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the healthcare complex employs millions. all these people would lose jobs. so there's really zero political will to crack the monolith, and why things like Oba

the healthcare complex employs millions. all these people would lose jobs. so there's really zero political will to crack the monolith, and why things like Obama care go forward, because they're bandaids. then there's the who employer leverage that businesses live having to immobilize a significant portion of their work force. it's absolutely not complicated to understand why nothing has moved the needle.

SteveNuts 3y ago
Right. If these huge insurance companies had to "compete" with a real universal system, there's no way they could even exist. All they do is scrape profit off the top of every healthcare procedure in the US. The most useless middleman to ever exist, in my opinion.
- vinay427 3y ago
  I agree with your broader point, but it’s worth noting that insurance middlemen exist in many European countries with universal health insurance, so surely some form of this can exist in a more regulated health insurance/provider market.
  - rqtwteye 3y ago
    I had private insurance in Germany. The big difference is that they have to compete there instead of having a captive audience they have in the US with employer based health insurance. Your employer picks the insurance options that are convenient for them, they don't care much about what's good for you. So you are basically trapped unless you are willing to not take insurance from your employer but go on the open market which will be very expensive. A while ago I asked my employer to just give me the money they give to Optum so I can buy insurance via ACA but they wouldn't do it.
  - kevin_thibedeau 3y ago
    The problem is the US has for-profit medical insurance as well as mutual insurance (collectively owned by their members). The laws were altered in the 90s to permit mutuals to convert to for-profit. This was generally a bad move as it takes out any real incentive to manage costs when jacking them up is the only way to boost profits so the C-levels can get 8-figure bonuses.
keenmaster 3y ago
More competition increases the number of jobs
- bearjaws 3y ago
  Optum has billions of dollars in profit annually, none of that is going into the employees pockets or patient savings.
standardUser 3y ago
Not everyone in the healthcare industry would lose their jobs, that's absurd. It would mostly be the redundant insurance staff (and redundant sets of highly-paid insurance execs).
- NickC25 3y ago
  This! Execs would lose their jobs. Billing specialists (who do a 4 year degree in medical billing, which is in and of itself fucking absurd) would lose their jobs. You know who wouldn't lose their jobs? Doctors and nurses. The actual people who the system's outcome is dependent on.
  - FireBeyond 3y ago
    > Billing specialists (who do a 4 year degree in medical billing, which is in and of itself fucking absurd) What? I have never heard of such a thing, and I worked in the claims benefit management industry for nearly a decade. So I searched this, "bachelor medical billing" and while I got plenty of results, all of them were for certificate courses, which I'd expect. "Top rated medical billing courses" were all at community colleges. I am yet to find a Bachelor degree in medical billing. Indeed, on ... Indeed: > Can you get a bachelor's degree in medical billing and coding? > While a bachelor's degree in medical coding and billing isn't an option, people interested in pursuing this career can earn a degree in a related field instead. For example, you might consider earning a bachelor's in health care management or health information management. A certificate/diploma is going to be 9 months to 1 year. An associate diploma? 2 years. I also can't find any four year courses in medical billing.
  - lotsofpulp 3y ago
    The managed care apparatus in the United States is about allocating insufficient supply of healthcare to excess demand based on the political value of the healthcare recipient. That is why Medicare pays doctors more than Medicaid for the same work (old people are worth more since they vote more than poorer and younger people). You can endlessly bucket people into infinite changing tiers based on their political power using reimbursement, deductible, out of pocket maximum, in and out of network providers, formularies, and prior authorization protocols. For example, you can give members of the military a different quality/quantity of healthcare than US federal Senators, who have a different set of policies, who in turn have a different set of policies from a highly profitable white collar firm’s employees, and yet again different from a less profitable business with lower paid employees, and so on and so forth. You can adjust reimbursements so that some people can immediately see doctors whereas others have to go to Physician Assistants or Nurse Practitioners. The system is a thing of beauty from a political point of view, and I bet countries with nationalized healthcare like UK and Canada move closer and closer to the US system as the population pyramids go upside down and cuts have to be made. And the whole time, people will waste their time being mad at managed care organizations, when the government leaders are the ones hiring them to be the “bad guy”.
slipperybeluga 3y ago
[dead]
monksy 3y ago
They're also firing people for fun. I know of a guy who is deep in the weeds upgrading their scala libraries that just got laid off within the week. (You have to do that to stay on top of all of the cves)

