8 ms·

'It's a money game to them':son takes on UnitedHealth over elderly father's care

171 points by howard941 2y ago

rqtwteye 2y ago
What i don’t get is that the US system is not only super expensive but also totally clunky. As patient you need to track who is in an out of network, nobody can tell you how much something will cost, provider directories by the insurance are often wrong, hospitals constantly make mistakes, insurance denies valid claims, insurance gives you wrong info, ambulance may 5000 or 0, nobody knows, cash prices may be cheaper than going through insurance . It almost feels like as patient you need to program the system in assembly where you need to know every little detail of the system without any documentation. Nothing makes sense but everything costs a lot of money. At a minimum there should be regulation (I know it’s a bad word now) to make the system easy to use without costly traps.
- CooCooCaCha 2y ago
  Costing money is the point. Confusion is the point. It’s built to extract as much money as possible.
  - titzer 2y ago
    Insurance companies are parasites. They extract $200 billion from the system in order to tell you that you can't get treatment. It's supposed to function as a risk pool and instead it functions as a tax--which is utterly dystopian, because it's a tax that goes to a private system that you can't even find a way to opt into if you have the wrong employer. It's so messed up.
- bell-cot 2y ago
  The US system is 99% for its own benefit, especially $profit. Patient experience is not a meaningful metric.
- martinbaun 2y ago
  I don't get it as well, though I think the situation is classical regulatory capture. In other words, the wrong regulation. I like the style the Czech/German system is doing healthcare. It is public but kinda private. You pay to the government, but you decide where to go so the hospitals/doctors compete for your money. It is very different than the centrally planned Danish or English based where there's basically some person in top that decides everything.
  - anthonyskipper 2y ago
    It has NOTHING to do with regulatory capture. The US is polarized with the republicans not wanting any socialized health care because they don't want to care for people not like them. You can't organize and correctly run a health care systems when half you politicians actively sabotage and burn it down.
    - Supermancho 2y ago
      > not wanting any socialized health care because they don't want to care for people not like them because they don't want to care for people not like them. Categorically, older individuals tend to vote more conservative and more republican. This doesn't make sense to me at all. What makes more sense is that they argue against the socialization of any industry that funds their campaigns. Democrats seem to take a more middle ground. ie Obamacare socialized low cost solutions and pushed costs uphill toward people who need more expensive care.
    - DontchaKnowit 2y ago
      Do you really think politicians are motivated by "not wanting to care for people not like them" That's such an insane assumption to make.
      - hn_acc1 2y ago
        Do you live in the US? There were supporters of a certain party complaining that the president wasn't hurting the right people fast enough..
- unsnap_biceps 2y ago
  > As patient you need to track who is in an out of network It's not even which facility, but which staff member! My mother had a pair of surgeries at the same facility, but the first anesthesiologist was in network and the second one was out of network. Both worked for the same place, but the second one was a contracted employee and so they bill differently then the direct hired ones. It was a major mess and ended up costing us an extra 10k or so.
  - sumtechguy 2y ago
    I am currently fighting a 4k bill. For some super glue and gauze and 'oh it shouldn't be more than 150 that you are paying today'. They literally just charged me the max they possibly could to my insurance. The insurance just said 'oh well' and paid part of it. Now I am in collections over 1/3rd of the amount I can easily pay. The provider will not even tell me what procedures got it up to 4k. How the hell did that pass the insurance sniff test. These jackasses are just sending out bills and hoping someone will pay it. Your credit screwed over. Oh well. They already got paid. My mother ended up with a collapsed lung. The doctor caused. Then they charged her for it. My mom had a nurse hand my mom her own purse and my mom fished out a bottle Tylenol. 400 bucks. No one knows what is going on or how things are being charged. At this point it is obviously on poupous. This is not health care. It is racket designed to steal money from people who are sick.
    - hn_acc1 2y ago
      Seriously. If it wasn't for Kaiser making this somewhat sane (even though maybe their care isn't as good as "the best" specialists), I would probably be a nervous wreck, trying to juggle stuff for my family..
  - twoodfin 2y ago
    Not helpful to you now, of course, but this billing practice is now illegal: https://www.cms.gov/nosurprises/ending-surprise-medical-bills https://www.cms.gov/nosurprises/ending-surprise-medical-bill... (Signed by Trump during the 2020 lame duck!)
- api 2y ago
  The US system combines everything bad about bureaucratic socialized medicine with everything bad about private health care.
- KittenInABox 2y ago
  Part of the issue is that regulation in this space is extremely difficult, as UHC is a for-profit corporation and thus is incentivized inherently against the societal goal of providing healthcare. Even if there is regulation to force UHC to spend 90-95% of the money given to it on healthcare, this incentivizes UHC to make healthcare expensive so the 5-10% portion it can keep can also grow. Not to say that governments shouldn't still try to make it more fair, but to say that UHC has a duty to its shareholders to find as many loopholes as possible to refuse to pay out healthcare.
- electric_mayhem 2y ago
  Where you’re going wrong is thinking that it’s intended to work for patients at all. If you look at it as a pump that’s intended to provide the worst possible care with the most friction it can tolerate and at the highest parasitic cost I’m certain you’ll find it makes perfect sense.
- thephyber 2y ago
  Data/information asymmetry is a feature. The side of the transaction who has better visibility+analysis, the more likely they are to win on the transactions.
- booboo12345 2y ago
  What's not to get? This is what privatization does. It's not for proper care of patients, it's for money to flow upwards to a single individual. Logically and financially, a single payer system makes way more sense. No marketing costs, no CEO costs, no costs for the entire medical billing industry, no costs for excessive paperwork. Just care. When my mom was in hospice last year for a month before she passed, Medicare covered that 100%. It was amazing, it's like, didn't have to worry about being bankrupt after she passed. No paperwork for us to deal with, no surprise bills, etc. just care. Imagine the world...
  - thephyber 2y ago
    To be fair, there are much better models for privatization (eg. Israel has 4 competing HMOs and the poor are given subsidies by the state). There are many problems with the US healthcare system, not the least of which is the fact that we have something like 18 different ones.
  - sneak 2y ago
    > This is what privatization does. Yes, this is the same reason it takes 7 weeks and two referrals to have my car serviced, or my floors cleaned. Private industry is terrible at these things.
    - vasco 2y ago
