Healthcare in the US is broken and they won’t let you fix it because the money is too good. Think about the fact that PBMs, which is there to save and manage on pharma is incentivized to promote drug price inflation. That’s just one “small” piece of this clusterf*k. It’s layers and layers of these convoluted system of incentives.
As to OP, the simplest solution is to move out of the US early enough or become “poor” enough and be in a wealthy blue state by the time you get to this predicament.
wnc3141 · 2h ago
I think the broader extrapolation is that the social contract has emerged around giving private enterprise wide latitude to promote the public welfare. However that does mean that the quality of said welfare entirely revolves how profitable you are to said enterprise. While great for airline tickets, its a tragedy for healthcare.
jqpabc123 · 5h ago
Delay, deny, defend --- this is the insurance industry's modus operandi.
Insurance is the only industry where customers are the enemy.
ta555555 · 18m 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.
SoftTalker · 2h 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 · 2h 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.
SilverElfin · 26m ago
Some states are forcing you to buy LTC insurance. I’ve heard Washington does this through some convoluted laws.
tiahura · 2h 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 · 1h ago
In my case they never paid. According to the lawyers I had involved, this isn't uncommon.
toomuchtodo · 3h ago
There seems to be no will to replace this dysfunctional arrangement with a social safety net unfortunately.
zackmorris · 2h 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 · 27m 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?
SilverElfin · 27m 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.
wwweston · 3h 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 · 3h 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.
mixmastamyk · 2h ago
Yes indeed. Part of the problem is having “insurance” draining part of the resources. Long term care means it isn’t an “accident,” but a constant recurring cost. Saving the money up front, producing income, and paying directly for what you need is often a better strategy.
Workaccount2 · 3h 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 · 2h ago
In reality the triangle is Doctors, Insurance, Hospitals, and you in the middle.
frankharv · 1h 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?
WarOnPrivacy · 2h ago
My youngest and I were discussing how removing zoning barriers to ADU (in-law suites) can be a big win for families and small win for housing in general.
In short, build an efficiency apartment on family property for an alone-living relative. Family can better provide support; the relative's residence goes back into the housing supply.
The municipality provides usual construction inspections but doesn't prevent the construction for non-pragmatic reasons.
> they each paid about $14,000 in annual premiums for 10 years, and the daily benefit started at $200 per day.
Insurance companies have to make money, but that's not that good of a deal, and the payout isn't that high ($73k annually) considering you won't be doing much else.
SoftTalker · 51m ago
Consider also that by the time you need a nursing home or some other form of continual skilled care you are probably going to die within that year.
"Long-Term" is sort of a scare tactic that is used to get you imagining that you're going to be needing expensive skilled care for years. That can happen, but isn't normal.
forrestthewoods · 35m ago
$140,000 in premium and $73,000/year in payout seems like a terrible deal for insurance.
Two sets of my grandparents have needed daily helpers for years. And that’s just for regular day to day care. Not in response to a particular trauma.
malshe · 2h ago
I wonder if moving his father to an assisted living facility at some point will be a better option. I have little experience with this topic so I am genuinely curious.
thepryz · 2h ago
In my experience, these facilities are all in crisis. They can't find people to staff the facilities and provide care and when they do, they can't afford to pay them.
My father has a neurodegenerative disorder and we've struggled to find a place that will provide consistent care. My mother, a retired nurse, is the one who tends to do a significant amount of the work to feed, clean, and otherwise care for him despite paying over $10k/month. It's infuriating.
malshe · 57m ago
Oh wow, that's frustrating! I hope you find someone to provide consistent care at a reasonable price. Btw do your parents live in a state with high cost of living or this is a general situation across the country?
thepryz · 18m ago
Midwest, so cost of living is relatively low to moderate. I don't have firsthand experience elsewhere but it's my understanding that what we experience isn't uncommon.
This is the third facility he's been in and options are limited because a lot of facilities aren't staffed to provide memory care. Unfortunately, there just aren't many options unless you're wealthy enough to have in-home care.
mud_dauber · 1h ago
his notes are EXACTLY my experience. bookmark it.
wrs · 1h ago
Same here…three times so far.
