5 ms·

Delay, deny, defend --- this is the insurance industry's modus operandi. Insurance is the only industry where customers are the enemy.

toomuchtodo 1y ago
There seems to be no will to replace this dysfunctional arrangement with a social safety net unfortunately.
- zackmorris 1y ago
  Because injustice is corruption. So every area of our lives that feels like it doesn't work like it used to - cost of living, healthcare, education, antitrust enforcement, journalism, accountability at the highest levels - represents a segment of the economy which has been corrupted. Through this lens, socioeconomic policies start to make sense. For example, if your goal is to skim a fraction of the income from everyone in an economy and redirect those funds to specific goals/organizations/individuals, you could put tariffs on common goods and pass the funds collected on to companies granted large government contracts. Then the largest companies like GM and Ford see their profits reduced or even show a loss, while Grok and Palantir have all the money they need for mass surveillance. Explanations for regulatory capture aren't normally this reductive, but wealth inequality has reached such monumental proportions that the simplest answer tends to be the right one when the needs of the few outweigh the needs of the many.
  - drstewart 1y ago
    So through that lens how do you explain the healthcare situation before the start of tariffs, or is your entire worldview shaped based only on the news you read in the last three days?
    - zackmorris 1y ago
      Sorry for my late reply. I believe that the US healthcare crisis started in 1973 when Nixon signed the HMO Act, which had the effect of tying health insurance to employment: https://en.wikipedia.org/wiki/Health_Maintenance_Organization_Act_of_1973 https://en.wikipedia.org/wiki/Health_Maintenance_Organizatio... The alternative would have been some kind of single-payer option where US tax dollars would fun Medicare and/or Medicaid for all. Here is an explanation I found: https://medicaiddirectors.org/resource/understanding-managed-care/ https://medicaiddirectors.org/resource/understanding-managed... This differs from a public option, which would be a generic insurance offered by the government at a substantial savings over private: https://www.currentaffairs.org/news/2019/07/why-a-public-option-isnt-enough https://www.currentaffairs.org/news/2019/07/why-a-public-opt... A public option likely would be 20-50% less expensive than private due to the 80/20 rule and the fact the European healthcare is about 1/2 the cost of US healthcare, so a current $400/month plan might be $200-320/month: https://www.aeaweb.org/research/regulating-health-insurers-aca-medical-loss-ratio https://www.aeaweb.org/research/regulating-health-insurers-a... https://nashbio.com/blog/healthcare/the-healthcare-divide-privatized-us-vs-public-european-models/ https://nashbio.com/blog/healthcare/the-healthcare-divide-pr... Unfortunately Obamacare (Romneycare) forced everyone to get insurance or face a tax penalty mandate, which was lifted by Trump in the Tax Cuts and Jobs Act of 2017: https://www.ehealthinsurance.com/resources/affordable-care-act/obamacare-tax-penalties https://www.ehealthinsurance.com/resources/affordable-care-a... - Knowing these facts, what's really going on? Two things: * Obamacare did little to address the natural monopoly aspect of healthcare, so costs exploded * Republican concerns about government overreach into our private lives (knowing our info and determining who receives care) and negative impacts on private health industries have not been heard Natural monopolies are things that everyone needs, such as water, sewer, trash, electricity, education, healthcare, etc: https://en.wikipedia.org/wiki/Natural_monopoly https://en.wikipedia.org/wiki/Natural_monopoly Meaning that eventually running a capitalist system results in 1 or 2 companies controlling the entire market and charging whatever they wish, since high cost of entry prevents competition. Without competition, there is no supply and demand curve to counteract price increases. In other words, whoever controls the water can sell it at any price. Or insulin, or Epipens, or Hepatitis C treatments. The only way to bring costs down on a natural monopoly is through regulation. Society chooses which firm(s) will supply the good or service, and how much it will cost. Overages are paid through subsidies, which can be high, but are at least under public review, unlike when private industry controls a market. These are the reasons why healthcare got so expensive. But the meaning behind it, that's more nuanced. The US is very into individual