5 ms·

There are a lot of people making a lot of money on the inefficiencies of the US system. They won’t give up their revenue streams without a fight, and they are f

• patcon 2mo ago
  Aside from war, there is likely no other place where one class "winning" means so certainly that countless others are dying.
• joering2 2mo ago
  this is a great example. What a horrible human... https://www.miamiherald.com/news/politics-government/article288431251.html https://www.miamiherald.com/news/politics-government/article...
  • Detrytus 2mo ago
    This is a top-level example but you do not have to look at the top, really. The whole private insurance system is a scam at every level. I mean: I immigrated to US couple years ago, and I can tell you that any hospital visit, or a diagnostics, such as CT scan or ultrasound are 15-20x more expensive here than in my home country (which is in the EU). Funny thing is: if you tell the hospital that you do not have an insurance they will charge you a price that actually sounds reasonable, say $700 for a CT scan (which is still like 2x more than in my home country, but then the US is a high cost of living place), but if you do have insurance they will try to extort as much money as possible from your insurer: initial bill will be like $10k, and then they will settle for, say, $6k.
    • opo 2mo ago
      >...Funny thing is: if you tell the hospital that you do not have an insurance they will charge you a price that actually sounds reasonable, say $700 for a CT scan That has not been my experience. Insurance negotiates lower rates and without insurance, the full fare price suggested price has always been higher.
      • anjel 2mo ago
        Providers are contractually forbidden by insurers to show you the much lower "out of pocket+ price schule if you have insurance. It's why the first question posed to new patients is always " do you have insurance?"
    • bentt 2mo ago
      This is true and I have seen it in many cases.
    • jasonfarnon 2mo ago
      I'm clueless about healthcare economics, but this sounds fishy to me. Why would insurers go along with that? In fact I would expect insurers to be in a much better position to bargain with a hospital than a private party. Actually it's if the hospital were billing the govt (not as motivated as a private party) where I would expect that overcharging to creep up and up.
      • ThunderSizzle 2mo ago
        Insurers can only spend 15% of premiums on admin spend (e.g. salaries, etc). That means if the CEO (and everyone else) wants more money, they need to pay more money to the hospitals, so their 15% cut grows. Also, for beyond that, unspend premiums have to be refunded, which also cuts into the potential admin spend bucket, so it's best to always ensure your paying as much as possible in claims. Plus, patients hate denied claims, because typically your forced to sign paperwork saying your responsible for anything insurance refuses to pay. And with most health insurance spending being locked to employer benefits, the big market is the group market, which means your stuck with either getting your job's option(s), finding a new job, or not getting insurance basically. In other words, you don't have a price choice as an individual in a group.
        • ahartmetz 2mo ago
          >typically your forced to sign paperwork saying your responsible for anything insurance refuses to pay Now that is some sick shit. Making every doctor's visit a gamble you might lose, discouraging people from seeing a doctor.
          • ThunderSizzle 2mo ago
            It's even worse when they claim to be "in-network" and they make you sign that. To me, the entire point of being in network is I shouldn't have to worry about the provider filing claims correctly on my behalf, and if there is an issue, it should be on the "network" side, not my side.
        • virgildotcodes 2mo ago
    • goodmythical 2mo ago
      >The whole private insurance system is a scam at every level. All for profit insurance must by definition bring in more than it pays out. From cars to homes to health to pets. If instead of paying all your premiums, you'd be far more likely to be able to afford the services that the insurers are supposedly paying for. Like, yeah, there's a chance you need a new engine, and a small chance that all of your monthly car insurance totals up to less than the cost of the engine, but the entire point of the company is that they know that it is far more likely that you will end up paying more for their service than you'd have actually payed for turns out the only thing that ever went wrong was a small crack in your windshield.
      • hibikir 2mo ago
        On car insurance, you have a competitive market with actuaries trying to identify actual risks, and that, with their prices, modify bad behavior and purchases of cars that are expensive to repair. So all in all, you can end up with very narrow margins, and end up ahead only on the float between receiving premiums and paying out. Health insurance, especially how it works in the US, with no public system williyto cover all the expensive stuff for catastrophic situations and chronic conditions, would compete by trying to fail to insure risky people. But since most insurance is handled by employers, all the levers for that fail too, so it's an especially bad insurance system. Home insurance, car insurance, normal life insurance... all more competitive and more beneficial economically, as their efforts lower costs overall.
        • charcircuit 2mo ago
          >fail to insure risky people Why can't they just charge higher rates to more risky people. If you are a risky driver you pay more, and if you have a risky body you should also pay more.
