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Universal health care? I don’t want government making my health care decisions! We have for-profit companies for that.
Death panels?
Believe it or not, that’s also Frank.
Frank is a busy man. Denying medical treatments, sitting on death panels. Is there nothing Frank can do?
Oh yeah, Frank can’t approve medical treatment.
Don’t be so sure it would be different. I collapsed, nearly drove off the road 3 times in one week and decided that it was enough and went to the doctor. He sent me home, wrote me in as extreme burnout (completely true, I had to sleep at work for every coffee break to make it through the day and 30 mins before driving home to actually make it). So I thought Great, I will rest for a few months and go back to work after that! Nope. The state heath insurance office said Our specialists decided, that you are perfectly fine. No sick pay. Get back to operating the industrial concrete blender. The health center doctors signed a letter, but no, I was fucked. So on top of this I got extreme financial stress. We got out of this crap by renting our cabin and starting going full into an outdoor adventure business. What a great time. Where was this? In Sweden in January 2019.
In theory a government is beholden to its constituents, a corporation is beholden to its shareholders. Governments aren’t perfect, but there are at least avenues to effect positive change without financial incentives being a prerequisite.
Sounds like a flaw in the system. I fail to see how health insurance should ever be involved between patient and doctor in a “universal” health care system. Sure doesn’t happen where I live.
Well, they got denied by Försäkringskassan, “Swedish Social Insurance Agency”. Basically wouldn’t be able to get sick-pay, but that’s about it. Which is a bit weird, as nearly all first-time requests get approved, but of course it happens.
So it’s not really the same thing as American insurance denying; they’re still able to seek care, just that the suggested treatment for burnout (pause from working) wouldn’t be economically comfortable if Försäkringskassan denies their sick-pay.
It’s cute that you expect Americans to feel sympathy because your employer didn’t take your burnout seriously
Oh, most of us do, we’re just too burnt out ourselves to do much but grunt out, “sorry, bub. I know it sucks.”
That’s how I end almost every conversation.
I knew someone that literally went blind due to stress and still had to go in for work lol
Yum… crab bucket.
Do people believe that there? I can assure you the government has no roll in our health care decisions, and what the doctor wants the patient can always get.
Oh yeah, it was a major propaganda position back in the 00s and it’s part of how obamacare got that way.
Yep. The two main arguments were that the ACA would create death panels and that people would no longer have a choice in their healthcare providers. But both of those were, and still are, the status quo with private, for profit health insurance providers being involved in care.
i have a friend who’s a transplant patient and has been taking the same meds for over 10 years post transplant-- every year it’s a furious battle with insurance who, every year, decides the meds are no longer “medically necessary” and drops coverage for it. fucking helloooo these are anti-rejection pills, the textbook definition of “medically necessary.”
it’s not that insurance companies are stupid, it’s that they’re saving money on people dying when those people don’t get what they needed to live.
insurance is the biggest fucking scam of all time
The insurance system does not work in the medical field, it would never work because insurance is for managing risks that are unknown, like a house flooding or your car getting hit in an intersection.
In medical “insurance” it is often dealing with known issues, and the insurance system is just not set up to deal with preventative care, annual check ups, mammograms, blood tests, or pre-existing conditions. It would be like trying to use car insurance to pay for an oil change, which is just as ridiculous as it sounds in your head.
That’s exactly why the term “insurance” should be used when discussing a single payer system, it’s not really insurance, it should be a collective action group that works together with the medical community to find a middle ground where hospitals can still exist and pay wages to their staff, the people can get the medical care they need without getting thrown into poverty for daring to get sick, and the government benefits from having a healthier population as a whole.
Too bad theres way too much money in the short term in keeping this all private, and having a sicker population, so we have decades of insurance company propaganda to work against, and a huge population of people that don’t understand that by doing single payer health care your taxes would go up, but you also wouldn’t be paying out the nose for medical insurance & medical care (because they don’t cover anything). Also think of a world where your health care isn’t beholden to your employment, all the different choices you’d make in your life.
