5 ms·

All the time. I have a UnitedHealthcare “platinum” plan, and it may as well not include pharmacy benefits because it never covers anything. Generic thyroid meds

All the time. I have a UnitedHealthcare “platinum” plan, and it may as well not include pharmacy benefits because it never covers anything. Generic thyroid meds went from $2/month with Aetna to $70 with UHC. ADHD meds went from $10 to $300. The threatened “death panels” we heard about when ACA was being debated are actually employees of insurers who decide what they’re not going to pay for. I was raised a die-hard capitalist and in many ways still am. When it comes to healthcare these days, I’m somewhere to the left of Marx. What we have now is a failed system. It simply does not work. The turnip has been squeezed and there’s no blood left to wring from it.

azemetre 1y ago
These are completely human systems that can be changed any time for any reasons. The current system is achieving exactly what it was designed for: wealth extraction. There’s no reason why this system has to exist. We can make it better any time we want.
- kstrauser 1y ago
  There’s a huge reason it continues to exist: exorbitant lobbying from the people profiting from the death panels. Almost everyone supports Medicare, but too many have been convinced that Medicare for all is some kind of nefarious communist plot.
- mrcommentwriter 1y ago
  First they sell you the problem, then they sell you the solution. There is no emphasis on long term planning or prevention. Everyone is grabbing with both hands.
arwhatever 1y ago
1. A properly competitive marketplace 2. Socialized medicine 3. What we have now I would like to see #1 tried but at this point I’ll gladly accept #2
- mattnewton 1y ago
  I just don't think #1 is possible, how can you have a functioning marketplace for a good when the demand is hard to forecast for an individual, almost completely inelastic and often extremely time sensitive. I'd say the US really tried and the incentives just aren't there for a stable system.
  - arwhatever 1y ago
    When did the U.S. really try?
    - mattnewton 1y ago
      Isn’t this just a no true Scotsman? The US claims at least to have built a free market solution, and if nobody else has been able to make it work at scale, why isn’t that enough.
      - eviks 1y ago
        > why isn’t that enough. Because why would you ever only rely on some vague "US claims" instead of looking at reality?
      - arwhatever 1y ago
        I don’t think so, although that seems like a fair question of you to ask. I’ve tried on numerous occasions to get pricing quotes for healthcare both paying fully out of pocket, and for getting an estimate for what I’ll be left covering after insurance negotiates ads pays their part. In every attempt I get absolutely nowhere price estimate-wise and wind get this or that procedure done just hoping and praying that the ultimate bill will be remotely reasonable We’re so far off the mark for having a healthy marketplace for healthcare pricing that I just can’t see considering it dysfunctional to itself be an appeal to some purity. Perhaps one might argue that a formerly functional healthcare pricing system will inevitably degenerate into this robber Baron situation that we’ve got currently, but otherwise I don’t see the no true Scotsman.
      - 1y ago
lotsofpulp 1y ago
> The threatened “death panels” we heard about when ACA was being debated are actually employees of insurers who decide what they’re not going to pay for. The employees of the managed care organization are often just using the criteria of the payer (often times the federal or state government for Medicaid/Medicare/federal employee or other large self funded plans). The US government leaders are in a good spot. They get the managed care organizations (MCOs) to take the heat for denying coverage, while setting the rules to deny the coverage. MCOs even get audited and fined for approvals that don’t meet criteria. In any case, all systems with limited resources will have to have someone approving or denying payments, whether it be a government employee or someone contracted out by the government. But the most salient metric here is all the MCOs earn only 2% to 3% profit margins. And their market caps are tiny, and returns abysmal. (Except UNH, but that is due to its significant provider and software business). Blame MCO employees all you want, but you will be doing exactly what government leaders want you to do.
deleted 1y ago
[deleted]
georgemcbay 1y ago
Healthcare, when you actually need it, is an inelastic demand very often combined with an inelastic supply (or more exactly, an inelastic supply of suppliers) due to IP laws and the realities of specialization. It is not at all surprising that capitalism fails miserably here, IMO.
SpicyLemonZest 1y ago
> The threatened “death panels” we heard about when ACA was being debated are actually employees of insurers who decide what they’re not going to pay for. The key insight, though, is that this is fundamentally unavoidable. Someone, somewhere has to decide how a limited healthcare budget will be allocated among all the various healthcare it could go towards. You and I agree that it would be best to have a system where this is never the patient's problem. Someone determines a standard of care that will achieve the best patient results with the resources available, and then any patient can get whatever treatment's best for them within that framework. That's why I have and recommend Kaiser, they do a good job of presenting that abstraction. Other people are terrified of the idea of having the standard of care determined by some centralized committee, because what if they decide a treatment that my doctor and I like isn't appropriate? I think the fear is wrong, to be clear, but it's genuine and does deserve to be addressed. Thus all the promises about "if you like your plan you can keep your plan". (A third group of people believe that healthcare is only limited because of shenanigans, and with the appropriate reforms we could build a system where anyone is entitled to any treatment that might reasonably help them. I'm never quite sure what to tell them, since I don't think that's true but I don't know how to prove it beyond the lack of examples.)
- kstrauser 1y ago
  For context, I’ve co-owned a medical practice for about 25 years, and spent the previous decade working for a healthcare startup that processed insurance claims to do data science. The system is broken. It’s useless to extrapolate how things might work based on their current functionality. It doesn’t have to be like this. Everywhere else in the world manages it better than we do, and we’re not special snowflakes who require some hellish mashup out of Cyberpunk 2077 to take our kids to the doctor.
  - notmyjob 1y ago
    “Everywhere else in the world manages it better than we do” If that were true, why do people come to get health care in the US? (Because we have better healthcare and it’s free if you don’t have money or aren’t a citizen.)