GnarfGnarf · 3h ago
There are three things a nation needs to accept about universal health care:
(1) It’s expensive
(2) Everybody has to pay
(3) The government’s gotta run it
bluGill · 3h ago
Government does not have to run it. Gokernment needs to ensure it is run well but there is no reason they have to run it.
reactordev · 2h ago
Oversight doesn’t work, look at the finance markets.
gruez · 3h ago
>The government’s gotta run it
But there are plenty of countries with functioning healthcare systems that are private? The Swiss, for instance. Moreover depending on what counts as "government’s gotta run it" (paying for it? administering it? actually providing care?) you can argue that the German or even Canadian systems aren't government run, at least to some degree.
mike_d · 2h ago
In the Swiss system the private insurance companies are required to be non-profits. The government sets the standard for care and coverage and all the companies can do is compete on price.
Basically what Obamacare was originally intended to be before they had to compromise to get it passed.
vondur · 1h ago
I've heard good things about the Dutch system of healthcare and that it may be adoptable to the US. I'd totally agree that healthcare corporations become non profit like Kaiser here in the US. They aren't perfect, but they seem to be better than the their for profit competitors.
olddustytrail · 2h ago
So why don't we see Republican Americans advocating to adopt the Swiss system which provides universal coverage at a lower per capita cost?
dayjah · 2h ago
If you only ever look at the way a system works at a specific point in time you only observe it at that point in time.
America has had multiple attempts at solutions for healthcare over the years, each started with good intent and then waylaid by various causes to produce what we have right now.
A sibling comment mentions political compromise to pass the ACA, as an example of this.
Another example is that HMOs were started with inherent goodness, but got “corrupted” (in my mind) by profit seeking.
To directly answer your question: a core tenet of the Republican tent is minimal government involvement in day to day lives of the citizenry. Ergo, the Swiss system won’t work because it involves a lot of bureaucracy. Republicans link bureaucracy to cost, and feel this is not an appropriate use of tax payers dollars.
The holes in this political doctrine are not part of my answer here fwiw. Please no “but…” comments to that end :)
fnordpiglet · 1h ago
To be fair the tenet is minimal involvement in the day to day operations of the economy and maximal involvement in the day to day lives of the citizenry.
dayjah · 1h ago
I do find the ironies in political platforms quite beautiful. I also love how they provides endless fodder for largely fruitless internet discussion ^_^
MontgomeryPy · 1h ago
In speaking with my republican father in law on his opposition to universal healthcare, it dawned on me that he views it as a sort of zero sum game. If he has healthcare today, and then universal healthcare offers it to folks that don't have it today, it is a loss for him.
wredcoll · 1h ago
Something I've run into in similar situations is the "moral necessity of punishment", sort of a reverse just-world fallacy.
"There are people not good enough for health care and helping them would violate this natural order".
fnordpiglet · 1h ago
This is going to be the ultimate issue if we do achieve some sort of post scarcity world where human labor is redundant. The idea that it’s not someone’s fault their indenture is unnecessary let alone a moral failing deserving of punishment is foreign to a lot of American thinking. The puritanical labor is godly mentality combined with the long term warping of anti Soviet propaganda is going to lead to some serious wide spread suffering that would take what should be the greatest achievement of man kind and turn it into a scourge.
vjvjvjvjghv · 1h ago
Almost nobody in US politics who talks about something doesn't understand it or thinks it through. That's for people on the left and and on the right. They just repeat talking points that are given to them by wealthy party donors.
Spooky23 · 1h ago
Obamacare was a replica of Romneycare, which was implemented in Massachusetts. It was the republican approach of leveraging private enterprise and encouraging consolidated medical networks.
The difference now is the republicans have changed, and nuanced issues are just not welcome on the platform of a party following a cult of personality.
Loughla · 2h ago
Because it's any amount of government spending for one. And for two (this one is more of my opinion than the last one) the US has a problem where we, as a culture, view poor people as somehow morally or ethically broken, which is what causes them to be poor. Therefore, we shouldn't spend money that could positively impact them, regardless of its overall benefit. I got mine, so anyone can, but as the cultural zeitgeist.
daveguy · 1h ago
They were advocating for it before Obama tried to get it done. It was implemented in Massachusetts and termed "Romneycare" as Mitt Romney was the governor. Once Obama tried to implement it, it was government overreach and had to be watered down to get consensus. Personally I think we should have a govt option along side others, but all healthcare should be nonprofit (as in the Swiss model). Profit extraction is antithetical to healthcare.
