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Health "insurance" companies in the US are not actually, primarily insurers. For the most part, they are not in the business of insuring rare events. Maybe they
by cs702 2y ago
Health "insurance" companies in the US are not actually, primarily insurers. For the most part, they are not in the business of insuring rare events. Maybe they were primarily in the insurance business at some point in the past, but today they are mainly in the business of entrenching themselves in the middle of all interactions between patients, doctors, and hospitals, and extracting rents from all of them. Health "insurance" companies have become extractive businesses that produce nothing of evident value except unpleasant paperwork, and extract an economic rent for it, to the detriment of everyone else. I call them "paperwork-shuffling processors."
- WorldWideWebb 2y agoAccurate. They are literally middle men taking a cut without offering anything to the process. Switch to single payer, dump the middlemen, and have our taxes pay for essential services (keeping us alive and healthy). Seems simple enough but…
- tptacek 2y agoBut literally every state in the country disagrees with you and so it's not going to happen.
- mostlysimilar 2y ago(decades of propaganda and state capture by the insurance companies later...) oh I guess the people just don't want it! Too bad.
- bdangubic 2y agotrue but that doesn’t make it right when people are running these states are paid by the same people who benefit from the current system…
- tptacek 2y agoThe people in those states do not want it, which is why state single payer referenda fail.
- paulryanrogers 2y agoRomneycare and the ACA were a pretty big step in the single payer direction. Popular enough to overcome vetos and attempts to roll them back.
- tptacek 2y agoI like the ACA. I think the Swiss system makes a lot of sense. Community rating, guaranteed issue, mandate, subsidy, then universal single payer at retirement, where costs are concentrated. It's a sane system. The problem isn't the system structure.
- rawgabbit 2y agoWhat one thing would you change in the American system?
- tptacek 2y agoI would drastically increase the number of residency slots Medicare funds.
- valval 2y agoI would never have expected your answer to be “spend more of other people’s money”.
- bdangubic 2y agoall of insurance and all of healthcare is "other people's money" :) it just depends where other people's money is going. this is amazing thing to me as European living in the United States, people want Gov to spend money for education or healthcare or ... COMMUNISM!! but corporate subsidies and 984 trillion dollars to the department of offense - oh RIGHT ON - let me get another gig job to pay more to that :)
- rrrrrrrrrrrryan 2y agoMost Americans support a public option, which is the transition step toward a healthcare system that more closely aligns with other first world nations.
- tptacek 2y agoOnly in the abstract. When you work out a concrete proposal that involves people paying for programs, support evaporates.
- antisthenes 2y agoPeople are already paying for the healthcare one way or another, whether they understand it or not.
- tptacek 2y agoOh, you can get a lot of stuff done if you just assume you know better than voters do and make the decisions for them.
- antisthenes 2y agoYou think the ruling classes in the US don't assume that they know better than the voters? And they still get nothing done when it comes to entrenched interests. Let's not glorify the average voter either.
- locopati 2y agoThe voters are for the most part uninformed, bordering on flat out ignorant. I feel safe in saying the experts who solve problems like this do know better than voters.
- jzb 2y agoBut regulatory capture ensures that can’t happen.
- tbrownaw 2y ago> Switch to single payer, dump the middlemen, and have our taxes pay for essential services (keeping us alive and healthy). Seems simple enough but… ... But you still have group A (patients) paying group B (doctors) with group C's (taxpayers', or currently insurers'/policyholders') money.
- sundaeofshock 2y agoUh, group A and group C are the same. We would see much more preventative care if such care was free at time of service.
- MattPalmer1086 2y agoSure - but it's a lot simpler with less middlemen and way more cost effective. What point are you making here?
- rich_sasha 2y agoI suppose, careful what you wish for. The NHS (UK's single payer health provider), allegedly the envy of whole wide world, is failing under the burden of insufficient funding, aging society and years of mismanagement by politicians. We're talking, properly dysfunctional, like ambulances taking hours to be dispatched to life-threatening emergencies or people dying on emergency wards due to neglect.
- stackedinserter 2y agoSame for Canadian healthcare.
- piva00 2y agoThe NHS was properly sabotaged by the Tories, exactly because they wanted to privatise it. Starving the NHS has been per design, no accident there. - https://tribunemag.co.uk/2023/07/defunding-the-nhs https://tribunemag.co.uk/2023/07/defunding-the-nhs
- tptacek 2y agoLiterally the same thing is true of health care providers, which is why we have artificially constrained supply of physicians, sky-high delivery of procedures other countries don't routinely do, and integer multiple compensation across the board for practitioners.
- cs702 2y agoYes. I almost added a comment about that too. In my experience, all doctors, nurses, and other caregivers with whom I have interacted at hospitals have told me they feel treated like "factory workers" who must meet stringent "quality of care" KPIs, set by hospital executives far removed from actual patient care.
- tptacek 2y agoSo why are we putting jerseys on and taking the field against the insurers when virtually all of the actual money is going to providers? We could zero out all insurance costs, putting insurers into literal de jure indentured servitude, and get nothing more than a grocery store circular coupon discount on health costs, because insurers are not in fact where the costs are.
- cs702 2y agoThey are an integral part of the mess we're in, and they have a vested interest in the status quo. Otherwise, I agree with you.
- tptacek 2y agoI'm certainly not going to valorize insurers, but I find it deeply frustrating the providers are getting a pass here. You can see it on this thread, where there are commenters expressing surprise that I'd even suggest providers are the primary beneficiaries of the current system.
- cs702 2y ago
- apsec112 2y agoA lot of private "health insurance" at large companies is just: - the company pays out-of-pocket for all employee health expenses - they don't want to directly deal with bills from doctors and hospitals, so they contract that out to a third-party administrator (TPA), which purely handles paperwork and has no financial role at all but this doesn't remove the tension between the employer wanting to pay less, and the patient wanting more to be paid for (and for single-payer systems, you still have the tension between taxpayers wanting to pay less and patients wanting more care, although those groups at least overlap a lot more)
- tbrownaw 2y agoInsurers will also sometimes contract out their claim handling to those same TPAs.
- econ40432 2y agoIf I go to a doctor or get Lasik surgery, can't I pay them directly without using my insurance?
- tptacek 2y agoYes, but unless it's literally Lasik, which has a robust private market, your provider will probably literally make a price up on the spot. That happened to me several years ago, when we needed urgently to get a CT scan for our daughter; it was late in the afternoon, the provider couldn't get the insurer on the horn, they proposed to do it the next day, I was jumpy and said "fuck it I'll pay out of pocket", they looked confused and then just made up a price: $1000.