      Exactly, this is clearly not a problem of privatization. In The Netherlands for example the system is privatized but highly regulated and there's no such issues. And like you said there's infinite industries without interference from the state where you clearly know prices and can decide what you want and no shenanigans. The US just fucked up the system somehow but privatization isn't the problem.
  - Flozzin 2y ago
    I am sure there is a cost savings if insurers were just required to pay. I have to imagine, they put a lot of effort auditing if medical service was in-network/covered by the plan. And more effort in fighting the people over claims. This isn't to say there is not genuine fraud or abuse going on by hospitals/doctors, but you often hear of people just trying to get their treatments covered.
- TheRealPomax 2y ago
  Does it make a little more sense when you remember that "health care" and "health insurance" are industry segment names in the US, not literally descriptions for what those segments are centered on? Both of them are for-profit industries that focus on converting maladies, and the absence of maladies, into money, respectively. That's their prime focus. And you can be cynical about that and go "So, what, it's in their interest to get people sick and then keep them sick? That's insane!" And yes. Yes it is.
- jallmann 2y ago
  > As patient you need to track who is in an out of network It's worse than that, there are also "tiers" within a network, even for different physicians under the same health group. We were actually debating moving our kids to a different doc (but in the same office!) because of this. The whole system is madness.
  - wil421 2y ago
    Never experienced what you describe. My pediatric practice is the largest in the state and has like 10 doctors and 10 NPs. We can see whoever we want. Maybe the health care conglomerates in my city are decent but I’ve never ever tried to book any appointment and been told they are out of network. Never had a hospital experience where some random doctor was out of network but everyone else is.
    - ceejayoz 2y ago
      There's been regulatory action on this in the last few years, but the really insidious scenario here was in-network facilities employing out-of-network staff in ERs and ORs, where several different providers are involved. https://www.nytimes.com/2022/06/30/well/live/surprise-medical-bills.html https://www.nytimes.com/2022/06/30/well/live/surprise-medica... > These bills arise because even if you visit an in-network provider, you can still be treated by an out-of-network physician who works there, said Karen Pollitz, the co-director of the Kaiser Family Foundation’s Program on Patient and Consumer Protections. “The doctors who work in hospitals generally don’t work for the hospitals,” she said. “They bill independently, and they can decide which networks they participate in.” Things like a major operation where the hospital, surgeon, nurses etc. were in-network, but the anesthesiologist - who you may never have even encountered while conscious - was not. https://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html https://www.nytimes.com/2014/09/21/us/drive-by-doctoring-sur... > In Mr. Drier’s case, the primary surgeon, Dr. Nathaniel L. Tindel, had said he would accept a negotiated fee determined through Mr. Drier’s insurance company, which ended up being about $6,200. (Mr. Drier had to pay $3,000 of that to meet his deductible.) But the assistant, Dr. Harrison T. Mu, was out of network and sent the $117,000 bill. > Patricia Kaufman’s bills after a recent back operation at a Long Island hospital were rife with such charges, said her husband, Alan, who spent days sorting them out. Two plastic surgeons billed more than $250,000 to sew up the incision, a task done by a resident during previous operations for Ms. Kaufman’s chronic neurological condition. > “The idea of having an assistant in the O.R. has become an opportunity to make up for surgical fees that have been slashed,” said Dr. Abeel A. Mangi, a professor of cardiac surgery at Yale, who said the practice had become commonplace. “There’s now a whole cadre of people out there who do not have meaningful appointments as attending surgeons, so they do assistant work.” In Mr. Drier’s case, each surgeon billed for each step of the procedure. Dr. Tindel billed $74,000 for removing two disks and an additional $50,000 for placing the hardware that stabilized Mr. Drier’s spine. Dr. Mu billed $67,000 and $50,000 for those tasks. If the surgery had been for a Medicare patient, the assistant would have been permitted to bill only 16 percent of the primary surgeon’s fee. With current Medicare rates, that would have been about $800, less than 1 percent of what Dr. Mu was paid.
- dfxm12 2y ago
  Our government largely works for the billionaires who make money off this system. This is a problem. Keep this in the back of your mind until the next primary election you can vote in & tell your current representatives that you want a healthcare system that works for you.
- xadhominemx 2y ago
  “As patient you need to track who is in an out of networK” I just specify my insurance provider/plan in zocdoc and generates a list of doctors who are in network and their calendar of availability. I think this was a bigger hassle 10 years ago, yes.
  - cyberax 2y ago
    Oh, a sweet summer child. That's only for the initial GP visits and maybe for simple tests. Once you get into specialized treatment, it's a whole another world. For example, if you are admitted to an in-network hospital, an infectious disease specialist can be out-of-network, and you will have to pay for them.
  - Grimm665 2y ago
    I am currently fighting a bill for a yearly physical, which should be covered 100%, because my doctor is in network and covered, but "the facility" (aka his office) is billed as a separate entity. Insanity.
    - xadhominemx 2y ago
      Did you receive your physical at a hospital?
- harmmonica 2y ago
  A way to understand it is to look at it at a higher level. Republicans, in modern US terms, want to privatize or remove any spending where the government gives things away to people for "free." And sorry to be pedantic, but free's in quotes because what the government gives away for free is of course funded with taxpayer dollars or government-issued debt, both of which almost all Republicans have traditionally been vehemently against (yes, I'm ready for comments about how Republicans don't care about debt as long as it funds their priorities; you're right of course but it's not all Republicans saying that). The belief, and this is very apparent at the moment with all the stories about DOGE and the Trump admin, is that the government wastes money and the private sector can do it better. In cases where there's no return on investment to be had, Republicans would want that "free," government-provided service/product to be cut entirely (again, see recent DOGE actions). Btw, when I say ROI, in the eyes of Republicans, the more nebulous the ROI the more likely they are to say "kill it" because this really is about dollars and cents (with some culture war issues thrown in, but that's a very small part of the larger dollars and cents issue that almost all Republicans care about). And to put a finer point on it, the Republican Party believes a significant percentage of the US population doesn't work hard enough (or at all) and that therefore those people don't deserve to get anything for free (i.e., I don't want to pay taxes or have the government issue debt for the sake of people who haven't earned it). That's why you'll have a hard time arguing that very wealthy people shouldn't take advantage of the government because in the eyes of Republicans those people have, literally, earned whatever