as usual.
Shame on society