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No one argues that the California or Texas power grids were geared to be unreliable and fail, but they were deliberately engineered over the years in specific w

No one argues that the California or Texas power grids were geared to be unreliable and fail, but they were deliberately engineered over the years in specific ways for specific reasons. Our medical system is no different. Insurers developed byzantine claims departments and custom plans as a way to make medical coding complicated and error prone for the purpose of denying claims due to error. They setup private panels and doctors to reviews claims and treatment plans with the explicit purpose of denying claims as not medically necessary. The system is designed to intimidate, overwhelm, and confuse and it's stacked against both the customer and the medical provider.

jjoonathan 6y ago
There are three heads to this beast: hospitals, insurance companies, and drug companies. Each swears it is innocent and points to the other two and calls them the problem, but they are all guilty. You've covered the evil tactics of insurers, but providers absolutely engage in intentional opaqueness, overbilling, and as much screwball behavior as the market will bear. No, the insurance company did not force them to charge $500 for an aspirin and "accidentally" bill in full for a procedure that was discussed as a hypothetical but never actually happened. "Look over there!" isn't going to cut it as an excuse forever.
- cptskippy 6y ago
  Over billing is a result of the complexity of the system. Care providers have to hire full-time staff trained to deal with insurance and file claims. Insurers negotiate rates with care providers that put them in a position of having no customers or ones they're paid poorly for. They have responded by playing games with billing and insurance to make ends meet. Is it fair or honest? No but if they suddenly became fair and honest it would solve nothing because they're a symptom of the problem, not a source.
  - jjoonathan 6y ago
    Same goes for insurance companies: just letting providers overbill would not solve the problem. I'm sure the overbilling and weaponized opaqueness are plausibly deniable, but I'm just as sure that providers don't mind one bit when they work, just as an insurance company doesn't mind when they discover an excuse to deny coverage. Providers are not "making ends meet," they are testing the limits of how far they can exploit the blank checks they have been written. They are not solely responsible for this mess, but they have a full share of moral and systemic culpability.

jjoonathan 6y ago

There are three heads to this beast: hospitals, insurance companies, and drug companies. Each swears it is innocent and points to the other two and calls them the problem, but they are all guilty. You've covered the evil tactics of insurers, but providers absolutely engage in intentional opaqueness, overbilling, and as much screwball behavior as the market will bear. No, the insurance company did not force them to charge $500 for an aspirin and "accidentally" bill in full for a procedure that was discussed as a hypothetical but never actually happened. "Look over there!" isn't going to cut it as an excuse forever.

cptskippy 6y ago
Over billing is a result of the complexity of the system. Care providers have to hire full-time staff trained to deal with insurance and file claims. Insurers negotiate rates with care providers that put them in a position of having no customers or ones they're paid poorly for. They have responded by playing games with billing and insurance to make ends meet. Is it fair or honest? No but if they suddenly became fair and honest it would solve nothing because they're a symptom of the problem, not a source.
- jjoonathan 6y ago
  Same goes for insurance companies: just letting providers overbill would not solve the problem. I'm sure the overbilling and weaponized opaqueness are plausibly deniable, but I'm just as sure that providers don't mind one bit when they work, just as an insurance company doesn't mind when they discover an excuse to deny coverage. Providers are not "making ends meet," they are testing the limits of how far they can exploit the blank checks they have been written. They are not solely responsible for this mess, but they have a full share of moral and systemic culpability.