they get, including "free" things from the government (this mostly takes the form of pro-business regulations/subsidies). More specific to single-payer health care, if the US offered it, Republicans believe it would take away an incentive for people to work because for working-age people that's how you traditionally get health insurance. To repeat from above, no work = nothing free. That is a feature of the system in the eyes of Republicans, not a bug. For those wanting to understand more, ask ChatGPT/Google/etc. for Republican proposals for how to manage Social Security, Health Care in general, Medicare specifically (see "Medicare Advantage"), Medicaid, food stamps, Social Security Disability, etc.). If you really want to understand it fully read it straight from the Republicans' own websites. Visit the Heritage Foundation, or Americans for Tax Reform). Every one of these topics is discussed in detail. Particularly relevant at the moment given this administration is doing much more to make all of this a reality. Prior Republican admins did some of it as well, of course, but not as aggressively as this one. I say this on a lot of my (mostly long-winded posts--sorry!): I'm attempting to be factual here. If you're reading a politically-biased angle please reply and say so, and if you can tell me which words in particular are triggering you, I'd genuinely like to know because my intent is to communicate the rough facts on the ground. edit: changed one incorrect word
- RandomUser4976 2y ago
  This! Agreed! I wish more people understood this reality before they shout, “but you have to wait in Canada and the UK… socialism evil”, “higher taxes”, and “no other country has the same freedoms America has”.
josefritzishere 2y ago
[flagged]
tombert 2y ago
insert generic American progressive take about why we should have socialized healthcare here. My wife had an issue with her eye that was giving similar symptoms to macular degeneration [1] in 2016. I had insurance (it might have even been UHC, but I'm not 100% sure), so we went to an ophthalmologist's office, to get it looked at. When we get to the office, we find out that just the copay for this was going to be $550. I was kind of crap at saving money back then, and I had a job that didn't pay great, and I remember I had exactly $578.23 in my bank account at the time, and I still needed to pay my rent. I had to kind of awkwardly tell my wife "sorry, we don't have the money to have your eye looked at and pay our rent", so we leave without her getting any treatment. About 4-5 months later, I got a better job with much better health insurance, so she went to that same ophthalmologist, and our copay was less than $50. The entirety of the work that this ophthalmologist did was refer her to a retinal specialist. This means that I was initially going to have paid more than $500 just to get a god damned referral, and just to re-emphasize this, we had health insurance. I remember how upset and frustrated I was with that entire situation; it felt like I was doing things the "right" way by getting a desk job with health insurance and yet I still couldn't afford to get the treatment that my wife needed. It just felt...unfair? Like what exactly was I supposed to do differently here? It didn't really "change" my perspective on this, I had already been in favor of moving to a universal healthcare system, but this thoroughly solidified my perspective on it. [1] Fortunately, it wasn't that, it was an autoimmune thing. Still not great but better than we initially thought.
- KittenInABox 2y ago
  I have complicated feelings about universal healthcare... namely that the issue seems to be more-or-less not whether the system is socialized or private but if the healthcare system is provided adequate funding (via government or a private entity) to give acceptable outcomes on a population level. A lot of the detractors to private healthcare is simply that healthcare isn't being administered appropriately (pressure to only see patients for 15 minutes for example or to charge by procedure encouraging specialists where systemic issues go ignored) but so is the case for socialized medicine (waiting too long for specialists, understaffed hospitals).
  - 2y ago
bix6 2y ago
Well duh it’s a private for profit corporation. It literally exists to be a money game.
- throwway120385 2y ago
  The question isn't whether this is obviously a result of the current structure, but rather, is this good for the people of the US to live like this? Should we tolerate people being evicted from nursing home programs because their coverage was wrongfully revoked? And when we have story after story of private insurers doing this kind of thing, do we keep living with it to stay in our capitalist utopia, or do we conceive of something different and collectively pay for that instead of for the private insurance we all hate?
  - bix6 2y ago
    We shouldn’t tolerate it so hopefully these pieces can convince citizens to start forcing better alternatives.
    - xadhominemx 2y ago
      UNH makes low operating margins. If they they took those margins to zero, there would not be a noticeable increase in the amount of care they fund.
- owisd 2y ago
  The deal private for profit corporations make with society is that profit provides an incentive that leads to better outcomes, yet every developed country with a not-for-profit healthcare system has better outcomes.
  - bix6 2y ago
    Did UHC explicitly make that deal or are we just expecting them to act in good faith? Healthcare is a quasi public good so I’m not surprised not for profit countries do better.
bastardoperator 2y ago
Americans love to talk about freedom and rights, you don't even have the right to die with dignity in this country. Healthcare in America is just a basic racketeering scam at this point.
- napoleongl 2y ago
  And how low of a tax they pay compared to SoCiAlIsT countries where the tax also takes care of health related things… It seems deeply ingrained they’d rather pay a 1000 bucks for themselves and not risk helping someone else rather than pay 100 bucks that someone else might also benefit from.
  - DontchaKnowit 2y ago
    The problem is our government is so unfuckingbelievably irresponsible with money that increasing taxes wouldn't actually move the needle. And our taxes are not really that low. If 30% income tax is low then idk what the fuck to tell you.
Animats 2y ago
This is a problem with "Medicare Advantage", which is an HMO scheme. The Government pays the HMO a flat fee per patient, and they try to minimize expenses. Don't take that route. For now, "Traditional Medicare" plus a commercial supplement is a far safer deal. However, this may change. See [1], p. 465, which proposes to make "Medicare Advantage" the default. "Medicare Advantage (MA), a system of competing private health plans, is the major alternative to traditional Medicare for America’s large and growing cohort of seniors. The program provides beneficiaries with a wide range of competitive health plan choices—a richer set of benefits than traditional Medicare provides and at a reasonable cost. Equally as important, the MA program has been registering consistently high marks for superior performance in delivering high-quality care. Critical reforms are still needed to strengthen and improve the program for the future. Specifically: 1. Make Medicare Advantage the default enrollment option. ... " [1] https://static.project2025.org/2025_MandateForLeadership_CHAPTER-14.pdf https://static.project2025.org/2025_MandateForLeadership_CHA...
- bry4n 2y ago
  may i ask if you could explain in more details why medicare advantage is a bad choice to make if a person is already on regular medicare? assume that the person trying to make this decision is stubborn and not informed about the differences. thanks, i appreciate it.