I work for a neurologist practice, and the amount I have to argue with insurance (and inevitably have to get the neurologist on the phone to directly request something for many) is insane. A good chunk of my job isn’t providing care, but arguing with insurance that the care is necessary. These companies are actively delaying patient care, and try to blame the physician whenever possible.
Wildly infuriating, especially when the denials are worded along the lines of “we reviewed this, and don’t consider it medically necessary”. Motherfucker, a doctor said it was necessary and listed the clinical reasons why this test or procedure would be beneficial. Nothing has radicalized me for universal healthcare more than working in healthcare.
How is that even legal? How is someone who hasn’t examined the patient and isn’t their physician allowed to make treatment decisions? If they even have the necessary qualifications.
Because of money!
Every time you see something that feels illegal but isn’t, or that makes no sense in general, look for the money trail. There’s always one, and it always leads to the explanation.
In this case, insurance companies have made such an absolute ass ton of money by killing off their customers that they have become a political entity. They now use their deep pockets to lobby politicians to keep their scam legal.
This is 100% the answer
They’re technically not making treatment decisions, they’re making payment decisions about treatment decisions. Effectively it’s a distinction without a difference though. And it’s usually a “doctor” working for the healthcare company rubber stamping the denials. It’s a thoroughly shitty system.
Specifically, it’s the doctors who technically passed med school, but only just. They’re not going to practice medicine anywhere else, but they can make good money writing up legally protected reports that say “in my professional opinion, this patient’s lack of arms does not prevent him from going back to his roofing job”.
People love to shit on the VA, because they’re the largest American healthcare provider in the country so there’s a lot of bad stories
But my last MRI went like this:
Doctor: you need an MRI, let me check if it’s open. (Less than a minute on laptop). Ok, go down to room ____ and they can get you in now.
There’s a huge up front cost for that machine, so for profit hospitals went everyone to use it to make the money back, and insurance wants no one to use it so they don’t have to pay.
Take insurance out of the picture, take the hospital trying to make money out of the picture. And it’s really that easy. No one pushes for unnecessary tests, no one tries to prevent necessary tests. And there’s a huge push towards preventive medicine, because it’s cheaper to catch shit early.
We already pay more than what it would cost, it’s just the healthcare industry donates to both parties, so as long as both standards are “at least they’re not the other team” shits never going to get fixed.
If we hold higher standards than that, it won’t take many election cycles to get change to actually happen
It’s cheaper to catch shit early.
This is a huge takeaway. Insurance doesn’t care about your longevity, health, quality of life or even long term costs.
People hop insurance providers all the time so the companies are literally focused on profits quarter by quarter.
On the flip side, I can’t imagine being the person arguing for the insurance companies makes them a better or happy person in the long term. Being a devil’s henchman, over time it must destroy important parts of them like empathy, trust in people, and their basic human decency. Virtues that are needed now more than ever in society.
And some doctors themselves will be hesitant to give care that might not be provably required beyond all doubt but is objectively prudent.
And when the patient turned out to be fine after the scan, the insurance company will try to blame that the doctors are lying so that the insurance company has to pay the hospital more It’s like they thought that the doctors must be able to see through the patients’ body as if they forgot that the reason for these equipments to exist in the first place is that because the doctors can’t really be 100% sure about what’s actual situation inside human body
There’s two sides to this coin. On the one end, you have insurance companies refusing to pay for anything because the modern industry is just six scams in a trench coat.
But on the other, you have doctor’s offices where the physician literally leases an MRI machine to the tune of several million dollars and then has to run a certain number of patients through the scanner every year or lose money. That’s because the MRI patent is held by GE and they can charge 10-100x markups on hardware that is fundamental to modern medicine.
Its the same with diabetes treatments. Insurance companies will try and refuse service or kick people off their policies if they are at risk. But then pharmacy companies will sell $3 of insulin for $75, then kickback a chunk of the balance to judicial/congressional bribes in order to guarantee the cash flow.