      • demibabs 2mo ago
        > All for profit insurance must by definition bring in more than it pays out. From cars to homes to health to pets. Well yes, but you are paying for reduced variance, which itself has a value.
  • arh5451 2mo ago
    This is largely misunderstood. At the time the government went after many hospitals for what it perceived as "fraud" in a politically driven campaign. The hospital group he led was the largest at the time and targeted as such. While there are/were bad actors in the system is extremely complicated so try not to generalize. https://pmc.ncbi.nlm.nih.gov/articles/PMC1115078/ https://pmc.ncbi.nlm.nih.gov/articles/PMC1115078/
• danlitt 2mo ago
  They are already playing as dirty as possible.
  • margalabargala 2mo ago
    I assure you that is not true.
• jasonhong 2mo ago
  I saw Jim Clark (of SGI and Netscape fame) talk one time about his new healthcare startup (Healtheon). He said something insightful that captures a lot of why it's hard to get things done in general: one person's inefficiency is someone else's bottom line.
  • hibikir 2mo ago
    The flip side of Bezos' "your margin is my opportunity". But that's for competitive markets, not for heavily regulated multi-party setups with minimal competition. That's the real wonder of American healthcare, as it manages to neither be a good market, nor to have regulator mercilessly going after the largest profit centers. Near the worst of both worlds.
  • root_axis 2mo ago
    And someone else's bottom line is also the wages of friends and neighbors. Last I heard healthcare is like the only employment sector that's seeing real growth right now.
    • rswail 2mo ago
      Actual healthcare delivery is a growing field because boomers are getting old and dying and advances in health care mean that people that would otherwise die (eg people with cancers) are now receiving treatments that keep them alive. Note that this is a Good Thing. The issue with US (and privatized) healthcare delivery is that there is an incentive (by insurers) to deny treatment, as well as an incentive for healthcare suppliers (hospitals, doctors) to over-deliver treatment, as well as incentives to use more expensive solutions. Demand in healthcare is inelastic, no one is ever "too healthy". Supply is always insufficient, so there needs to be a mechanism to resolve that. In the US, that mechanism is money, or the cost of insurance etc to provide a restriction on demand. In universal healthcare, that mechanism is a combination of subsidizing medications based on results and waiting lists for limited supplies, prioritized by need (eg surgeries).
      • ggm 2mo ago
• frmersdog 2mo ago
  If someone shoots some more CEOs, they'll have a change of heart. (A lot of people are going to be very mad at me about this comment, without having the awareness to understand that this is the inevitable conclusion to, "You wanna play rough, ah?!"ing people's access to life-saving treatment. Please grok that we can preclude any more assassinations by cutting profits and letting people get the care they need.)
  • bentt 2mo ago
    If it were only the CEOs that were at fault you might have a point. Hundreds of thousands if not millions of Americans benefit from this system and the leaders are accountable to them - the shareholders, employees, and on down the chain. Congress is our only hope, along with a president who signs reform.
    • root_axis 2mo ago
      The people are in charge of congress, and they consistently show they do not support socialized healthcare systems. It will never be a politically viable path for the u.s, regardless of the economics. Even if it somehow passed, opposition would quickly sabotage and dismantle it. Obama had a generational mandate and couldn't even pass a public option which, is far more moderate than a single payer approach. Even the abomination of the ACA that actually got signed into law was subsequently gutted to the bone in the following years. There is room for more tweaking, but the system we're living with now is pretty close to what most voters prefer.
  • mft_ 2mo ago
    You’re right. Two related observations: 1) In the immediate aftermath of Thompson being shot, policies were deliberately briefly softened. Anecdotally, people were helped to live longer by this. It didn’t last long. 2) The response to Thompson’s assassination was the closest I’ve seen to a class consciousness almost forming in the US, as people from across the political divide who had suffered at the hands of the healthcare insurance companies found common ground.
  • nijave 2mo ago
• 6LLvveMx2koXfwn 2mo ago
  We're also at the point that if there existed validated evidence that 'Universal Healthcare' made everyone rich and happy and beautiful and able to freely stroke kittens at will then we would still vote against it as a socialist conspiracy benefiting weak, lily livered failures.
• andrehacker 2mo ago
  Right.... but it is also an industry that provides an insane amount of (often well paying) jobs to a large amount of people to do "make work", admin tasks. Reliable details are hard to come by, but some estimations are that more people in the industry are doing admin tasks than instead of providing care, admin tasks that will be reduced drastically once the industry is streamlined. Once we get affordable care there will be less people who can... afford.
