3 ms·

How about just prohibiting them from denying coverage at all, except for bona fide fraud? So much of the rot of the healthcare system stems from this broken reg

How about just prohibiting them from denying coverage at all, except for bona fide fraud? So much of the rot of the healthcare system stems from this broken regulatory approach of thinking that corporate bureaucrats will somehow "manage" care better than patients and doctors can. These "insurance" companies should be relegated to a purely financial role, as a basic table stakes reform.

oldpersonintx 3y ago
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bombcar 3y ago
Because everything is misaligned. There’s no reason to get a MRI for a basic headache, but if it’s free, why not? And attempts to solve this just muddle it worse, but some could help - nobody is going to voluntarily take insulin, for example, so just make those impossible to deny.
- BobaFloutist 3y ago
  > There’s no reason to get a MRI for a basic headache, but if it’s free, why not? Because an MRI is an exhausting, irritating experience.
  - bberenberg 3y ago
    Yes and if your doctor tells you that you need to do one will you argue? My understanding is that we’re already “over testing”, though would defer to someone with a citation on the topic.
    - mindslight 3y ago
      Yes, obviously you should "argue" and require an explanation of the doctor's reasoning. I just literally rejected doing an MRI this past weekend, in an emergency context, that would have been financially "free". The things it might have found were already disimplied by bloodwork, or were rare with no treatment options, and in my opinion the amount of iatrogenic harm from the procedure would have been unjustified. A patient or trusted advocated needs to be involved in a patient's own care, and the current "insurance" system does a great job at destroying this as doctors focus on "insurance" companies and associated bureaucracy as decision makers rather than patients. IMO this is precisely where the request to do an MRI was coming from in the first place - bureaucratic ass-covering.
      - singleshot_ 3y ago
        What harm is caused to your body by an MRI?
        mindslight 3y ago
        Placing an IV after they had already botched it three times, living on lactated Ringer's instead of real food for the better part of a day, IV sedation anesthesia and its possible complications, (I didn't investigate side effects of the contrast), and the further destruction of bodily autonomy and resulting lack of alertness that comes from all those.
        singleshot_ 3y ago
        Yikes. Seems like a pretty serious MRI. Good luck. On one hand, this defensive practice of medicine is objectionable. On the other, it only exists because people like to sue providers when outcomes are bad. I’m glad you had a good outcome.
        mindslight 3y ago
        Everything turned out fine, thank you. I do get why in an emergency context doctors want to do as many tests as possible in parallel, and have very little context to guide them otherwise. But also I don't have much sympathy for things "only" being a certain way because of some other thing. The medical industry is a whole set of self-reinforcing terrible dynamics, which is why we need sweeping reform. I've also got to wonder how much this narrative bemoaning MRIs for "headaches" is because doctors have rightfully moved to doing less harmful MRIs instead of less expensive X-ray CTs.
- mindslight 3y ago
  Standard "insurance" generally includes copayments for services, sometimes even percentage based. Insurance companies would obviously adapt to such a reform, and my entire point is to align the incentives better. Over the long term, "insurance" companies operating on a cost-plus basis don't even really want to keep costs down, rather denials stem from needing to make sure any payouts are bureaucratically justifiable.
qgin 3y ago
If the US could get costs down to levels of other developed countries, we could approve everything and still afford it. As of now, medical care in the US is about 2x-3x the cost it is in other developed countries.
- luxuryballs 3y ago
  cost of living though
  - qgin 3y ago
    Maybe in some cases, though overall cost of living in Australia is slightly higher than the US while still spending about half what we do on medical costs.
  - nfmcclure 3y ago
    No offense, but there is real irony in your statement here.
    - luxuryballs 3y ago
      double entendre

oldpersonintx 3y ago

[dead]

bombcar 3y ago

Because everything is misaligned. There’s no reason to get a MRI for a basic headache, but if it’s free, why not? And attempts to solve this just muddle it worse, but some could help - nobody is going to voluntarily take insulin, for example, so just make those impossible to deny.

BobaFloutist 3y ago
> There’s no reason to get a MRI for a basic headache, but if it’s free, why not? Because an MRI is an exhausting, irritating experience.
- bberenberg 3y ago
  Yes and if your doctor tells you that you need to do one will you argue? My understanding is that we’re already “over testing”, though would defer to someone with a citation on the topic.
  - mindslight 3y ago
    Yes, obviously you should "argue" and require an explanation of the doctor's reasoning. I just literally rejected doing an MRI this past weekend, in an emergency context, that would have been financially "free". The things it might have found were already disimplied by bloodwork, or were rare with no treatment options, and in my opinion the amount of iatrogenic harm from the procedure would have been unjustified. A patient or trusted advocated needs to be involved in a patient's own care, and the current "insurance" system does a great job at destroying this as doctors focus on "insurance" companies and associated bureaucracy as decision makers rather than patients. IMO this is precisely where the request to do an MRI was coming from in the first place - bureaucratic ass-covering.
    - singleshot_ 3y ago
      What harm is caused to your body by an MRI?
      - mindslight 3y ago
        Placing an IV after they had already botched it three times, living on lactated Ringer's instead of real food for the better part of a day, IV sedation anesthesia and its possible complications, (I didn't investigate side effects of the contrast), and the further destruction of bodily autonomy and resulting lack of alertness that comes from all those.
        singleshot_ 3y ago
        Yikes. Seems like a pretty serious MRI. Good luck. On one hand, this defensive practice of medicine is objectionable. On the other, it only exists because people like to sue providers when outcomes are bad. I’m glad you had a good outcome.
        mindslight 3y ago
        Everything turned out fine, thank you. I do get why in an emergency context doctors want to do as many tests as possible in parallel, and have very little context to guide them otherwise. But also I don't have much sympathy for things "only" being a certain way because of some other thing. The medical industry is a whole set of self-reinforcing terrible dynamics, which is why we need sweeping reform. I've also got to wonder how much this narrative bemoaning MRIs for "headaches" is because doctors have rightfully moved to doing less harmful MRIs instead of less expensive X-ray CTs.
mindslight 3y ago
Standard "insurance" generally includes copayments for services, sometimes even percentage based. Insurance companies would obviously adapt to such a reform, and my entire point is to align the incentives better. Over the long term, "insurance" companies operating on a cost-plus basis don't even really want to keep costs down, rather denials stem from needing to make sure any payouts are bureaucratically justifiable.

qgin 3y ago

If the US could get costs down to levels of other developed countries, we could approve everything and still afford it. As of now, medical care in the US is about 2x-3x the cost it is in other developed countries.

luxuryballs 3y ago
cost of living though
- qgin 3y ago
  Maybe in some cases, though overall cost of living in Australia is slightly higher than the US while still spending about half what we do on medical costs.
- nfmcclure 3y ago
  No offense, but there is real irony in your statement here.
  - luxuryballs 3y ago
    double entendre