You must log in or register to comment.
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.
So Tricare, one of the USAF providers pays more than CMS, , generally speaking. I was at a small community pharmacy today that has two employees, both pharmacists, both running the register, calling in refills, talking to insurance, stocking shelves, unloading trucks. They had a sign up saying they can no longer afford to fill Tricare prescriptions, because they won’t pay enough for the two-owner employee team to cover the cost of medicine alone, not to mention bottles, caps, labels and ink. That’s not counting store rent, utilities, and other costs.
Yeah the actual health care providers get the screwjob on a regular basis. Meanwhile there’s some insurance fatcat going door to door doing sales to employers.
I shit you not I once watched an insurance middleman asshole come into the office and be like “the problem with health care costs is definitely not the insurance companies”. Like yeah, it’s totally not the fact that you have a job going around to the offices in the area accomplishing nothing, Mr. Combover, it’s totally the health care workers that actually provide service that are the problem.
I’ve worked in, for and with the health insurance industry, in the past, and adjacent industries (mental, physical, occupational, speech therapies, gp* skilled nursing facilities, etc). It’s definitely the middle -men.
They like to push the blame on:
- “Torts” because why allow people killed or very injured by crappy medical practice to sue? /s
- “Government regulation” because we all know that the US government is just out of hand when it comes to regulatory assistance to the public /s (Seriously though the fact that the government got involved proves that people were bleeding out of the ass for decades after being fucked so hard by the healthcare and health insurance industries)
- Greedy healthcare facilities …now these sometimes could carry maybe 0.5% of the blame, but (a) they’re actually providing a service, and (b) it’s not always the case that they’re trying to rake you over the coals…sometimes they’re just trying to keep the lights on
A few major issues that immediately spring to mind: corporate/wealthy individual lobbiests, insurance corporations buying up entire practice providers/insurance-owned pharmacies, such as CVS.
I have triwest, which is the veteran version of tricare. I’m totally fucked trying to find care in an already sparse Healthcare provider state.
The government says well this service was only worth xxx in 2000 so that’s what we’ll pay. And then they act all shocked when none of us can find care
I’m really sorry to hear that. I did a very quick search, so I’m not sure how current that information is, with regard to executives. Do you live near enough the VA facility to schedule an in-person visit? If not, can you contact them and ask for assistance in meeting your needs? Do you receive any sort of disability or Medicare, that can help cover costs? If you may or not qualify for disability, please request go online and request your DD-214, and start proceedings to get your records to and apply. If I’m understanding correctly (and I may not be, my information is sparse and outdated), the government has to prove that any disabilities did not arise from your service duties.
I’m currently trying to help a community veteran with this process, so if you’ll DM me so I don’t forget, I’ll pass along information as I learn, but we just requested the DD-214 this week, so it may be a long, convoluted process. My very best of luck to you, I am sorry this is how we thank our service members and vets for their service. I appreciate you, and I’m pulling for you.
I live in one of those sparsely populated states, I have to drive 5 hours one way to see a neurologist. Because the one that is two hours away only sees a small number of veterans due to the way the VA pays them.
Thank you for the offer of help, I now have 100% disability with the VA and I’m also on ssdi. Good luck helping your veteran, and please appeal when the VA gives them a rating. They like to lowball us, I was given 70% after my first c&p.
insurancemedical mafiaWant to hear something crazier? They don’t even have doctors. Non doctors are telling your doctor what is medically necessary.
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.
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 hate our healthcare system and especially the parasites that run health insurance companies, but they do provide a product.
- They pool our money together so that the ones that need healthcare can afford it. Barely anyone can afford out-of-pocket cancer treatment or a stay in the ICU after a serious accident. It could be a serious pain in ass to get insurance to pay sometimes if they even do, but overall, they do pay. If they never paid, we’d have a revolution by now. The last time they started with not paying, people started demanding change, which almost lead to the public option.
- They offer a check on healthcare providers that want to over -treat and -prescribe to charge more money, or doctors that go rogue with whacky ideas. Since the general population doesn’t know much about medicine, doctors would be able to prescribe all sorts of illegitimate treatments if we didn’t have a body making sure that their recommendations were legit.