  - Animats 2y ago
    Claim denial, pre-authorization problems, delays, and out of network problems, mostly.[1] Medicare Advantage is an HMO. If you can afford a good Medicare supplement (type F if you can get it), and can cover eyeglasses and hearing aids yourself, that's the most comprehensive coverage. But it will cost more. [1] https://www.kiplinger.com/retirement/medicare/medicare-advantage-plans-prior-authorization-denial-rates https://www.kiplinger.com/retirement/medicare/medicare-advan...
    - tzs 2y ago
      Plan G is probably better than plan F for most people now. The only coverage difference between the two is that plan F covers the Medicare part B deductible ($257 this year) and plan G does not. Plan F is not open to new enrollees in less they were eligible for Medicare before 2000-01-01 and so the pool of people with plan F is shrinking and aging. Plan G on the other hand is open to all, and is the most popular choice for new Medicare enrollees with something like 70% of the people who buy a supplement plan choosing it. That gives it a younger and growing pool. Accordingly plan G is generally cheaper than plan F which is usually more than enough to make up for not covering the $257 deductible. G just needs to be at least $21.42 month cheaper than F to come out ahead which is the case in a few sates I looked at.
tejohnso 2y ago
“They were just cutting him off because they could cut him off and reduce their expense,” Robby Martin said in an interview. “It’s all a money game to them.” What else would it be to them? They're not a charity. I don't see why people keep directing their hate toward the corporations for doing what they're intended to do. The hate and effort should be directed toward the politicians who prevent the implementation of changes that people want. Or do the majority of people not want changes that would prevent this kind of thing?
- ceejayoz 2y ago
  > What else would it be to them? They're not a charity. I mean, they could be a not-for-profit entity. > The hate and effort should be directed toward the politicians who prevent the implementation of changes that people want. Why not both? I can be mad at the companies who are purchasing those politicians, too.
- thinkingtoilet 2y ago
  No. This is the "just doing my job" defense. If your job is to kill people so you can make a buck, then you are a garbage human and I'm not going to cry if someone hunts you down in the street.
  - tejohnso 2y ago
    Well, I think we saw that and yeah, most people weren't crying about it. And yes, the "Just doing my job" (or, just following orders) defense is very powerful. That's why it shouldn't be surprising that this kind of thing happens given the incentives and systems involved.
- mandmandam 2y ago
  > I don't see why people keep directing their hate toward the corporations... > The hate and effort should be directed toward the politicians who prevent the implementation of changes that people want. Who do you think is hiring the lobbyists to pay off the politicians? Who do you think is paying the media to make sure people don't know that we're actually pretty agreed on this issue? I have enough anger for 'both' political parties, the corporations that buy them, and the media (social and corporate) that runs cover for both. And I'm not remotely apologetic for that; I believe it's the only rational and humane opinion to have about healthcare in the US.
like_any_other 2y ago
I wonder if reporting on this stuff will also be called "stochastic terrorism".
- franktankbank 2y ago
  stochastic justice maybe
chrisbrandow 2y ago
Side note: Medicare advantage is the worst. If you have an elderly relative, make sure they stay on traditional Medicare.
- kstrauser 2y ago
  My wife's a doctor who sees a lot of Medicare patients, and she warns all of them about Medicare Advantage. Don't do it.
  - bry4n 2y ago
    > My wife's a doctor who sees a lot of Medicare patients, and she warns all of them about Medicare Advantage. > > Don't do it. could you please explain in more detail why a move to medicare advantage from regular medicare is a bad decision? i'm asking because a family member is on regular medicare but is being pressured to move to an advantage plan. i would like some facts to help bolster his decision to stay on regular medicare (since i've also heard MA is a bad idea). thanks in advance.
- bry4n 2y ago
  > Side note: Medicare advantage is the worst. If you have an elderly relative, make sure they stay on traditional Medicare. could you please explain further? why is MA worse than regular medicare? a family member is being pressured to move from regular medicare to advantage, and i need some facts to help them see why advantage plans are worse than regular medicare. thank you.
thow16161 2y ago
I'm stuck in a Kafkaesque situation w/my insurance company (Anthem). I currently get infusions of a biologic for Crohn's. These are incredibly expensive as well as inconvenient. I'm lucky, in that my insurance company pays for almost all of this. The same drug is now available in the form of a self-administered pen which is far less expensive and more convienient. However, that falls under the purview of CVS Caremark, who Anthem has designated as its pharmacy benefits manager. CVS Caremark is denying the pen, saying I have to try a whole host of other meds which do not work for me first. I talked to Anthem yesterday, and they have no idea how to get this approved. Their best suggestion is that my doctor schedule a call with the CVS doctor to argue with them. My doctor is not motivated to do this, as I'm already getting a treatment that works for me. So I'm stuck wasting hours every few weeks for an infusion that could be replaced by an injection I give myself. And the hilarious part is that the insurance company stands to benefit the most, as they would pay far less. This is the kind of thing that, if we had actual socialized medicine, I might be able to appeal to a government official to fix. But how can you appeal corporate bureaucracy?
- ericmcer 2y ago
  I don't know if the ease and speed at which government officials fix things is a compelling argument for socialized medicine.
  - bfrankline 2y ago
    Yet people love Medicare and Medicaid.
- Schiendelman 2y ago
  You are probably best off just not fighting it. Keep getting the infusions. Stop worrying about it. Let the insurance company make a decision if they think they can save money.
  - inkcapmushroom 2y ago
    How I Learned to Stop Worrying and Love the Injections.
ChrisArchitect 2y ago
Related: Health Insurers Deny 850M Claims a Year. The Few Who Appeal Often Win https://news.ycombinator.com/item?id=43032224 https://news.ycombinator.com/item?id=43032224 UnitedHealth Is Sick of Everyone Complaining About Its Claim Denials https://news.ycombinator.com/item?id=42992121 https://news.ycombinator.com/item?id=42992121
- franktankbank 2y ago
  In case you weren't already pissed here's some more readings!
svilen_dobrev 2y ago
wasn't the plot in "Man called Ove" about similar "get the money" schema? And that's Sweden..
blufish 2y ago
[flagged]
- wetpaws 2y ago
  [dead]
nojvek 2y ago
Majority of Americans voted for Trump. Who openly declared he only concepts of a plan, no real plan for healthcare. Who openly said he will side with the billionaires and corporations. His policies are inflationary and gonna add trillions of debt for the next generation. That being said, it's not like Kamala was going to go after making healthcare any cheaper. It's a duopoly that is funded by corporations no matter who we chose. Bernie had some chance but the duopoly didn't like him.