At some level, the only insurance companies that can survive in such a market are the ones that say “No!” to everything. The even-remotely-ethical firms just get fleeced by the for-profit industry until they get bought out or go bankrupt. That, or you’re Medicare/Medicaid and you have an infinite wallet backstopped by the US Treasury. You don’t care if you’re paying multiples of whatever any other clinic anywhere else in the world would charge on an enormous population of poor and elderly patients, because you have an unlimited money cannon to mow it all down with.
Very uninformed take, its almost laughable.
GE isn’t the only one who makes MRIs. The other big players are Siemens, Philips, United, and to some extent Canon, Fujifoto, and Hitachi.
No, that’s really how much it costs. The margin on MRI machines is terrible. I’d like to see you do it cheaper… “Just” build then supercool magnet for superconduction for 3T of homogenius magnetic field, build coils that handle KW of RF/gradients that can fit a human comfortably without artifacts, build the high power and precision circuitry to transmit and receive said RF, then control that equipment accurately and safely.
Super easy, off-the-shelf stuff.
Oh, and you can’t use any ferrous parts, nor can your power supplies generate any noise.
That’s like, senior design level stuff amirite
The other big factor in cost is supply chain. Everything has to be tracable. So the supply chains have to do a lot of paperwork, inspection audits, since a defective part can kill someone.
Shouldn’t that patent have expired by now?
This kind of thing is why it bothers me when people complain about “free market medicine”.
A market where only one entity is allowed to build MRI machines, or license the tech to others to build, is not a free market. That’s a government-enforced monopoly.
Even the fact that a patient can’t just go get their own MRI at Scans-R-Us, but needs to get a doctor’s referral first, is a huge departure from what an actually free market for medicine would look like.
Shouldn’t that patent have expired by now?
It’s an evolving technology. We get new patents with every iteration.
A market where only one entity is allowed to build MRI machines, or license the tech to others to build, is not a free market.
If you spend a few years in Business School getting your MBA, you get an earful about how and why patent law exists. The core argument is that private investment is predicated on returns and we can’t have nice things unless we have men with guns come for the property and freedom of anyone who “steals an idea”.
But more practically, this shit is just a racket. Lots of lobbyist money changes hands to make sure the decks at the casino are properly stacked. Medical treatment is just another opportunity to apply leverage through debt to control other people.
I understand the value of a patent system, but patents should expire.
Is there some reason why previous-generation technology, like the tech being used for MRIs in the 90s, can’t be used to manufacture more competitively-priced machines?
Like, is there a law specifying that the new technology must be used for an MRI to be usable as a diagnostic tool?
patents should expire
They do. It’s just that they can be renewed under various circumstances, typically as an incentive to increase production.
Is there some reason why previous-generation technology, like the tech being used for MRIs in the 90s, can’t be used to manufacture more competitively-priced machines?
You need a certain amount of industrial capital geared towards making these machines and GE is the only one that really does (excepting manufacturers overseas). A big part of the problem is that we don’t have a good mechanism for introducing new small businesses to the market. You really need to know someone that needs a steady number of MRI machines on a regular basis to make a new MRI factory worth it, and unless you have that business connection you have no buyers.
So you’d need to have a single integrated business, just to get all that information in-house.
The same company could build the machines, and sell the MRI scanning service.
Then you’d need a lot of conversations with various doctor’s offices.
But there are probably lots of places who’d rather be able to provide patients with a lower-cost, lower-quality MRI, so it should be possible to collect a number of providers saying “if such a service exists, I’ll use it”.
My guess is there’s gonna be a lot of government money available soon for people who want to build new manufacturing capability in the US
*cough* single payer fixes all this *cough*
Sorry, cough has been acting up. I should go see a doctor with a MRI about that…
cough single payer fixes all this cough
I’d go one further and say a National Health System fixes all this. Rather than paying a guy to pay a guy, you just have publicly financed clinics and hospitals. This is the traditional way of building up medical infrastructure, btw. City hospitals used to be the norm. We only entered the era of corporate consolidation when we sold off our public infrastructure for a song during the neoliberal turn of the 70s and 80s.