responsibility. Our belief is that a strong citizenry ensures a strong nation. Because we defeated not just fascism in WWII, but the rise of socialism and communism during the Cold War. Our privately funded athletes beat state-funded athletes in the Olympics. Our private industry runs more efficiently than (for example) national construction projects in Russia and China which built cities that nobody lives in. We have our own pork barrel projects, but they tend to be limited by public scrutiny, unlike in communist nations. The US is also very into privacy. We have medical privacy laws like HIPAA which may not exist with state-funded medical care. Now, this is a half-truth, because Europe has arguably the same or better privacy than we do. Because there is little incentive to sell medical information there, unlike here. What it really comes down to is that people who are used to paying through the nose for US health insurance after a lifetime of hard work aren't ready to see others receive it for free through the government. They don't want someone determining how long they have to wait for care, or if they receive it at all. They perceive government red tape as making health providers even more expensive or putting them out of business. As in, why would doctors go to medical school merely to be paid little more than teachers and other public servants? Yes, privacy may be impacted with single-payer. But in the US, the answer is usually about $$$. Sadly, this debate has resulted in the lose-lose we see today: rising costs with no backstop, and threatened privacy due to regulatory capture by health companies which have misaligned incentives and are too big to fail. - My solution to this political impasse would be a gradual transition to single-payer healthcare (probably Medicare for All) on an opt-in basis, either at the state or individual level. Knowing that taxpayers who opt in may pay a higher rate for a time to supplement those on private insurance. Until enough people are in the single-payer system that it becomes self-evidently better and the majority switch to it. Similar to private school vouchers, except going the other direction: public healthcare vouchers. People could still buy private insurance to supplement Medicare for All and go to the front of the line. I don't like it, because I believe that healthcare is a human right that shouldn't depend on money, but this is America. If someone has the money to pay doctors overtime, then it probably makes little economic sense to stop them. Medical research should go back to the previous university/publicly funded model. So grants would be available for companies pursuing billion dollar cures for cancer and other diseases which diminish quality of life or its duration. Then medications would be sold at close to wholesale price. This eliminates the current problems where pharmaceutical companies sell treatments instead of cures, that tend to start out very expensive. - Sorry this got so long. I believe that you'd receive a similar summary from an LLM, and that without this context, a debate would fall into dogmatic attacks that lead nowhere. Edit: fixed small typos.
- TuringNYC 1y ago
  >> There seems to be no will to replace this dysfunctional arrangement with a social safety net unfortunately. I think one problem is that healthcare in many cases is meant to tackle the 1.5-2 sigma problems -- so naturally few people really encounter bad healthcare. The others thing they have good healthcare, until they are unlucky enough to encounter an issue. I'm shocked how many people on my exact same health plan at work think it is a great plan.
wwweston 1y ago
The crucial understanding is that incentives are cross aligned because the product is risk coverage. The more immediate/pressing your need for risk coverage, the worse it is for them to sell it to you. The less you need it, the better it is for them to sell it to you and the worse for you to buy it. Pretty different than ice cream or cars or housing. Too many people just think “oh corporate greed” without thinking about the underlying economics (partly because of how us culture pretends markets are magic).
- pyuser583 1y ago
  This is why state's have insurance commissions. In the past, insurance companies (think: liability, fire, life, shipping) responded to a claim by hiring a lawyer and negotiating down. Like most contracts. So states began creating insurance commissions, which serve as law firms that defend consumers from insurance companies. In practice, their existence forces insurance companies to pay what they are owed. We need insurance commissions for health insurance. If there is a reason why the policy shouldn't pay (services received after policy expired, for example), the insurance commission has to sign off. This is how normal insurance works. Health insurance, of course, is not normal insurance.