I agree that they do fucked up things, like withhold on pay outs, deny interventions that may save lives, charge way too much, and lobby to maintain or even improve their wealth and power, but they do still offer a product. I’m someone that is lucky enough to have access to 100% free government healthcare in the US. Even with that, I’m often jealous of people that have private insurance because I find many benefits to their healthcare over mine.
If we want to improve our healthcare, I think it would be best to acknowledge the reality of the situation rather than exaggerate it.
The issue is that they are run as for-profit businesses but the product that they provide is a public good. They make money by providing as little product as possible. This type of structure is fine if your company makes luxury goods, but in the case of health insurance it results in unnecessary pain and death.
They offer a check on healthcare providers that want to over -treat and -prescribe to charge more money, or doctors that go rogue with whacky ideas. Since the general population doesn’t know much about medicine, doctors would be able to prescribe all sorts of illegitimate treatments if we didn’t have a body making sure that their recommendations were legit.
My dad can’t get a medication that actually resolves one of his health problems because it’s not on whatever list of medications his insurance company has for that issue. Even though his doctor prescribed it and it worked up until he got a new insurance. Now he has to use some other medication that barely helps. Insurance companies are bullshit. Doctors should be reviewing what other doctors are doing. Not some office peon who probably gets a bonus for rejecting claims.
Yeah, the system is jacked up. We need a better one like our lives depend on it.
…what? Insurance companies are not a “barrier” between doctors and patients. What, do you think some sort of insurance gremlin will manifest out of the ground and kick you in the nuts if you try to visit a doctor while uninsured? Doctors don’t care whether you’re insured or not, as long as they get paid. Insurance companies exist to soften the blow of expensive treatment. The product is not getting completely fucked over if you get very unlucky, just like with any other insurance (life insurance, car insurance, whatever). It’s kind of like bitcoin mining pools, but the other way around. Now, is mandatory health insurance justified? That’s a different discussion.
Insurance transition from protection against highly unlikely emergencies to our default payment system is the biggest scam in world history.
Yeah, it’s a big misunderstanding to think that insurance is not a product. It is product. The problem is that these companies all have the most shit versions of this product. It’s like living somewhere where every sandwich shop had a slice of bolongne on white bread, and they just changed which brand of mayonnaise they used.
This is a serious part of the problem. Home insurance, car insurance, can be bad, but at least you don’t usually have to deal with them. You can go years without needing anything from your home insurance.
You WILL need healthcare, minimum once a year. Most people need it every month or every few months. Your car insurance doesn’t pay for your oil changes or new tires because those are guaranteed maintenance costs, not unexpected emergencies.
Yeah no kidding. A company gets to profit off keeping us from getting treatment and it’s just accepted and normal.
This! Health insurance is the reason why medical costs in the US are so ridiculous. Health insurance, and IMO all insurance, is a scam. And since the “customers” (people who NEED care) can’t see the price of service beforehand, there is no way for them to choose the most cost efficient option, which allows providers to charge whatever they want. Then the insurance company can come up with reasons not to pay and put the client on the line for the cost.
It’s gambling, so the house always wins, except it’s worse with insurance because you could only win by losing.
Health insurance would make sense if it was cheap. My parents used to have “major medical” plan, indemnity vs very high bills, not healthcare just literal insurance. But it was cheap.
Now I have the High Deductible with HSA plan, same thing except it comes with some free preventative care. But it’s expensive! What the fuck!
I disagree with the idea that all insurance is a scam. Insurance is a risk mitigation tool. I’m fine with paying a little bit of money every month so that my family is financially secure if I die unexpectedly or I can replace my home if it burns down. All in all, insurance can be a fairly good and cost effective risk mitigation tool.
The problem is that an insurance business model is incompatible with healthcare. It’s not likely that I’m going to die within the next year. It’s very likely that I’m going to need medical care within the next year. As we [Americans] have increasingly leaned on health insurance to pay for routine medical care, health insurance companies have done a great job of muddying the water and making it more and more difficult to understand how the process works, much less get good quality medical care. There’s a clear conflict of interest between making money and paying for medical care.
Insurance itself isn’t bad. But health insurance is bad. The fact that health issurance is often tied to employment is also bad. Ironically, it has a negative impact on the economy. Maybe even a significant impact although that’s hard to say for sure.