171 points by howard941 2y ago

What i don’t get is that the US system is not only super expensive but also totally clunky. As patient you need to track who is in an out of network, nobody can tell you how much something will cost, provider directories by the insurance are often wrong, hospitals constantly make mistakes, insurance denies valid claims, insurance gives you wrong info, ambulance may 5000 or 0, nobody knows, cash prices may be cheaper than going through insurance . It almost feels like as patient you need to program the system in assembly where you need to know every little detail of the system without any documentation. Nothing makes sense but everything costs a lot of money. At a minimum there should be regulation (I know it’s a bad word now) to make the system easy to use without costly traps.

CooCooCaCha 2y ago
Costing money is the point. Confusion is the point. It’s built to extract as much money as possible.
- titzer 2y ago
  Insurance companies are parasites. They extract $200 billion from the system in order to tell you that you can't get treatment. It's supposed to function as a risk pool and instead it functions as a tax--which is utterly dystopian, because it's a tax that goes to a private system that you can't even find a way to opt into if you have the wrong employer. It's so messed up.
bell-cot 2y ago
The US system is 99% for its own benefit, especially $profit. Patient experience is not a meaningful metric.
martinbaun 2y ago
I don't get it as well, though I think the situation is classical regulatory capture. In other words, the wrong regulation. I like the style the Czech/German system is doing healthcare. It is public but kinda private. You pay to the government, but you decide where to go so the hospitals/doctors compete for your money. It is very different than the centrally planned Danish or English based where there's basically some person in top that decides everything.
- anthonyskipper 2y ago
  It has NOTHING to do with regulatory capture. The US is polarized with the republicans not wanting any socialized health care because they don't want to care for people not like them. You can't organize and correctly run a health care systems when half you politicians actively sabotage and burn it down.
  - Supermancho 2y ago
    > not wanting any socialized health care because they don't want to care for people not like them because they don't want to care for people not like them. Categorically, older individuals tend to vote more conservative and more republican. This doesn't make sense to me at all. What makes more sense is that they argue against the socialization of any industry that funds their campaigns. Democrats seem to take a more middle ground. ie Obamacare socialized low cost solutions and pushed costs uphill toward people who need more expensive care.
  - DontchaKnowit 2y ago
    Do you really think politicians are motivated by "not wanting to care for people not like them" That's such an insane assumption to make.
    - hn_acc1 2y ago
      Do you live in the US? There were supporters of a certain party complaining that the president wasn't hurting the right people fast enough..
unsnap_biceps 2y ago
> As patient you need to track who is in an out of network It's not even which facility, but which staff member! My mother had a pair of surgeries at the same facility, but the first anesthesiologist was in network and the second one was out of network. Both worked for the same place, but the second one was a contracted employee and so they bill differently then the direct hired ones. It was a major mess and ended up costing us an extra 10k or so.
- sumtechguy 2y ago
  I am currently fighting a 4k bill. For some super glue and gauze and 'oh it shouldn't be more than 150 that you are paying today'. They literally just charged me the max they possibly could to my insurance. The insurance just said 'oh well' and paid part of it. Now I am in collections over 1/3rd of the amount I can easily pay. The provider will not even tell me what procedures got it up to 4k. How the hell did that pass the insurance sniff test. These jackasses are just sending out bills and hoping someone will pay it. Your credit screwed over. Oh well. They already got paid. My mother ended up with a collapsed lung. The doctor caused. Then they charged her for it. My mom had a nurse hand my mom her own purse and my mom fished out a bottle Tylenol. 400 bucks. No one knows what is going on or how things are being charged. At this point it is obviously on poupous. This is not health care. It is racket designed to steal money from people who are sick.
  - hn_acc1 2y ago
    Seriously. If it wasn't for Kaiser making this somewhat sane (even though maybe their care isn't as good as "the best" specialists), I would probably be a nervous wreck, trying to juggle stuff for my family..
- twoodfin 2y ago
  Not helpful to you now, of course, but this billing practice is now illegal: https://www.cms.gov/nosurprises/ending-surprise-medical-bills https://www.cms.gov/nosurprises/ending-surprise-medical-bill... (Signed by Trump during the 2020 lame duck!)
api 2y ago
The US system combines everything bad about bureaucratic socialized medicine with everything bad about private health care.
KittenInABox 2y ago
Part of the issue is that regulation in this space is extremely difficult, as UHC is a for-profit corporation and thus is incentivized inherently against the societal goal of providing healthcare. Even if there is regulation to force UHC to spend 90-95% of the money given to it on healthcare, this incentivizes UHC to make healthcare expensive so the 5-10% portion it can keep can also grow. Not to say that governments shouldn't still try to make it more fair, but to say that UHC has a duty to its shareholders to find as many loopholes as possible to refuse to pay out healthcare.
electric_mayhem 2y ago
Where you’re going wrong is thinking that it’s intended to work for patients at all. If you look at it as a pump that’s intended to provide the worst possible care with the most friction it can tolerate and at the highest parasitic cost I’m certain you’ll find it makes perfect sense.
thephyber 2y ago
Data/information asymmetry is a feature. The side of the transaction who has better visibility+analysis, the more likely they are to win on the transactions.
booboo12345 2y ago
What's not to get? This is what privatization does. It's not for proper care of patients, it's for money to flow upwards to a single individual. Logically and financially, a single payer system makes way more sense. No marketing costs, no CEO costs, no costs for the entire medical billing industry, no costs for excessive paperwork. Just care. When my mom was in hospice last year for a month before she passed, Medicare covered that 100%. It was amazing, it's like, didn't have to worry about being bankrupt after she passed. No paperwork for us to deal with, no surprise bills, etc. just care. Imagine the world...
- thephyber 2y ago
  To be fair, there are much better models for privatization (eg. Israel has 4 competing HMOs and the poor are given subsidies by the state). There are many problems with the US healthcare system, not the least of which is the fact that we have something like 18 different ones.
- sneak 2y ago
  > This is what privatization does. Yes, this is the same reason it takes 7 weeks and two referrals to have my car serviced, or my floors cleaned. Private industry is terrible at these things.
  - vasco 2y ago
    Exactly, this is clearly not a problem of privatization. In The Netherlands for example the system is privatized but highly regulated and there's no such issues. And like you said there's infinite industries without interference from the state where you clearly know prices and can decide what you want and no shenanigans. The US just fucked up the system somehow but privatization isn't the problem.
- Flozzin 2y ago
  I am sure there is a cost savings if insurers were just required to pay. I have to imagine, they put a lot of effort auditing if medical service was in-network/covered by the plan. And more effort in fighting the people over claims. This isn't to say there is not genuine fraud or abuse going on by hospitals/doctors, but you often hear of people just trying to get their treatments covered.
TheRealPomax 2y ago