  - lazyasciiart 1y ago
    LTC insurance is covered by insurance commissions.
  - mjevans 1y ago
    We need to just nationalize these things as basic civic infrastructure that everyone funds as part of the social contract.
    - pyuser583 1y ago
      My immediate worry is that insurance usually focuses on fixing private harm, not public harm. If my house burns down, there's both public harm and private harm. The public harm is the danger to bystanders, the loss of neighboring real estate values, etc. The private harm is the fact that I lost most of my equity and have to declare bankruptcy to get out of my mortgage. Insurance is focused around preventing private harm. So the state is now on it's own in preventing public harm (already the case), but also now liable to remedy the private harm too. I personally know many millionaires who lost their mansions in the LA fire. I'm glad tax payers aren't paying to rebuild their $20 million dollar houses. That's an extreme example, but insurance benefits those who have something to lose the most. Let's keep government insurance focused on things that private industry refuses to insure, like unemployment and health insurance for sick people.
Workaccount2 1y ago
People need to stop looking at it like this. Healthcare is a triangle. There are three players. You, Insurance, and Doctor. All three are adversaries and allies in different ways.
- Synthetic7346 1y ago
  In reality the triangle is Doctors, Insurance, Hospitals, and you in the middle.
  - frankharv 1y ago
    In reality what the article says is they needed adult-sitters. Family at first but USE PROFESSIONALS. Due to scummy ins company wanting docs. How is that health care? Babysitting is now health care??? We need a better way to deal with dementia. Not health care. A literal babysitter to make sure they eat and don't run into the street. I don't see dementia as sickness. Brain illness maybe. So we have to warehouse these feeble folk. That is the problem. We need a more humane way rather than Doctor K's method.. What about the poor old guys girlfriend?
SoftTalker 1y ago
I wrote a longer response but deleted it as it was just a personal anecdote. Suffice it to say I'll never buy LTC insurance or participate in any elder care such as "assisted living" or "nursing care." It's all (IMO) engineered to drain old people of their assets before they die. Providing care is nowhere on the list of motivations of anyone involved.
- thepryz 1y ago
  I could not agree more. My father has a neurodegenerative disorder that requires 24 hour care. He did tons of research and purchased LTC insurance decades before he was diagnosed. Experiencing first hand how difficult and predatory both the insurance company and the care facilities are has made it so I will never put my own children through it. My plan is to just euthanize myself when the time comes.
  - ta555555 1y ago
    [flagged]
    - seneca 1y ago
      [flagged]
      - rimbo789 1y ago
        [flagged]
- tiahura 1y ago
  I disagree. Getting a $3800/mo payment for up to 3 years sure was nice when I had to put mom in a $4000/mo assisted living facility. There’s a reason companies got away from offering these policies, they were losing money on them.
  - SoftTalker 1y ago
    In my case they never paid. According to the lawyers I had involved, this isn't uncommon.
SilverElfin 1y ago
I’ve heard from many recent moms that Aetna regularly denies normal labor and delivery charges that are explicitly covered in their plans. That then forces you through a months long process of calling them repeatedly, tolerating hold times of 1-2 hours each time, and getting virtually no help. And maybe at the end of it, when your child is almost one year old, they may pay out. That’s for a normal delivery with no complications. Aetna knows exhausted and stressed moms are less likely to persist. It is blatantly fraudulent but they get away with it because no one has the time or money to get their executives thrown in jail.
ta555555 1y ago
The alternative is to depose them. It's a massive shame how he is treated right now. Right after the deposition of one mass murderer CEO, another would-be mass murderer insurer backtracked their plans to limit time under anesthesia. Deposition works. Even those who believe human lives are equal (they are not) have to admit the price of one dead (bad) person outweighs the number of people who would have died or had serious complications from rushed procedures.