IThey can’t even be sure after the MRI. Which again, proves your point. It took one MRI battery and one alert and skilled MRI tech to catch my brain cyst, THEN another whole set, I straight up spend a whole 8hr shift in an MRI machine, Then a TEAM of neurologists studied my custom hand made brain for MONTHS. THEN they had a really good set of educated guesses. Then they did the surgery, and only after they opened up my brain case did the actually see what in the hell was going on. Even after all that, my neurologists was like ‘‘This is what we think is happening’’, I asked what it would take to really know factually, he said an autopsy. He didn’t recommend it. The point is, Doctors save lives with these scans, and nothing is certain. That’s not a barrier to treatment, but no scans Is a barrier to treatment.
My $7000/mo medication has a bunch of “cost relief” programs so they can pretend that they give a shit about affordability, then when you actually try to use them they make you do like 20 phone calls over the span of several months until they finally let you enroll and when you do it only lasts for a short amount of time before they kick you off and you have to start the process all over again. I’ve had to miss multiple doses of the medication which is dangerous for my physical health because I don’t have the money to pay for it and this process takes so fucking long.
Recently, they signed me up for some super shady thing where I pay for the medication upfront and then they pay me back after showing me the receipt. What they didn’t tell me is that it has a limit for how much it will pay for, so I pay for the medication, and what a surprise, they rejected my claim and now I lost $5000 to the medication, which could have paid for a car or a semester of community college. Our healthcare system does a great job at making dying sound like a decent alternative to healthcare.
Frank didn’t even look at it. He just fed your claim into their computer and it spat out a rejection.
Bold to assume he bothered to feed it to a computer when you can just reject without having to do that. Feeding something to a computer takes time, and time is money y’know.
Frank bought a self-inking stamp that says “REJECTED” and saw a 70% productivity increase.
Frank has management written all over him!
Nonsense. Frank was replaced with an AI years ago. It only took a half hour to train on a Raspberry Pi.
So here is a question:
A medical professional examined the person IN PERSON and has a requirement.
In comes the insurance to tell you your doctor is wrong and that you’re perfectly fine, your doctor is basically lying to you.
Question: how the fuck did any of this ever become legal?
It became legal when we decided medicine was too important to be handled by a free market, and we created a labyrinth of laws governing how medicine must be administered.
You literally take the wrong takeaway from all this.
A free market for healthcare is a disaster. A few big companies will form that will squeeze every last cent out of dying people, you get the US system. US healthcare and it’s free market literally is the worst. Be healthy and bankrupt or die
You do need some checks and balances because what’s to stop a hospital from profiting off the insurance companies by asking for a CT scan/whatever of every single patient just because they can.
I suppose we could have the government run the hospitals too. But noooooo, that’s never going to work out because communism or something.
Maybe we should try effective altruism and accelerationism instead? Let’s just hand over all our money to a few tech bros and then we can go beg them to pay for the scans. And if they don’t pay for it, surely someone will come up with a cheaper technology to do the same. Yes, that’ll definitely work.
If a hospital is found to push doctors to prescribe unneeded medicine or tests, the entire top staff should be questioned and jailed for fraud where applicable.
If an individual doctor does this, same treatment
We’re not just talking money here were talking human lives. If you risk health for money, off yo jail you go
You could just get rid of the for-profit medical industry entirely and then there would be no incentive to over treat patients.
Question: how the fuck did any of this ever become legal?
I would guess lobbying.
Also, there’s this common “feature”:
Dr: “You need this procedure.”
Me: “How much will it cost me?”
Office Manager: “I won’t know until I bill your insurance and find out if it is covered.”
Me: “What is the cash price I would pay you if it isn’t covered by insurance.”
Office Manager: “I have no idea.”
Actually, since January 2022, you have the right to request a good faith estimate for services from healthcare providers if you’re not billing insurance.
I’d like to see a law that says you get a complete and correct bill in 3 months or less as well. I avoid getting healthcare because even though I have insurance, every single time I’ve gone, the billing gets fucked up and I don’t find out about it until 6 months, or even up to 2 years later, and I’m on the hook for that. It ought to be law, that if your office is so fucked up that you can’t produce a correct bill for services in 3 months and deliver it to your customer, then you should have to nullify it.