Does it make a little more sense when you remember that "health care" and "health insurance" are industry segment names in the US, not literally descriptions for what those segments are centered on? Both of them are for-profit industries that focus on converting maladies, and the absence of maladies, into money, respectively. That's their prime focus. And you can be cynical about that and go "So, what, it's in their interest to get people sick and then keep them sick? That's insane!" And yes. Yes it is.
jallmann 2y ago
> As patient you need to track who is in an out of network It's worse than that, there are also "tiers" within a network, even for different physicians under the same health group. We were actually debating moving our kids to a different doc (but in the same office!) because of this. The whole system is madness.
- wil421 2y ago
  Never experienced what you describe. My pediatric practice is the largest in the state and has like 10 doctors and 10 NPs. We can see whoever we want. Maybe the health care conglomerates in my city are decent but I’ve never ever tried to book any appointment and been told they are out of network. Never had a hospital experience where some random doctor was out of network but everyone else is.
  - ceejayoz 2y ago
    There's been regulatory action on this in the last few years, but the really insidious scenario here was in-network facilities employing out-of-network staff in ERs and ORs, where several different providers are involved. https://www.nytimes.com/2022/06/30/well/live/surprise-medical-bills.html https://www.nytimes.com/2022/06/30/well/live/surprise-medica... > These bills arise because even if you visit an in-network provider, you can still be treated by an out-of-network physician who works there, said Karen Pollitz, the co-director of the Kaiser Family Foundation’s Program on Patient and Consumer Protections. “The doctors who work in hospitals generally don’t work for the hospitals,” she said. “They bill independently, and they can decide which networks they participate in.” Things like a major operation where the hospital, surgeon, nurses etc. were in-network, but the anesthesiologist - who you may never have even encountered while conscious - was not. https://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html https://www.nytimes.com/2014/09/21/us/drive-by-doctoring-sur... > In Mr. Drier’s case, the primary surgeon, Dr. Nathaniel L. Tindel, had said he would accept a negotiated fee determined through Mr. Drier’s insurance company, which ended up being about $6,200. (Mr. Drier had to pay $3,000 of that to meet his deductible.) But the assistant, Dr. Harrison T. Mu, was out of network and sent the $117,000 bill. > Patricia Kaufman’s bills after a recent back operation at a Long Island hospital were rife with such charges, said her husband, Alan, who spent days sorting them out. Two plastic surgeons billed more than $250,000 to sew up the incision, a task done by a resident during previous operations for Ms. Kaufman’s chronic neurological condition. > “The idea of having an assistant in the O.R. has become an opportunity to make up for surgical fees that have been slashed,” said Dr. Abeel A. Mangi, a professor of cardiac surgery at Yale, who said the practice had become commonplace. “There’s now a whole cadre of people out there who do not have meaningful appointments as attending surgeons, so they do assistant work.” In Mr. Drier’s case, each surgeon billed for each step of the procedure. Dr. Tindel billed $74,000 for removing two disks and an additional $50,000 for placing the hardware that stabilized Mr. Drier’s spine. Dr. Mu billed $67,000 and $50,000 for those tasks. If the surgery had been for a Medicare patient, the assistant would have been permitted to bill only 16 percent of the primary surgeon’s fee. With current Medicare rates, that would have been about $800, less than 1 percent of what Dr. Mu was paid.
dfxm12 2y ago
Our government largely works for the billionaires who make money off this system. This is a problem. Keep this in the back of your mind until the next primary election you can vote in & tell your current representatives that you want a healthcare system that works for you.
xadhominemx 2y ago
“As patient you need to track who is in an out of networK” I just specify my insurance provider/plan in zocdoc and generates a list of doctors who are in network and their calendar of availability. I think this was a bigger hassle 10 years ago, yes.
- cyberax 2y ago
  Oh, a sweet summer child. That's only for the initial GP visits and maybe for simple tests. Once you get into specialized treatment, it's a whole another world. For example, if you are admitted to an in-network hospital, an infectious disease specialist can be out-of-network, and you will have to pay for them.
- Grimm665 2y ago
  I am currently fighting a bill for a yearly physical, which should be covered 100%, because my doctor is in network and covered, but "the facility" (aka his office) is billed as a separate entity. Insanity.
  - xadhominemx 2y ago
    Did you receive your physical at a hospital?
harmmonica 2y ago
A way to understand it is to look at it at a higher level. Republicans, in modern US terms, want to privatize or remove any spending where the government gives things away to people for "free." And sorry to be pedantic, but free's in quotes because what the government gives away for free is of course funded with taxpayer dollars or government-issued debt, both of which almost all Republicans have traditionally been vehemently against (yes, I'm ready for comments about how Republicans don't care about debt as long as it funds their priorities; you're right of course but it's not all Republicans saying that). The belief, and this is very apparent at the moment with all the stories about DOGE and the Trump admin, is that the government wastes money and the private sector can do it better. In cases where there's no return on investment to be had, Republicans would want that "free," government-provided service/product to be cut entirely (again, see recent DOGE actions). Btw, when I say ROI, in the eyes of Republicans, the more nebulous the ROI the more likely they are to say "kill it" because this really is about dollars and cents (with some culture war issues thrown in, but that's a very small part of the larger dollars and cents issue that almost all Republicans care about). And to put a finer point on it, the Republican Party believes a significant percentage of the US population doesn't work hard enough (or at all) and that therefore those people don't deserve to get anything for free (i.e., I don't want to pay taxes or have the government issue debt for the sake of people who haven't earned it). That's why you'll have a hard time arguing that very wealthy people shouldn't take advantage of the government because in the eyes of Republicans those people have, literally, earned whatever they get, including "free" things from the government (this mostly takes the form of pro-business regulations/subsidies). More specific to single-payer health care, if the US offered it, Republicans believe it would take away an incentive for people to work because for working-age people that's how you traditionally get health insurance. To repeat from above, no work = nothing free. That is a feature of the system in the eyes of Republicans, not a bug. For those wanting to understand more, ask ChatGPT/Google/etc. for Republican proposals for how to manage Social Security, Health Care in general, Medicare specifically (see "Medicare Advantage"), Medicaid, food stamps, Social Security Disability, etc.). If you really want to understand it fully read it straight from the Republicans' own websites. Visit the Heritage Foundation, or Americans for Tax Reform). Every one of these topics is discussed in detail. Particularly relevant at the moment given this administration is doing much more to make all of this a reality. Prior Republican admins did some of it as well, of course, but not as aggressively as this one. I say this on a lot of my (mostly long-winded posts--sorry!): I'm attempting to be factual here. If you're reading a politically-biased angle please reply and say so, and if you can tell me which words in particular are triggering you, I'd genuinely like to know because my intent is to communicate the rough facts on the ground. edit: changed one incorrect word
RandomUser4976 2y ago
This! Agreed! I wish more people understood this reality before they shout, “but you have to wait in Canada and the UK… socialism evil”, “higher taxes”, and “no other country has the same freedoms America has”.