LocalH · 2h ago
Because Republican Americans tend to overwhelmingly think "government bad, private business good". Even the "small-c conservatives".
vjvjvjvjghv · 1h ago
Although they think government is good at controlling their version of morality.
bradleyjg · 2h ago
It’s not a matter of acceptance. We can’t accept the cost of anything consistently growing at a rate faster than GDP. That’s just math, not ethics or political choice theory or anything else. Health care cost growth is going to slow one way or the another.
toomuchtodo · 2h ago
But growth is also going to slow due to demographics, and this is unavoidable. Are we going to prioritize caring for humans? Or line goes up? Because line goes up is going to hit the demographic wall eventually.
It has more to do with demand than being anything. Demand for healthcare is highly inelastic. If the price of Pokémon’s grew faster than GDP consistently we would be fine. But if the price of a necessity for life does, we will not be fine.
This is why life necessities are often treated as a public responsibility. Health care is one of the few that is treated as a luxury.
wredcoll · 1h ago
What part of the cost of healthcare involves providing profits for middlemen?
reactordev · 2h ago
Watch what happens to the GDP if they don’t tackle the health care problem. You think it’s expensive now? Negotiating drug prices isn’t going to solve the problem. Having “health insurance” isn’t going to work when an AI decides whether your illness warrants saving you.
You all need to think about what’s going to happen to you when you can’t move anymore. Will you have enough money? Triple it. Maybe 6x it. Only the rich will be able to live healthy unless you’re diligent about your own health or strike it rich in an IPO.
vjvjvjvjghv · 1h ago
(1) is not correct. The US spends more than other nation per capita on health care
(3) isn't correct either. It needs to be regulated in some way. Government doesn't have to run it. I think it should be treated more like a utility
tiahura · 1h ago
This isn’t about health care. Please read the article.
i80and · 1h ago
Elder care and memory care are under the umbrella of healthcare.
That they're nonsensically broken out as a separate insurance category is intrinsically linked to the problems the article describes
gosub100 · 2h ago
Computers and software used to be extremely expensive about 30 years ago, yet private industry advanced the state of the art and brought the prices down.
There seems to be very little talk about making medical education cheaper and more accessible. Why wouldn't it be cheaper if we had more MDs and nurses? What if we made it easier to become an MD ?
The insurance system is a cartel and they are greedy. However the regulations (upheld by the government) enable it.
aerostable_slug · 1h ago
We've done that to some extent via the legal enablement of nurse practitioner and physician assistant led care. Of course, largely speaking all they do is supervise the recording of patient metrics and prescribe drugs in label-consistent ways, but that often works out reasonably well for the patient. When the patient needs specialty care then the NP or PA simply punts them into the winds of referrals and insurance justifications.
I'm not sure there's any realistic way to enhance the availability of specialists. You can't 'stub' your way through providing the care of a skilled gastroenterologist by substitution with a NP, though PAs in specialty care are becoming common.
gosub100 · 1h ago
Why not open more medical schools? And eliminate the matching system? If you want to be an ____-ologist, here is the list of requirements. Meet the requirements and you are the ___ologist. Not whether or not a practice group likes you, or your parents knew which colleague to talk to. Don't allow the supply of MDs to be constrained.
Spooky23 · 1h ago
Because your congressman gets lots of donations from doctors and hospitals. Doctors like to drive fancy cars.
In places with Catholics, you usually get the bishops advocating for the local Catholic hospital system.
gosub100 · 1h ago
So government (my congressman) IS the problem! Thanks for reinforcing what Reagan said 40 years ago.
wredcoll · 1h ago
Sure, but what these types of people fail to understand is that the only way to solve the problem is also government.
It turns out the real world is a big complicated messy place and there's rarely a simple answer like "delete government!"
throwawayqqq11 · 1h ago
Without relgulation, the profit seekers would remain in power and the same applies to more medical staff.
The insurance system is a profit seeking institution, that functions as intended. Why dont you talk about that BURNING aspect?
gosub100 · 1h ago
You didn't address a single thing I said
cowcity · 3h ago
Americans are perfectly conditioned to instinctively and aggressively deny all three. :(
dayjah · 2h ago
Hey now. America is a broad spectrum of people — some of us are heretical and believe governments have a role in everyday life, some of us believe the opposite.
cowcity · 2h ago
Nitpick all you want, but what I said is exactly right and you probably know that.
bluGill · 3h ago
You need to get this long before you need it, but also ensure it is good plan that will take care of you. The person in the article is lucky to have kids doing that, if you don't have kids who care who will care for you.
vjvjvjvjghv · 1h ago
"ensure it is good plan that will take care of you. "
That's basically impossible. You will only know if you made the right choice once you are actually starting to use the insurance.