toomuchtodo 1y ago

There seems to be no will to replace this dysfunctional arrangement with a social safety net unfortunately.

zackmorris 1y ago
Because injustice is corruption. So every area of our lives that feels like it doesn't work like it used to - cost of living, healthcare, education, antitrust enforcement, journalism, accountability at the highest levels - represents a segment of the economy which has been corrupted. Through this lens, socioeconomic policies start to make sense. For example, if your goal is to skim a fraction of the income from everyone in an economy and redirect those funds to specific goals/organizations/individuals, you could put tariffs on common goods and pass the funds collected on to companies granted large government contracts. Then the largest companies like GM and Ford see their profits reduced or even show a loss, while Grok and Palantir have all the money they need for mass surveillance. Explanations for regulatory capture aren't normally this reductive, but wealth inequality has reached such monumental proportions that the simplest answer tends to be the right one when the needs of the few outweigh the needs of the many.
- drstewart 1y ago
  So through that lens how do you explain the healthcare situation before the start of tariffs, or is your entire worldview shaped based only on the news you read in the last three days?
  - zackmorris 1y ago
    Sorry for my late reply. I believe that the US healthcare crisis started in 1973 when Nixon signed the HMO Act, which had the effect of tying health insurance to employment: https://en.wikipedia.org/wiki/Health_Maintenance_Organization_Act_of_1973 https://en.wikipedia.org/wiki/Health_Maintenance_Organizatio... The alternative would have been some kind of single-payer option where US tax dollars would fun Medicare and/or Medicaid for all. Here is an explanation I found: https://medicaiddirectors.org/resource/understanding-managed-care/ https://medicaiddirectors.org/resource/understanding-managed... This differs from a public option, which would be a generic insurance offered by the government at a substantial savings over private: https://www.currentaffairs.org/news/2019/07/why-a-public-option-isnt-enough https://www.currentaffairs.org/news/2019/07/why-a-public-opt... A public option likely would be 20-50% less expensive than private due to the 80/20 rule and the fact the European healthcare is about 1/2 the cost of US healthcare, so a current $400/month plan might be $200-320/month: https://www.aeaweb.org/research/regulating-health-insurers-aca-medical-loss-ratio https://www.aeaweb.org/research/regulating-health-insurers-a... https://nashbio.com/blog/healthcare/the-healthcare-divide-privatized-us-vs-public-european-models/ https://nashbio.com/blog/healthcare/the-healthcare-divide-pr... Unfortunately Obamacare (Romneycare) forced everyone to get insurance or face a tax penalty mandate, which was lifted by Trump in the Tax Cuts and Jobs Act of 2017: https://www.ehealthinsurance.com/resources/affordable-care-act/obamacare-tax-penalties https://www.ehealthinsurance.com/resources/affordable-care-a... - Knowing these facts, what's really going on? Two things: * Obamacare did little to address the natural monopoly aspect of healthcare, so costs exploded * Republican concerns about government overreach into our private lives (knowing our info and determining who receives care) and negative impacts on private health industries have not been heard Natural monopolies are things that everyone needs, such as water, sewer, trash, electricity, education, healthcare, etc: https://en.wikipedia.org/wiki/Natural_monopoly https://en.wikipedia.org/wiki/Natural_monopoly Meaning that eventually running a capitalist system results in 1 or 2 companies controlling the entire market and charging whatever they wish, since high cost of entry prevents competition. Without competition, there is no supply and demand curve to counteract price increases. In other words, whoever controls the water can sell it at any price. Or insulin, or Epipens, or Hepatitis C treatments. The only way to bring costs down on a natural monopoly is through regulation. Society chooses which firm(s) will supply the good or service, and how much it will cost. Overages are paid through subsidies, which can be high, but are at least under public review, unlike when private industry controls a market. These are the reasons why healthcare got so expensive. But the meaning behind it, that's more nuanced. The US is very into individual responsibility. Our belief is that a strong citizenry ensures a strong nation. Because we defeated not just fascism in WWII, but the rise of socialism and communism during the Cold War. Our privately funded athletes beat state-funded athletes in the Olympics. Our private industry runs more efficiently than (for example) national construction projects in Russia and China which built cities that nobody lives in. We have our own pork barrel projects, but they tend to be limited by public scrutiny, unlike in communist nations. The US is also very into privacy. We have medical privacy laws like HIPAA which may not exist with state-funded medical care. Now, this is a half-truth, because Europe has arguably the same or better privacy than we do. Because there is little incentive to sell medical information there, unlike here. What it really comes down to is that people who are used to paying through the nose for US health insurance after a lifetime of hard work aren't ready to see others receive it for free through the government. They don't want someone determining how long they have to wait for care, or if they receive it at all. They perceive government red tape as making health providers even more expensive or putting them out of business. As in, why would doctors go to medical school merely to be paid little more than teachers and other public servants? Yes, privacy may be impacted with single-payer. But in the US, the answer is usually about $$$. Sadly, this debate has resulted in the lose-lose we see today: rising costs with no backstop, and threatened privacy due to regulatory capture by health companies which have misaligned incentives and are too big to fail. - My solution to this political impasse would be a gradual transition to single-payer healthcare (probably Medicare for All) on an opt-in basis, either at the state or individual level. Knowing that taxpayers who opt in may pay a higher rate for a time to supplement those on private insurance. Until enough people are in the single-payer system that it becomes self-evidently better and the majority switch to it. Similar to private school vouchers, except going the other direction: public healthcare vouchers. People could still buy private insurance to supplement Medicare for All and go to the front of the line. I don't like it, because I believe that healthcare is a human right that shouldn't depend on money, but this is America. If someone has the money to pay doctors overtime, then it probably makes little economic sense to stop them. Medical research should go back to the previous university/publicly funded model. So grants would be available for companies pursuing billion dollar cures for cancer and other diseases which diminish quality of life or its duration. Then medications would be sold at close to wholesale price. This eliminates the current problems where pharmaceutical companies sell treatments instead of cures, that tend to start out very expensive. - Sorry this got so long. I believe that you'd receive a similar summary from an LLM, and that without this context, a debate would fall into dogmatic attacks that lead nowhere. Edit: fixed small typos.
TuringNYC 1y ago
>> There seems to be no will to replace this dysfunctional arrangement with a social safety net unfortunately. I think one problem is that healthcare in many cases is meant to tackle the 1.5-2 sigma problems -- so naturally few people really encounter bad healthcare. The others thing they have good healthcare, until they are unlucky enough to encounter an issue. I'm shocked how many people on my exact same health plan at work think it is a great plan.