If politicians really cared about small businesses, they would pass a universal healthcare bill ASAP. I would bet my left arm we would see a huge increase in small businesses if the potential small business owners didn’t have to worry about getting healthcare from their current employers.
What is this thread? Since I got chronically ill my insurance has paid my salary for a year and is now paying into unemployment and pension for my wife, who’s caring for me. And besides that they’re still paying for all our medical expenses despite me not paying into them anymore.
Yeah, I had to fight for them to pay for a transport. But overall they definitely are offering a service I am greatly benefitting from.
I’m truly glad that it’s helping someone; however, for every one of you there are a hundred people denied important procedures because insurance has decided its opinion is more important than the doctor’s.
An easily available example off the top of my head is Styropyro’s most recent video where he might have cancer but Insurance has denied his brain scan.
The problem is greatly unequal access to healthcare. I’m glad your insurance is doing well for you, but there are many out there who are struggling to pay for expensive family insurance with high deductibles that still leave them in medical debt.
I’m also currently in a situation where I’d like to find a new job, but I have some expensive medication ($750 a month for one of them) and I am worried about losing my insurance/not being able to afford the premium while I wait for benefits to kick in at a new job. I also have absolutely no way of knowing if another employer’s plan will cover my medication or if my current group of providers will be in network. All this added stress, and yet I’m lucky to work in a field where almost every employer offers health insurance.
Ideally, there would be universal safety nets to provide the services you’re benefiting from to all Americans. It’s not even like we’re saving money by relying on private insurance, as the US spends way more per capita on Healthcare for average results, at best.
So I’m glad that your insurance is taking care of you, truly I am. But spare a thought for the thousands of Americans out there who are struggling to survive under the same system.
I think the issue is that you look like you are talking about health insurance in the US. There is basically a zero percent change the person you are responding to is talking about insurance from any plan in the US.
Yeah, I should have realised that everyone is talking about the US. Everything about their medical system sucks. It’s powered by greed and not much else. I bet most third world countries have better health care than them.
Not sure if you are in the USA or Germany based on your URL but The general idea is that a private company should not have to hold the cards for our fate, and our health treatment. That’s what you are clearly missing. If you get chronically ill in some of the better parts of Europe, you won’t have any medical or financial consequences of that. Ambulance is don’t cost much of anything directly, hospital stays don’t cost you much. In the USA you cannot say the same. Going to the hospital for some major illness like cancer or emergency surgery could cost you anywhere from $15,000 to $200,000. Look up the cost of having a baby at a hospital especially when there are complications. It’s unbelievable.
The idea is that you should pay into a system that works for everyone, namely the government and taxes, and they help you out in return once you have a hardship at a low or no cost because you have been paying into it. This is not how insurance works. In most cases, you pay stupid amounts of money into insurance, and once the new year rolls around, you have lost your entire deductible and you’re out of pocket is completely reset. You have severe limitations on your FSA or health savings accounts so you can’t save enough money. Literally not allowed for you to save and stockpile lots of money for covering healthcare. You have to pay into this stupid for-profit company that doesn’t give a damn about you and will never lift a finger to help you. Sometimes people are lucky and benefit from the insurance. Those situations are extremely rare, and situations in which people are financially ruined by insurance and healthcare are far more common.
I’m glad that the system in place has worked for you currently. But that does not mean it works for everyone, and that’s something you need to understand. Just because something works for you doesn’t mean it’s a great system.
Yeah, I’m in Germany. It is widely known that the US medical system absolutely sucks ass. Doesn’t mean that the concept of health insurance sucks. In most of the developed world it works well. It’s only the US implementation that is majorly flawed.
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.
For a second I was like why does any drivers licenses have Ms on them for people that have had masectomy? Durrr.
The funny thing is, I probably wouldn’t have had gender surgery if it wasn’t a legal requirement. I barely had anything and could pass topless anyway. I just needed to be able to get a job, which was proving difficult with the non matching ID. It is 100% legal where I live to fire someone for being trans, and it had happened at multiple times by that point.
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.
TBH Hospital Boards aren’t all that innocent, either.
So the boards should be reformed and have equal parts worker/union, patient, and shareholder representation.
Nah fuck that lets just do singlepayer.
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)
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
Pretty much the same as bankers
And half the finance industry.
Same as student loan “servicers” collecting billions in interest to just keep track of peoples’ debts.