As to OP, the simplest solution is to move out of the US early enough or become “poor” enough and be in a wealthy blue state by the time you get to this predicament.
Insurance is the only industry where customers are the enemy.
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.
There’s a reason companies got away from offering these policies, they were losing money on them.
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.
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.
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).
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.
Healthcare is a triangle. There are three players. You, Insurance, and Doctor.
All three are adversaries and allies in different ways.
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?
In short, build an efficiency apartment on family property for an alone-living relative. Family can better provide support; the relative's residence goes back into the housing supply.
The municipality provides usual construction inspections but doesn't prevent the construction for non-pragmatic reasons.
ref: https://duckduckgo.com/?t=h_&q=zoning+to+allow+ADU%2C+in-law...
Insurance companies have to make money, but that's not that good of a deal, and the payout isn't that high ($73k annually) considering you won't be doing much else.
"Long-Term" is sort of a scare tactic that is used to get you imagining that you're going to be needing expensive skilled care for years. That can happen, but isn't normal.
Two sets of my grandparents have needed daily helpers for years. And that’s just for regular day to day care. Not in response to a particular trauma.
My father has a neurodegenerative disorder and we've struggled to find a place that will provide consistent care. My mother, a retired nurse, is the one who tends to do a significant amount of the work to feed, clean, and otherwise care for him despite paying over $10k/month. It's infuriating.
This is the third facility he's been in and options are limited because a lot of facilities aren't staffed to provide memory care. Unfortunately, there just aren't many options unless you're wealthy enough to have in-home care.
(1) It’s expensive (2) Everybody has to pay (3) The government’s gotta run it
But there are plenty of countries with functioning healthcare systems that are private? The Swiss, for instance. Moreover depending on what counts as "government’s gotta run it" (paying for it? administering it? actually providing care?) you can argue that the German or even Canadian systems aren't government run, at least to some degree.
Basically what Obamacare was originally intended to be before they had to compromise to get it passed.
America has had multiple attempts at solutions for healthcare over the years, each started with good intent and then waylaid by various causes to produce what we have right now.
A sibling comment mentions political compromise to pass the ACA, as an example of this.
Another example is that HMOs were started with inherent goodness, but got “corrupted” (in my mind) by profit seeking.
To directly answer your question: a core tenet of the Republican tent is minimal government involvement in day to day lives of the citizenry. Ergo, the Swiss system won’t work because it involves a lot of bureaucracy. Republicans link bureaucracy to cost, and feel this is not an appropriate use of tax payers dollars.
The holes in this political doctrine are not part of my answer here fwiw. Please no “but…” comments to that end :)
"There are people not good enough for health care and helping them would violate this natural order".
The difference now is the republicans have changed, and nuanced issues are just not welcome on the platform of a party following a cult of personality.
https://www.mckinsey.com/mgi/our-research/dependency-and-dep...
https://www.cato.org/cato-journal/spring/summer-2018/demogra...
https://www.cato.org/commentary/clear-eyed-look-our-demograp...
https://www.sas.upenn.edu/~jesusfv/Slides_London.pdf
This is why life necessities are often treated as a public responsibility. Health care is one of the few that is treated as a luxury.
You all need to think about what’s going to happen to you when you can’t move anymore. Will you have enough money? Triple it. Maybe 6x it. Only the rich will be able to live healthy unless you’re diligent about your own health or strike it rich in an IPO.
(3) isn't correct either. It needs to be regulated in some way. Government doesn't have to run it. I think it should be treated more like a utility
That they're nonsensically broken out as a separate insurance category is intrinsically linked to the problems the article describes
There seems to be very little talk about making medical education cheaper and more accessible. Why wouldn't it be cheaper if we had more MDs and nurses? What if we made it easier to become an MD ?
The insurance system is a cartel and they are greedy. However the regulations (upheld by the government) enable it.
I'm not sure there's any realistic way to enhance the availability of specialists. You can't 'stub' your way through providing the care of a skilled gastroenterologist by substitution with a NP, though PAs in specialty care are becoming common.
In places with Catholics, you usually get the bishops advocating for the local Catholic hospital system.
It turns out the real world is a big complicated messy place and there's rarely a simple answer like "delete government!"
The insurance system is a profit seeking institution, that functions as intended. Why dont you talk about that BURNING aspect?
That's basically impossible. You will only know if you made the right choice once you are actually starting to use the insurance.