josefritzishere 2y ago

[flagged]

tombert 2y ago

insert generic American progressive take about why we should have socialized healthcare here. My wife had an issue with her eye that was giving similar symptoms to macular degeneration [1] in 2016. I had insurance (it might have even been UHC, but I'm not 100% sure), so we went to an ophthalmologist's office, to get it looked at. When we get to the office, we find out that just the copay for this was going to be $550. I was kind of crap at saving money back then, and I had a job that didn't pay great, and I remember I had exactly $578.23 in my bank account at the time, and I still needed to pay my rent. I had to kind of awkwardly tell my wife "sorry, we don't have the money to have your eye looked at and pay our rent", so we leave without her getting any treatment. About 4-5 months later, I got a better job with much better health insurance, so she went to that same ophthalmologist, and our copay was less than $50. The entirety of the work that this ophthalmologist did was refer her to a retinal specialist. This means that I was initially going to have paid more than $500 just to get a god damned referral, and just to re-emphasize this, we had health insurance. I remember how upset and frustrated I was with that entire situation; it felt like I was doing things the "right" way by getting a desk job with health insurance and yet I still couldn't afford to get the treatment that my wife needed. It just felt...unfair? Like what exactly was I supposed to do differently here? It didn't really "change" my perspective on this, I had already been in favor of moving to a universal healthcare system, but this thoroughly solidified my perspective on it. [1] Fortunately, it wasn't that, it was an autoimmune thing. Still not great but better than we initially thought.

KittenInABox 2y ago
I have complicated feelings about universal healthcare... namely that the issue seems to be more-or-less not whether the system is socialized or private but if the healthcare system is provided adequate funding (via government or a private entity) to give acceptable outcomes on a population level. A lot of the detractors to private healthcare is simply that healthcare isn't being administered appropriately (pressure to only see patients for 15 minutes for example or to charge by procedure encouraging specialists where systemic issues go ignored) but so is the case for socialized medicine (waiting too long for specialists, understaffed hospitals).
- 2y ago

bix6 2y ago

Well duh it’s a private for profit corporation. It literally exists to be a money game.

throwway120385 2y ago
The question isn't whether this is obviously a result of the current structure, but rather, is this good for the people of the US to live like this? Should we tolerate people being evicted from nursing home programs because their coverage was wrongfully revoked? And when we have story after story of private insurers doing this kind of thing, do we keep living with it to stay in our capitalist utopia, or do we conceive of something different and collectively pay for that instead of for the private insurance we all hate?
- bix6 2y ago
  We shouldn’t tolerate it so hopefully these pieces can convince citizens to start forcing better alternatives.
  - xadhominemx 2y ago
    UNH makes low operating margins. If they they took those margins to zero, there would not be a noticeable increase in the amount of care they fund.
owisd 2y ago
The deal private for profit corporations make with society is that profit provides an incentive that leads to better outcomes, yet every developed country with a not-for-profit healthcare system has better outcomes.
- bix6 2y ago
  Did UHC explicitly make that deal or are we just expecting them to act in good faith? Healthcare is a quasi public good so I’m not surprised not for profit countries do better.

bastardoperator 2y ago

Americans love to talk about freedom and rights, you don't even have the right to die with dignity in this country. Healthcare in America is just a basic racketeering scam at this point.

napoleongl 2y ago
And how low of a tax they pay compared to SoCiAlIsT countries where the tax also takes care of health related things… It seems deeply ingrained they’d rather pay a 1000 bucks for themselves and not risk helping someone else rather than pay 100 bucks that someone else might also benefit from.
- DontchaKnowit 2y ago
  The problem is our government is so unfuckingbelievably irresponsible with money that increasing taxes wouldn't actually move the needle. And our taxes are not really that low. If 30% income tax is low then idk what the fuck to tell you.

Animats 2y ago

This is a problem with "Medicare Advantage", which is an HMO scheme. The Government pays the HMO a flat fee per patient, and they try to minimize expenses. Don't take that route. For now, "Traditional Medicare" plus a commercial supplement is a far safer deal. However, this may change. See [1], p. 465, which proposes to make "Medicare Advantage" the default. "Medicare Advantage (MA), a system of competing private health plans, is the major alternative to traditional Medicare for America’s large and growing cohort of seniors. The program provides beneficiaries with a wide range of competitive health plan choices—a richer set of benefits than traditional Medicare provides and at a reasonable cost. Equally as important, the MA program has been registering consistently high marks for superior performance in delivering high-quality care. Critical reforms are still needed to strengthen and improve the program for the future. Specifically: 1. Make Medicare Advantage the default enrollment option. ... " [1] https://static.project2025.org/2025_MandateForLeadership_CHAPTER-14.pdf https://static.project2025.org/2025_MandateForLeadership_CHA...

