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It’s so bizarre to me that this uniquely US phenomenon of for-profit-middlemen inserted into the healthcare system has resulted in an adverserial relationship b

• superq 2y ago
  True! Really, it's a three-way relationship: customer - insurer: the govt (or, far more rarely, the employer) is the customer insurer - recipient: the recipient is you. You're really just a necessary but unwelcome side-effect.
  • wat10000 2y ago
    Once AI is able to replace patients, the industry is really going to take off.
• egypturnash 2y ago
  Death panels.
  • olddustytrail 2y ago
    What about them?
    • thephyber 2y ago
      The political boogeyman was that government bureaucrats would be the members of “death panels” if we went full socialized healthcare industry, but in practice we already have death panels in health insurance claims adjusters and (less maliciously) doctors on transplant review boards.
      • _DeadFred_ 2y ago
        My mother beat cancer. Insurance paid for follow up testing every 2 years. I tried to convince her to pay out of pocket and do it every year but she said 'they know best'. My mom did not beat cancer the second time when it came back and too much time elapsed between screenings. I know 'pro status quo' people will say online anecdotes are all lies and not relevant, but there are a heck of a lot of people with a lot of animosity to the current system and it's 'for profit death panels'. I think it would be easier to swallow if it were societal chosen death panels over failed doctors (that can't make it so they go work for the insurance company) or random AIs doing the decision making.
        • jopsen 2y ago
          With a socialized healthcare system the system would have delays and you'd get the screening every 2.5 years, even if it was scheduled for every 2 years. Because of wait lists. To be fair, it's impossible to know of it matters :) I moved back to Europe from the US. And I can certainly feel that healthcare is slower, less eager to jump and investigate everything. But on the other hand, in the US you most certainly risk talking your self into procedures you don't need!
          • josephg 2y ago
            I live in Australia, and I don’t pay for private health insurance. Last year after travelling to Egypt I ended up in hospital with some gut related issue. I was let straight in from the emergency room. The doctors were great. I stayed overnight in one of the wards hooked up to machines and all that. I was discharged the next day. I didn’t pay a cent. I didn’t even see a bill. I don’t think they made one. I keep hearing stories from Americans about wait times in other countries. I’m sure it happens, but I’ve never seen it myself. My experiences with the medical system here has been pretty universally excellent. When I was in America I was very impressed with how proactive everything is. My insurer paid for yearly physical exams. I’d never done that before. It’s certainly possible I would have even better health outcomes in America. But, I’m way happier here. And I’m a lot less stressed than I was when I lived in the Bay Area. That counts for a lot.
• beezlebroxxxxxx 2y ago
  > That’s a financial product, not a medical one. It often goes unsaid, but America, on a cultural and political level, is really ideologically fixated on a distinction between working and non-working individuals, and, in a far deeper sense, whether an individual "deserves" healthcare or not. This makes access to healthcare intricately connected to class, wealth, and income, in America. That's why access to healthcare is seen as a product in and of itself. You can either afford it ("you've earned it"), or you go into debt for it ("you have to earn it"), or you simply have no expectation of ever paying for it ("you cheated the system"). The entire conversation is often dominated by these ideas in a way that often makes talking about healthcare with Americans baffling to people that come from many single-payer or universal systems.
  • xdfgh1112 2y ago
    I get this feeling a lot. For example the UK typically has unlimited paid sick days for salaried jobs, while I have heard of US employees pooling together and "donating" sick days to someone. The UK has a ton of benefits for the sick, unemployed, single mothers, carers etc. in the US I am sure those exist but I get the sense that charity is supposed to play more of a role.
    • _DeadFred_ 2y ago
      [flagged]
      • brigandish 2y ago
        They don't exist in the UK either, what company would offer unlimited sick days? Getting a job at those companies would represent a lottery win.
        • the_mar 2y ago
          I mean your employment can't technically be terminated because you are taking sick days, unless it's whatever qualifies as long term illness (18 or 28 weeks I forget). Technically they are not obligated to continue to pay you and the govt sick pay is like 100 quid per week. in the us they can fire you the day you don't show up
• crmd 2y ago
  In my view, the root cause of the bizarreness is that medical care is one of a few enterprises that are inherently social in nature, and is therefore a prima facie exception to the common wisdom that free markets create the most positive outcomes for the largest number of people. Because in the US we are taught from a young age that private sector capitalism is "all there is", we end up tying ourselves into knots trying to solve medical care using the wrong toolset.