  • King-Aaron 2mo ago
    > Once we get affordable care there will be less people who can... afford. This just plainly isn't true. The US is unique in the way it doesn't have affordable public healthcare, but the rest of the western world doesn't have an affordability problem because of less bean counters scamming patients.
  • netsharc 2mo ago
    So is that a defense of the broken system? Feels like their job is mostly to enrich the corporations profiteering from these inefficiencies, they're doing admin fighting the sick and dying who also gained the job of admin of fighting them (a job thrown at them to - in a lot of cases - literally save their lives, financially and physically).
  • davidw 2mo ago
    This is what's called the "broken window fallacy"
• sghiassy 2mo ago
  Agreed And, there’s also a lot of people who actually believe we have a superior system because M’urica and Europe is communist or something
• beloch 2mo ago
  "Healthcare costs have been rising faster than inflation, and a staggering share of that spending is consumed by administrative middlemen, soaring drug prices, and emergency care for conditions that should have been treated earlier and for less" ----- It's a n-tuple-whammy. Co-pays and deductibles discourage early diagnoses by preventing most people from visiting doctors for issues that aren't serious. The painful process of claiming the small amounts that would cover preventive care discourage people from getting it even if they've seen a doctor and been told to. Preventable conditions balloon into things that are very expensive and unpleasant. This process takes years though, and there are many, many insurance companies, plus people change jobs and coverage frequently. Odds are, the company denying preventive care won't be on the hook for the heavy costs down the road. If they are, they have ways to wriggle out of it. Also, with more people waiting until conditions get bad before seeking treatment, the whole system consumes more resources to keep people less healthy, on average, than if the system pushed preventive care effectively. When governments assume responsibility for medical coverage, incentives start to be much less perverse. You pay taxes while you work. You work while you're healthy. So, the government wants you healthy. The government wants to do that as cheaply as possible, so they're incentivized, not just to provide preventive care, but to make sure you take advantage of it. I live in Canada. I have a genetic condition that could cause me problems if I don't get preventive care. One of my relations had those problems, so they tested her and found the problem gene. The government then tasked a genetic counsellor to seek out everyone related to her. I had the gene, so they now book me for the care I need to manage it. I don't have to pay for this. I don't have to fight insurance companies to prove I need preventive care. I just do what they ask me to do and I get to live longer. This is the kind of stuff that happens when the incentives are right. Insurance companies need to be cut out of the loop entirely. They know they're what's wrong, so they employ expensive lobbyists. Americans need to realize this and start making it an election issue. _______ EDIT: TIL that preventative and preventive are used interchangeably in the context of medicine, so I changed my very inconsistent use of them to just one.
  • timr 2mo ago
    You’re blaming it on lack preventative care, but the truth is that there is very little preventative care that is shown to be effective at anything more than burning money. The few things that are effective (e.g. vaccines) are largely inexpensive, and don’t require “insurance” as we know it. Most of the things that are predictable and lead to long-term bad outcomes are behavioral (i.e. diet and exercise; smoking cessation; quitting drugs), and therefore both largely unaffected by medical care, and heavily confounded with socioeconomic status. Your doctor cannot make you eat better and exercise and quit smoking. In the developed world, if you don’t die at birth or succumb to diseases of lifestyle (diabetes, heart disease, addiction) or accidents, you basically then die of cancer. The lifestyle diseases cannot be prevented by a doctor, and we have essentially no ability to prevent cancer. It’s all just acute treatment. North Americans in particular hate to hear this, because they have an almost religious faith in doctors based on decades of bad TV. Honestly, though, doctors are pretty impotent when it comes to prevention of illness, and it is ironically this desire for treatment that is helping to balloon costs.
• clickety_clack 2mo ago
  Not just the wealthy people on top. All the administrators and suppliers, and all the machinery of pharmaceuticals and insurance brokerage, even HR benefits specialists in corporations are all tied to the current system. That’s a massive block of voters to be overcome.
• Krasnol 2mo ago
  Are those still "inefficiencies" or is it just the usual market-greed?
• gmerc 2mo ago
  Luigi had that idea already.
• burnte 2mo ago
  They absolutely will, but I've been on the provider side of healthcare for over a decade and I can assure you there are lots of organizations who are EAGER to move to single payer and will absolutely help the fight. If you told a healthcare CEO that in 6 months they could let go of 90% of their RCM staff and 100% of their benefits verification staff, they'd be THRILLED. And the PE firms getting in to healthcare delivery space will take up that fight too, so they can keep more of what they make.