azemetre 1y ago

These are completely human systems that can be changed any time for any reasons. The current system is achieving exactly what it was designed for: wealth extraction. There’s no reason why this system has to exist. We can make it better any time we want.

kstrauser 1y ago
There’s a huge reason it continues to exist: exorbitant lobbying from the people profiting from the death panels. Almost everyone supports Medicare, but too many have been convinced that Medicare for all is some kind of nefarious communist plot.
mrcommentwriter 1y ago
First they sell you the problem, then they sell you the solution. There is no emphasis on long term planning or prevention. Everyone is grabbing with both hands.

arwhatever 1y ago

1. A properly competitive marketplace 2. Socialized medicine 3. What we have now I would like to see #1 tried but at this point I’ll gladly accept #2

mattnewton 1y ago
I just don't think #1 is possible, how can you have a functioning marketplace for a good when the demand is hard to forecast for an individual, almost completely inelastic and often extremely time sensitive. I'd say the US really tried and the incentives just aren't there for a stable system.
- arwhatever 1y ago
  When did the U.S. really try?
  - mattnewton 1y ago
    Isn’t this just a no true Scotsman? The US claims at least to have built a free market solution, and if nobody else has been able to make it work at scale, why isn’t that enough.
    - eviks 1y ago
      > why isn’t that enough. Because why would you ever only rely on some vague "US claims" instead of looking at reality?
    - arwhatever 1y ago
      I don’t think so, although that seems like a fair question of you to ask. I’ve tried on numerous occasions to get pricing quotes for healthcare both paying fully out of pocket, and for getting an estimate for what I’ll be left covering after insurance negotiates ads pays their part. In every attempt I get absolutely nowhere price estimate-wise and wind get this or that procedure done just hoping and praying that the ultimate bill will be remotely reasonable We’re so far off the mark for having a healthy marketplace for healthcare pricing that I just can’t see considering it dysfunctional to itself be an appeal to some purity. Perhaps one might argue that a formerly functional healthcare pricing system will inevitably degenerate into this robber Baron situation that we’ve got currently, but otherwise I don’t see the no true Scotsman.
    - 1y ago

lotsofpulp 1y ago

> The threatened “death panels” we heard about when ACA was being debated are actually employees of insurers who decide what they’re not going to pay for. The employees of the managed care organization are often just using the criteria of the payer (often times the federal or state government for Medicaid/Medicare/federal employee or other large self funded plans). The US government leaders are in a good spot. They get the managed care organizations (MCOs) to take the heat for denying coverage, while setting the rules to deny the coverage. MCOs even get audited and fined for approvals that don’t meet criteria. In any case, all systems with limited resources will have to have someone approving or denying payments, whether it be a government employee or someone contracted out by the government. But the most salient metric here is all the MCOs earn only 2% to 3% profit margins. And their market caps are tiny, and returns abysmal. (Except UNH, but that is due to its significant provider and software business). Blame MCO employees all you want, but you will be doing exactly what government leaders want you to do.

deleted 1y ago

[deleted]

georgemcbay 1y ago

Healthcare, when you actually need it, is an inelastic demand very often combined with an inelastic supply (or more exactly, an inelastic supply of suppliers) due to IP laws and the realities of specialization. It is not at all surprising that capitalism fails miserably here, IMO.

SpicyLemonZest 1y ago

> The threatened “death panels” we heard about when ACA was being debated are actually employees of insurers who decide what they’re not going to pay for. The key insight, though, is that this is fundamentally unavoidable. Someone, somewhere has to decide how a limited healthcare budget will be allocated among all the various healthcare it could go towards. You and I agree that it would be best to have a system where this is never the patient's problem. Someone determines a standard of care that will achieve the best patient results with the resources available, and then any patient can get whatever treatment's best for them within that framework. That's why I have and recommend Kaiser, they do a good job of presenting that abstraction. Other people are terrified of the idea of having the standard of care determined by some centralized committee, because what if they decide a treatment that my doctor and I like isn't appropriate? I think the fear is wrong, to be clear, but it's genuine and does deserve to be addressed. Thus all the promises about "if you like your plan you can keep your plan". (A third group of people believe that healthcare is only limited because of shenanigans, and with the appropriate reforms we could build a system where anyone is entitled to any treatment that might reasonably help them. I'm never quite sure what to tell them, since I don't think that's true but I don't know how to prove it beyond the lack of examples.)

kstrauser 1y ago
For context, I’ve co-owned a medical practice for about 25 years, and spent the previous decade working for a healthcare startup that processed insurance claims to do data science. The system is broken. It’s useless to extrapolate how things might work based on their current functionality. It doesn’t have to be like this. Everywhere else in the world manages it better than we do, and we’re not special snowflakes who require some hellish mashup out of Cyberpunk 2077 to take our kids to the doctor.
- notmyjob 1y ago
  “Everywhere else in the world manages it better than we do” If that were true, why do people come to get health care in the US? (Because we have better healthcare and it’s free if you don’t have money or aren’t a citizen.)