Last time my doctor had to bill my insurance he said he would just run it immediately, because apparently “routine denial” is a thing where they just automatically deny it because if you really need it the doctor will then have his office try again with more justifications. He hated this a lot, because it basically meant he had to just assume first denial for no real reason and then his staff had to take the time to almost always go back and resubmit. He said sometimes he would submit it with the info, it would be denied, and then he would resubmit it two more times and suddenly it would be approved.
Like seriously, what the fuck. But only does that hold up necessary care, it also makes doctors do more bureaucratic work and hire more staff, which, of course, makes medicine more expensive. Brilliant.
Shared risk pools are a good idea. Making them for profit is not.
Prior authorization should 100% be outlawed. It’s either insurance adjusters practicing medicine without a license, or insurance doctors making diagnoses without examining a patient, both of which are unethical or illegal.
Though I think the real solution is a system where every time a prior authorization denial is overruled by the DOO or a court, the insurance company has to pay punitive damages of at least $200,000 to the patient.
Had my buddy over who brought over his incredibly questionable 30yo brother who shared some real incel levels of talk. He used my bathroom and asked if I wore tampons since a pack was visible. Like bro, I have a wife and a daughter.
Anyways, that guy works in health insurance!
I don’t know how much decisions he can actually make. But that dude has a middle-school level education about sex ed and struggled to explain what a period is. And he is one of the barriers to approving/rejecting your health care.
You should see what @pancakes@sh.itjust.works wrote in this very thread. You basically just answered their question about what this industry must do to a person’s ability to empathize and be a decent person to others. Or in this case, maybe lack thereof is a job requirement?
I had a friend who needed a CT head, chest and abdomen. The insurance company decided she could have the head and abdomen, but not the chest, and couldn’t really explain why when asked. American health care is a joke.
I recently went in because I had a thunderclap headache, thought it was about to die from a brain aneurysm. No insurance. They did 1 CT scan and billed me for a Head CT, Neck CT and a Cervical Spine CT, each costing over $3K. After months of calling their billing department I ended up having to setup a payment plan before they sent it to collections. Not a single person in the billing department, up to and including the head of billing, could tell me the difference between a neck CT and a cervical spine CT. Still on the hook for over $11K. Probably going to have to file for bankruptcy soon. My life is effectively over.
Your life isn’t over. Discharge the debt through bankruptcy and move on. I honestly mean no offense, but if you were already uninsured and an 11K debt would effectively end your life, you’re not going to be much further back than where you were before bankruptcy. Maybe even a little ahead.
Bankruptcy isn’t just for rich people and corporations, although it sure is treated that way sometimes. Do it now, don’t keep letting debt holders guilt you into “bootstrapping” it. They’re just squeezing as much money out of you as possible while they can.
The cruelty of the US American for-profit health system is what should be uniting all US Americans in protest, riot, and violent overthrow of the current system.
They hire doctors who can’t handle being practicing doctors to prop up their delusions. I’ve only had one on the line in a dispute and he acted quite offended when I asked for his license to prove he was a real doctor. Turns out he was barely a doctor at all. He decided instead of practicing medicine and killing people he would work for a insurance company and kill them that way.
So like did he complete his residency then head straight for insurance field?
From what I remember he was so bad he had trouble being employed. I looked him up and gathered information for my lawyer.
Wild. With how gnarly residency is you’d THINK most of them would be ground out, but guess some folks just see those dollar bills working as a corporate doctor.
Sometimes the Frank is an AI that is wrong 90% of the time. That’s fine, because reasons.
I fucking wish. At least then I wouldn’t have to be put on hold for 30 min just to have to eventually explain to a person who was hired 3 weeks ago how to do their job.
Private insurance always has you speak to an actual adjuster for authorization, mainly because they know any sort of automated system would be more accurate and faster than having you talk to their undertrained and understaffed employees.
Private insurance’s goal is to erect as many barriers between the provider and the patients as possible, and then blame the provider for all the barriers. It works every time.
“I have the best insurance, they told me it would be covered”. Nope, Medicare is the best insurance and you traded that away for a privatized Medicare supplemental that lies to you about your coverage.