• saxonww 2y ago
  I think the industry terminology separates the provider (a doctor) from the payer (or payor; an insurance company in this case).
• nox101 2y ago
  in Japan where the government sets the prices, dentists do things over 3 visits that dentists in other places would do in 1 because then they can bill the government set price 3 times instead of one
  • nightshift1 2y ago
    that's crazy ! Do they at least schedule the 3 visits back to back in the same day ?
  • pilotneko 2y ago
    Well, that seals the deal. If it doesn’t work for dentists in Japan, there is no point changing anything at all for US healthcare policy.
  • josephg 2y ago
    There are certainly problems in the healthcare systems in other countries. I don’t think there’s any perfect system. But if you ask me, “you have to go to the dentist 3 times” is a much better problem than “even people with health insurance go bankrupt regularly as a result of getting ill and needing medical care”. The US government spends a similar amount of money per person on healthcare as other western countries do. But unlike Europe, Australia, Canada, Japan and so on, people don’t even get free healthcare in exchange for all that tax money. The system is deeply flawed. I don’t know anything about the Japanese healthcare system, but I’d still choose to be sick in Japan than America any day of the week.
  • hattmall 2y ago
    I'm sure you could offer the Japanese dentist 10% of what the procedure would cost in the US and they would do it in one trip. It cost about 25% of US prices to fly to Costa Rica, stay at a resort, and get the procedure done in a top notch facility. And that's if you just need 1 root canal and crown. If you need even more done the savings move closer to 90%. And that is a really nice places. You could drive to Mexico and get it done at a decent place for comparatively nothing.
    • FireBeyond 2y ago
• rscho 2y ago
  Not unique to the US. This develops to a certain extent everywhere private insurance is sold. It is a completely logical consequence of the insurance company raking in the most when selling you insurance for everything that won't happen, and deny you any coverage for stuff that will happen. At that point, it is a mystery to me why so many people still think free market theory works for healthcare.
  • LtWorf 2y ago
    It doesn't work at all for anything without strong regulations.
• matheusmoreira 2y ago
  Somebody is paying for it. If not insurance companies, then the people through the government. As a citizen of a country with socialized health care, I will tell you the politicians promise the world but when the bill comes they can't seem to find their way out of the room fast enough. The only way to avoid this adversarial relationship is to pay for it yourself. No insurance, no government, nothing. That means vast amounts of people will not be able to afford even a doctor's private practice. It's sad but the bitter truth is nobody really wants to pay for other people's health care either. They only say they do because it wins them votes or clients. They all can't leave the room fast enough when the bill actually comes. Politicians have other far grander things they'd rather do with all that taxpayer money, and that's when they're not corrupt and pocketing it. Insurers obviously want profit. They're all betting you won't actually need all that fancy schmancy health care they promised you. They're literally banking on it. In my experience, people barely want to pay for their own health care. They "want" to but start appealing to the altruism of their fellow man the second the bill comes. In my country, doctors are shamed every day because of our "oath" to help others. People act like we are their slaves, not even entitled to payment for services rendered. The good doctor is the one who pursues medicine as a hobby, who walks the earth helping others in need, with no needs of his own to tend to. The good doctor somehow absorbs the costs of it all. Including the costs of the cures involved. Especially the opportunity costs. People are not prepared for the soulless utilitarianism of public health care. The bitter truth is there aren't enough medical resources for everybody. You must pick and choose who gets that fancy MRI scan. If you pick right you kill people. If you pick wrong you kill even more people. You have hundreds of millions of citizens, how do you help as many as possible as much as possible with the resources available? Decentralization via hundreds of basic clinics and hospitals turns out to be better than centralizing everything into one well equipped giga hospital. It's not about any one guy. It's about saving costs now so that you can help more people later. That's what primary care is all about. Saving costs, by promoting healthy lifestyles which means less sick people later in life where treatment is more expensive. It's about money, about resources. But people don't want that. Good lifestyles are hard to lead, they require sacrifices. They want to do whatever they want, then go to the doctors when they get sick, then they want others to pay for whatever's necessary to fix it, and they want it fixed good as new. They are like consumers who don't want to pay for the services they need. Nobody wants to pay for it, even the people who directly need the services.