SteveNuts 3y ago

Right. If these huge insurance companies had to "compete" with a real universal system, there's no way they could even exist. All they do is scrape profit off the top of every healthcare procedure in the US. The most useless middleman to ever exist, in my opinion.

vinay427 3y ago
I agree with your broader point, but it’s worth noting that insurance middlemen exist in many European countries with universal health insurance, so surely some form of this can exist in a more regulated health insurance/provider market.
- rqtwteye 3y ago
  I had private insurance in Germany. The big difference is that they have to compete there instead of having a captive audience they have in the US with employer based health insurance. Your employer picks the insurance options that are convenient for them, they don't care much about what's good for you. So you are basically trapped unless you are willing to not take insurance from your employer but go on the open market which will be very expensive. A while ago I asked my employer to just give me the money they give to Optum so I can buy insurance via ACA but they wouldn't do it.
- kevin_thibedeau 3y ago
  The problem is the US has for-profit medical insurance as well as mutual insurance (collectively owned by their members). The laws were altered in the 90s to permit mutuals to convert to for-profit. This was generally a bad move as it takes out any real incentive to manage costs when jacking them up is the only way to boost profits so the C-levels can get 8-figure bonuses.

keenmaster 3y ago

More competition increases the number of jobs

bearjaws 3y ago
Optum has billions of dollars in profit annually, none of that is going into the employees pockets or patient savings.

standardUser 3y ago

Not everyone in the healthcare industry would lose their jobs, that's absurd. It would mostly be the redundant insurance staff (and redundant sets of highly-paid insurance execs).

NickC25 3y ago
This! Execs would lose their jobs. Billing specialists (who do a 4 year degree in medical billing, which is in and of itself fucking absurd) would lose their jobs. You know who wouldn't lose their jobs? Doctors and nurses. The actual people who the system's outcome is dependent on.
- FireBeyond 3y ago
  > Billing specialists (who do a 4 year degree in medical billing, which is in and of itself fucking absurd) What? I have never heard of such a thing, and I worked in the claims benefit management industry for nearly a decade. So I searched this, "bachelor medical billing" and while I got plenty of results, all of them were for certificate courses, which I'd expect. "Top rated medical billing courses" were all at community colleges. I am yet to find a Bachelor degree in medical billing. Indeed, on ... Indeed: > Can you get a bachelor's degree in medical billing and coding? > While a bachelor's degree in medical coding and billing isn't an option, people interested in pursuing this career can earn a degree in a related field instead. For example, you might consider earning a bachelor's in health care management or health information management. A certificate/diploma is going to be 9 months to 1 year. An associate diploma? 2 years. I also can't find any four year courses in medical billing.
- lotsofpulp 3y ago
  The managed care apparatus in the United States is about allocating insufficient supply of healthcare to excess demand based on the political value of the healthcare recipient. That is why Medicare pays doctors more than Medicaid for the same work (old people are worth more since they vote more than poorer and younger people). You can endlessly bucket people into infinite changing tiers based on their political power using reimbursement, deductible, out of pocket maximum, in and out of network providers, formularies, and prior authorization protocols. For example, you can give members of the military a different quality/quantity of healthcare than US federal Senators, who have a different set of policies, who in turn have a different set of policies from a highly profitable white collar firm’s employees, and yet again different from a less profitable business with lower paid employees, and so on and so forth. You can adjust reimbursements so that some people can immediately see doctors whereas others have to go to Physician Assistants or Nurse Practitioners. The system is a thing of beauty from a political point of view, and I bet countries with nationalized healthcare like UK and Canada move closer and closer to the US system as the population pyramids go upside down and cuts have to be made. And the whole time, people will waste their time being mad at managed care organizations, when the government leaders are the ones hiring them to be the “bad guy”.

slipperybeluga 3y ago

[dead]

monksy 3y ago

They're also firing people for fun. I know of a guy who is deep in the weeds upgrading their scala libraries that just got laid off within the week. (You have to do that to stay on top of all of the cves)