wwweston 1y ago

The crucial understanding is that incentives are cross aligned because the product is risk coverage. The more immediate/pressing your need for risk coverage, the worse it is for them to sell it to you. The less you need it, the better it is for them to sell it to you and the worse for you to buy it. Pretty different than ice cream or cars or housing. Too many people just think “oh corporate greed” without thinking about the underlying economics (partly because of how us culture pretends markets are magic).

pyuser583 1y ago
This is why state's have insurance commissions. In the past, insurance companies (think: liability, fire, life, shipping) responded to a claim by hiring a lawyer and negotiating down. Like most contracts. So states began creating insurance commissions, which serve as law firms that defend consumers from insurance companies. In practice, their existence forces insurance companies to pay what they are owed. We need insurance commissions for health insurance. If there is a reason why the policy shouldn't pay (services received after policy expired, for example), the insurance commission has to sign off. This is how normal insurance works. Health insurance, of course, is not normal insurance.
- lazyasciiart 1y ago
  LTC insurance is covered by insurance commissions.
- mjevans 1y ago
  We need to just nationalize these things as basic civic infrastructure that everyone funds as part of the social contract.
  - pyuser583 1y ago
    My immediate worry is that insurance usually focuses on fixing private harm, not public harm. If my house burns down, there's both public harm and private harm. The public harm is the danger to bystanders, the loss of neighboring real estate values, etc. The private harm is the fact that I lost most of my equity and have to declare bankruptcy to get out of my mortgage. Insurance is focused around preventing private harm. So the state is now on it's own in preventing public harm (already the case), but also now liable to remedy the private harm too. I personally know many millionaires who lost their mansions in the LA fire. I'm glad tax payers aren't paying to rebuild their $20 million dollar houses. That's an extreme example, but insurance benefits those who have something to lose the most. Let's keep government insurance focused on things that private industry refuses to insure, like unemployment and health insurance for sick people.

Workaccount2 1y ago

People need to stop looking at it like this. Healthcare is a triangle. There are three players. You, Insurance, and Doctor. All three are adversaries and allies in different ways.

Synthetic7346 1y ago
In reality the triangle is Doctors, Insurance, Hospitals, and you in the middle.
- frankharv 1y ago
  In reality what the article says is they needed adult-sitters. Family at first but USE PROFESSIONALS. Due to scummy ins company wanting docs. How is that health care? Babysitting is now health care??? We need a better way to deal with dementia. Not health care. A literal babysitter to make sure they eat and don't run into the street. I don't see dementia as sickness. Brain illness maybe. So we have to warehouse these feeble folk. That is the problem. We need a more humane way rather than Doctor K's method.. What about the poor old guys girlfriend?

SoftTalker 1y ago

I wrote a longer response but deleted it as it was just a personal anecdote. Suffice it to say I'll never buy LTC insurance or participate in any elder care such as "assisted living" or "nursing care." It's all (IMO) engineered to drain old people of their assets before they die. Providing care is nowhere on the list of motivations of anyone involved.

thepryz 1y ago
I could not agree more. My father has a neurodegenerative disorder that requires 24 hour care. He did tons of research and purchased LTC insurance decades before he was diagnosed. Experiencing first hand how difficult and predatory both the insurance company and the care facilities are has made it so I will never put my own children through it. My plan is to just euthanize myself when the time comes.
- ta555555 1y ago
  [flagged]
  - seneca 1y ago
    [flagged]
    - rimbo789 1y ago
      [flagged]
tiahura 1y ago
I disagree. Getting a $3800/mo payment for up to 3 years sure was nice when I had to put mom in a $4000/mo assisted living facility. There’s a reason companies got away from offering these policies, they were losing money on them.
- SoftTalker 1y ago
  In my case they never paid. According to the lawyers I had involved, this isn't uncommon.

SilverElfin 1y ago

I’ve heard from many recent moms that Aetna regularly denies normal labor and delivery charges that are explicitly covered in their plans. That then forces you through a months long process of calling them repeatedly, tolerating hold times of 1-2 hours each time, and getting virtually no help. And maybe at the end of it, when your child is almost one year old, they may pay out. That’s for a normal delivery with no complications. Aetna knows exhausted and stressed moms are less likely to persist. It is blatantly fraudulent but they get away with it because no one has the time or money to get their executives thrown in jail.

ta555555 1y ago

The alternative is to depose them. It's a massive shame how he is treated right now. Right after the deposition of one mass murderer CEO, another would-be mass murderer insurer backtracked their plans to limit time under anesthesia. Deposition works. Even those who believe human lives are equal (they are not) have to admit the price of one dead (bad) person outweighs the number of people who would have died or had serious complications from rushed procedures.