bry4n 2y ago
may i ask if you could explain in more details why medicare advantage is a bad choice to make if a person is already on regular medicare? assume that the person trying to make this decision is stubborn and not informed about the differences. thanks, i appreciate it.
- Animats 2y ago
  Claim denial, pre-authorization problems, delays, and out of network problems, mostly.[1] Medicare Advantage is an HMO. If you can afford a good Medicare supplement (type F if you can get it), and can cover eyeglasses and hearing aids yourself, that's the most comprehensive coverage. But it will cost more. [1] https://www.kiplinger.com/retirement/medicare/medicare-advantage-plans-prior-authorization-denial-rates https://www.kiplinger.com/retirement/medicare/medicare-advan...
  - tzs 2y ago
    Plan G is probably better than plan F for most people now. The only coverage difference between the two is that plan F covers the Medicare part B deductible ($257 this year) and plan G does not. Plan F is not open to new enrollees in less they were eligible for Medicare before 2000-01-01 and so the pool of people with plan F is shrinking and aging. Plan G on the other hand is open to all, and is the most popular choice for new Medicare enrollees with something like 70% of the people who buy a supplement plan choosing it. That gives it a younger and growing pool. Accordingly plan G is generally cheaper than plan F which is usually more than enough to make up for not covering the $257 deductible. G just needs to be at least $21.42 month cheaper than F to come out ahead which is the case in a few sates I looked at.

tejohnso 2y ago

“They were just cutting him off because they could cut him off and reduce their expense,” Robby Martin said in an interview. “It’s all a money game to them.” What else would it be to them? They're not a charity. I don't see why people keep directing their hate toward the corporations for doing what they're intended to do. The hate and effort should be directed toward the politicians who prevent the implementation of changes that people want. Or do the majority of people not want changes that would prevent this kind of thing?

ceejayoz 2y ago
> What else would it be to them? They're not a charity. I mean, they could be a not-for-profit entity. > The hate and effort should be directed toward the politicians who prevent the implementation of changes that people want. Why not both? I can be mad at the companies who are purchasing those politicians, too.
thinkingtoilet 2y ago
No. This is the "just doing my job" defense. If your job is to kill people so you can make a buck, then you are a garbage human and I'm not going to cry if someone hunts you down in the street.
- tejohnso 2y ago
  Well, I think we saw that and yeah, most people weren't crying about it. And yes, the "Just doing my job" (or, just following orders) defense is very powerful. That's why it shouldn't be surprising that this kind of thing happens given the incentives and systems involved.
mandmandam 2y ago
> I don't see why people keep directing their hate toward the corporations... > The hate and effort should be directed toward the politicians who prevent the implementation of changes that people want. Who do you think is hiring the lobbyists to pay off the politicians? Who do you think is paying the media to make sure people don't know that we're actually pretty agreed on this issue? I have enough anger for 'both' political parties, the corporations that buy them, and the media (social and corporate) that runs cover for both. And I'm not remotely apologetic for that; I believe it's the only rational and humane opinion to have about healthcare in the US.

like_any_other 2y ago

I wonder if reporting on this stuff will also be called "stochastic terrorism".

franktankbank 2y ago
stochastic justice maybe

chrisbrandow 2y ago

Side note: Medicare advantage is the worst. If you have an elderly relative, make sure they stay on traditional Medicare.

kstrauser 2y ago
My wife's a doctor who sees a lot of Medicare patients, and she warns all of them about Medicare Advantage. Don't do it.
- bry4n 2y ago
  > My wife's a doctor who sees a lot of Medicare patients, and she warns all of them about Medicare Advantage. > > Don't do it. could you please explain in more detail why a move to medicare advantage from regular medicare is a bad decision? i'm asking because a family member is on regular medicare but is being pressured to move to an advantage plan. i would like some facts to help bolster his decision to stay on regular medicare (since i've also heard MA is a bad idea). thanks in advance.
bry4n 2y ago
> Side note: Medicare advantage is the worst. If you have an elderly relative, make sure they stay on traditional Medicare. could you please explain further? why is MA worse than regular medicare? a family member is being pressured to move from regular medicare to advantage, and i need some facts to help them see why advantage plans are worse than regular medicare. thank you.

thow16161 2y ago

I'm stuck in a Kafkaesque situation w/my insurance company (Anthem). I currently get infusions of a biologic for Crohn's. These are incredibly expensive as well as inconvenient. I'm lucky, in that my insurance company pays for almost all of this. The same drug is now available in the form of a self-administered pen which is far less expensive and more convienient. However, that falls under the purview of CVS Caremark, who Anthem has designated as its pharmacy benefits manager. CVS Caremark is denying the pen, saying I have to try a whole host of other meds which do not work for me first. I talked to Anthem yesterday, and they have no idea how to get this approved. Their best suggestion is that my doctor schedule a call with the CVS doctor to argue with them. My doctor is not motivated to do this, as I'm already getting a treatment that works for me. So I'm stuck wasting hours every few weeks for an infusion that could be replaced by an injection I give myself. And the hilarious part is that the insurance company stands to benefit the most, as they would pay far less. This is the kind of thing that, if we had actual socialized medicine, I might be able to appeal to a government official to fix. But how can you appeal corporate bureaucracy?

ericmcer 2y ago
I don't know if the ease and speed at which government officials fix things is a compelling argument for socialized medicine.
- bfrankline 2y ago
  Yet people love Medicare and Medicaid.
Schiendelman 2y ago
You are probably best off just not fighting it. Keep getting the infusions. Stop worrying about it. Let the insurance company make a decision if they think they can save money.
- inkcapmushroom 2y ago
  How I Learned to Stop Worrying and Love the Injections.

ChrisArchitect 2y ago

Related: Health Insurers Deny 850M Claims a Year. The Few Who Appeal Often Win https://news.ycombinator.com/item?id=43032224 https://news.ycombinator.com/item?id=43032224 UnitedHealth Is Sick of Everyone Complaining About Its Claim Denials https://news.ycombinator.com/item?id=42992121 https://news.ycombinator.com/item?id=42992121

franktankbank 2y ago
In case you weren't already pissed here's some more readings!

svilen_dobrev 2y ago

wasn't the plot in "Man called Ove" about similar "get the money" schema? And that's Sweden..

blufish 2y ago

[flagged]

wetpaws 2y ago
[dead]

nojvek 2y ago

Majority of Americans voted for Trump. Who openly declared he only concepts of a plan, no real plan for healthcare. Who openly said he will side with the billionaires and corporations. His policies are inflationary and gonna add trillions of debt for the next generation. That being said, it's not like Kamala was going to go after making healthcare any cheaper. It's a duopoly that is funded by corporations no matter who we chose. Bernie had some chance but the duopoly didn't like him.